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Hamo CE, Mukhopadhyay A, Li X, Zheng Y, Kronish IM, Chunara R, Dodson J, Adhikari S, Blecker S. Association between Visit Frequency, Continuity of Care, and Pharmacy Fill Adherence in Heart Failure Patients. Am Heart J 2024:S0002-8703(24)00090-5. [PMID: 38621576 DOI: 10.1016/j.ahj.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/25/2024] [Accepted: 04/09/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Despite advances in medical therapy for heart failure with reduced ejection fraction (HFrEF), major gaps in medication adherence to guideline-directed medical therapies (GDMT) remain. Greater continuity of care may impact medication adherence and reduced hospitalizations. METHODS We conducted a cross-sectional study of adults with a diagnosis of HF and EF≤40% with ≥2 outpatient encounters between 1/1/2017 and 10/1/2021, prescribed ≥1 of the following GDMT: 1) Beta Blocker, 2) Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker/Angiotensin Receptor Neprilysin Inhibitor, 3) Mineralocorticoid Receptor Antagonist, 4) Sodium Glucose Cotransporter-2 Inhibitor. Continuity of care was calculated using the Bice-Boxerman Continuity of Care Index (COC) and the Usual Provider of Care (UPC) index, categorized by quantile. The primary outcome was adherence to GDMT, defined as average proportion of days covered ≥80% over one year. Secondary outcomes included all-cause and HF hospitalization at 1-year. We performed multivariable logistic regression analyses adjusted for demographics, insurance status, comorbidity index, number of visits and neighborhood SES index. RESULTS Overall, 3,971 individuals were included (mean age 72 years (SD 14), 71% male, 66% White race). In adjusted analyses, compared to individuals in the highest COC quartile, individuals in the third COC quartile had higher odds of GDMT adherence (OR 1.26, 95% CI 1.03-1.53, p=0.024). UPC tertile was not associated with adherence (all p>0.05). Compared to the highest quantiles, the lowest UPC and COC quantiles had higher odds of all-cause (UPC: OR 1.53, 95% CI 1.23-1.91; COC: OR 2.54, 95% CI 1.94-3.34) and HF (UPC: OR 1.81, 95% CI 1.23-2.67; COC: OR 1.77, 95% CI 1.09-2.95) hospitalizations. CONCLUSIONS Continuity of care was not associated with GDMT adherence among patients with HFrEF but lower continuity of care was associated with increased all-cause and HF-hospitalizations.
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Affiliation(s)
- Carine E Hamo
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY.
| | - Amrita Mukhopadhyay
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY; New York University Grossman School of Medicine, Department of Population Health, New York, NY
| | - Xiyue Li
- New York University Grossman School of Medicine, Department of Population Health, New York, NY
| | - Yaguang Zheng
- New York University Rory Meyers College of Nursing, New York, NY
| | - Ian M Kronish
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York
| | - Rumi Chunara
- Department of Biostatistics, NYU School of Global Public Health, New York, New York
| | - John Dodson
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY; New York University Grossman School of Medicine, Department of Population Health, New York, NY
| | - Samrachana Adhikari
- New York University Grossman School of Medicine, Department of Population Health, New York, NY
| | - Saul Blecker
- New York University Grossman School of Medicine, Department of Population Health, New York, NY
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Chunara R, Gjonaj J, Immaculate E, Wanga I, Alaro J, Scott-Sheldon LAJ, Mangeni J, Mwangi A, Vedanthan R, Hogan J. Social determinants of health: the need for data science methods and capacity. Lancet Digit Health 2024; 6:e235-e237. [PMID: 38519151 PMCID: PMC11001304 DOI: 10.1016/s2589-7500(24)00022-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 12/02/2023] [Accepted: 01/31/2024] [Indexed: 03/24/2024]
Affiliation(s)
- Rumi Chunara
- School of Global Public Health, New York University, New York, NY 10003, USA; Tandon School of Engineering, New York University, New York, NY 10003, USA.
| | - Jessica Gjonaj
- School of Global Public Health, New York University, New York, NY 10003, USA; Grossman School of Medicine, New York University, New York, NY 10003, USA
| | | | - Iris Wanga
- College of Health Sciences, Moi University, Eldoret, Kenya
| | - James Alaro
- National Cancer Institute, National Institute of Health, Bethesda, MD, USA
| | | | - Judith Mangeni
- College of Health Sciences, Moi University, Eldoret, Kenya
| | - Ann Mwangi
- College of Health Sciences, Moi University, Eldoret, Kenya
| | - Rajesh Vedanthan
- Grossman School of Medicine, New York University, New York, NY 10003, USA
| | - Joseph Hogan
- Brown University School of Public Health, Brown University, Providence, RI, USA
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King AJ, Margolin D, Tong C, Chunara R, Niederdeppe J. Making Sense of Social Media Data About Colorectal Cancer Screening. J Am Coll Radiol 2024; 21:543-544. [PMID: 37838186 PMCID: PMC10954397 DOI: 10.1016/j.jacr.2023.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/03/2023] [Indexed: 10/16/2023]
Affiliation(s)
- Andy J. King
- Cancer Control & Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Communication, University of Utah, Salt Lake City, UT, USA
| | - Drew Margolin
- Department of Communication, Cornell University, Ithaca, NY, USA
| | - Chau Tong
- Department of Communication, Cornell University, Ithaca, NY, USA
| | - Rumi Chunara
- Department of Biostatistics, New York University, New York, NY, USA
- Department of Computer Science & Engineering, New York University, New York, NY, USA
| | - Jeff Niederdeppe
- Department of Communication, Cornell University, Ithaca, NY, USA
- Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, NY, USA
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Mukhopadhyay A, Blecker S, Li X, Kronish IM, Chunara R, Zheng Y, Lawrence S, Dodson JA, Kozloff S, Adhikari S. Neighborhood-Level Socioeconomic Status and Prescription Fill Patterns Among Patients With Heart Failure. JAMA Netw Open 2023; 6:e2347519. [PMID: 38095897 PMCID: PMC10722333 DOI: 10.1001/jamanetworkopen.2023.47519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/30/2023] [Indexed: 12/17/2023] Open
Abstract
Importance Medication nonadherence is common among patients with heart failure with reduced ejection fraction (HFrEF) and can lead to increased hospitalization and mortality. Patients living in socioeconomically disadvantaged areas may be at greater risk for medication nonadherence due to barriers such as lower access to transportation or pharmacies. Objective To examine the association between neighborhood-level socioeconomic status (nSES) and medication nonadherence among patients with HFrEF and to assess the mediating roles of access to transportation, walkability, and pharmacy density. Design, Setting, and Participants This retrospective cohort study was conducted between June 30, 2020, and December 31, 2021, at a large health system based primarily in New York City and surrounding areas. Adult patients with a diagnosis of HF, reduced EF on echocardiogram, and a prescription of at least 1 guideline-directed medical therapy (GDMT) for HFrEF were included. Exposure Patient addresses were geocoded, and nSES was calculated using the Agency for Healthcare Research and Quality SES index, which combines census-tract level measures of poverty, rent burden, unemployment, crowding, home value, and education, with higher values indicating higher nSES. Main Outcomes and Measures Medication nonadherence was obtained through linkage of health record prescription data with pharmacy fill data and was defined as proportion of days covered (PDC) of less than 80% over 6 months, averaged across GDMT medications. Results Among 6247 patients, the mean (SD) age was 73 (14) years, and majority were male (4340 [69.5%]). There were 1011 (16.2%) Black participants, 735 (11.8%) Hispanic/Latinx participants, and 3929 (62.9%) White participants. Patients in lower nSES areas had higher rates of nonadherence, ranging from 51.7% in the lowest quartile (731 of 1086 participants) to 40.0% in the highest quartile (563 of 1086 participants) (P < .001). In adjusted analysis, patients living in the lower 2 nSES quartiles had significantly higher odds of nonadherence when compared with patients living in the highest nSES quartile (quartile 1: odds ratio [OR], 1.57 [95% CI, 1.35-1.83]; quartile 2: OR, 1.35 [95% CI, 1.16-1.56]). No mediation by access to transportation and pharmacy density was found, but a small amount of mediation by neighborhood walkability was observed. Conclusions and Relevance In this retrospective cohort study of patients with HFrEF, living in a lower nSES area was associated with higher rates of GDMT nonadherence. These findings highlight the importance of considering neighborhood-level disparities when developing approaches to improve medication adherence.
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Affiliation(s)
- Amrita Mukhopadhyay
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Saul Blecker
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Xiyue Li
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, New York
| | - Rumi Chunara
- Department of Biostatistics, NYU School of Global Public Health, New York, New York
- Department of Computer Science & Engineering, Tandon School of Engineering, New York, New York
| | - Yaguang Zheng
- NYU Rory Meyers College of Nursing, New York, New York
| | - Steven Lawrence
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - John A. Dodson
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Sam Kozloff
- Department of Medicine, University of Utah, Salt Lake City
| | - Samrachana Adhikari
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
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Adhikari S, Mukhyopadhyay A, Kolzoff S, Li X, Nadel T, Fitchett C, Chunara R, Dodson J, Kronish I, Blecker SB. Cohort profile: a large EHR-based cohort with linked pharmacy refill and neighbourhood social determinants of health data to assess heart failure medication adherence. BMJ Open 2023; 13:e076812. [PMID: 38040431 PMCID: PMC10693878 DOI: 10.1136/bmjopen-2023-076812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/06/2023] [Indexed: 12/03/2023] Open
Abstract
PURPOSE Clinic-based or community-based interventions can improve adherence to guideline-directed medication therapies (GDMTs) among patients with heart failure (HF). However, opportunities for such interventions are frequently missed, as providers may be unable to recognise risk patterns for medication non-adherence. Machine learning algorithms can help in identifying patients with high likelihood of non-adherence. While a number of multilevel factors influence adherence, prior models predicting non-adherence have been limited by data availability. We have established an electronic health record (EHR)-based cohort with comprehensive data elements from multiple sources to improve on existing models. We linked EHR data with pharmacy refill data for real-time incorporation of prescription fills and with social determinants data to incorporate neighbourhood factors. PARTICIPANTS Patients seen at a large health system in New York City (NYC), who were >18 years old with diagnosis of HF or reduced ejection fraction (<40%) since 2017, had at least one clinical encounter between 1 April 2021 and 31 October 2022 and active prescriptions for any of the four GDMTs (beta-blocker, ACEi/angiotensin receptor blocker (ARB)/angiotensin receptor neprilysin inhibitor (ARNI), mineralocorticoid receptor antagonist (MRA) and sodium-glucose cotransporter 2 inhibitor (SGLT2i)) during the study period. Patients with non-geocodable address or outside the continental USA were excluded. FINDINGS TO DATE Among 39 963 patients in the cohort, the average age was 73±14 years old, 44% were female and 48% were current/former smokers. The common comorbid conditions were hypertension (77%), cardiac arrhythmias (56%), obesity (33%) and valvular disease (33%). During the study period, 33 606 (84%) patients had an active prescription of beta blocker, 32 626 (82%) had ACEi/ARB/ARNI, 11 611 (29%) MRA and 7472 (19%) SGLT2i. Ninety-nine per cent were from urban metropolitan areas. FUTURE PLANS We will use the established cohort to develop a machine learning model to predict medication adherence, and to support ancillary studies assessing associates of adherence. For external validation, we will include data from an additional hospital system in NYC.
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Affiliation(s)
- Samrachana Adhikari
- New York University Grossman School of Medicine, New York City, New York, USA
| | | | | | - Xiyue Li
- New York University Grossman School of Medicine, New York City, New York, USA
| | - Talia Nadel
- New York University Grossman School of Medicine, New York City, New York, USA
| | - Cassidy Fitchett
- New York University Grossman School of Medicine, New York City, New York, USA
| | - Rumi Chunara
- New York University, New York City, New York, USA
| | - John Dodson
- New York University Grossman School of Medicine, New York City, New York, USA
| | - Ian Kronish
- Center Behavioral Cardiovascular Health, Columbia University Medical Center, New York City, New York, USA
| | - Saul B Blecker
- New York University Grossman School of Medicine, New York City, New York, USA
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King AJ, Dunbar NM, Margolin D, Chunara R, Tong C, Jih-Vieira L, Matsen CB, Niederdeppe J. Global prevalence and content of information about alcohol use as a cancer risk factor on Twitter. Prev Med 2023; 177:107728. [PMID: 37844803 PMCID: PMC10872596 DOI: 10.1016/j.ypmed.2023.107728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/29/2023] [Accepted: 10/13/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVES Alcohol use is a major risk factor for several forms of cancer, though many people have limited knowledge of this link. Public health communicators and cancer advocates desire to increase awareness of this link with the long-term goal of reducing cancer burden. The current study is the first to examine the prevalence and content of information about alcohol use as a cancer risk on social media internationally. METHODS We used a three-phase process (hashtag search, dictionary-based auto-identification of content, and human coding of content) to identify and evaluate information from Twitter posts between January 2019 and December 2021. RESULTS Our hashtag search retrieved a large set of cancer-related tweets (N = 1,122,397). The automatic search process using an alcohol dictionary identified a small number of messages about cancer that also mentioned alcohol (n = 9061, 0.8%), a number that got small after adjusting for human coded estimates of the dictionary precision (n = 5927, 0.5%). When cancer-related messages also mentioned alcohol, 82% (n = 1003 of 1225 examined through human coding) indicated alcohol use as a risk factor. Coding found rare instances of problematic information (e.g., promotion of alcohol, misinformation) in messages about alcohol use and cancer. CONCLUSIONS Few social media messages about cancer types that can be linked to alcohol mention alcohol as a cancer risk factor. If public health communicators and cancer advocates want to increase knowledge and understanding of alcohol use as a cancer risk factor, efforts will need to be made on social media and through other communication platforms to increase exposure to this information over time.
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Affiliation(s)
- Andy J King
- Cancer Control & Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA; Department of Communication, University of Utah, Salt Lake City, UT, USA.
| | - Natalie M Dunbar
- Greenlee School of Journalism and Communication, Iowa State University, Ames, IA, USA
| | - Drew Margolin
- Department of Communication, Cornell University, Ithaca, NY, USA
| | - Rumi Chunara
- Department of Biostatistics, New York University, New York City, NY, USA; Department of Computer Science & Engineering, New York University, New York City, NY, USA
| | - Chau Tong
- Department of Communication, Cornell University, Ithaca, NY, USA
| | - Lea Jih-Vieira
- Department of Communication, Cornell University, Ithaca, NY, USA
| | - Cindy B Matsen
- Cancer Control & Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA; Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jeff Niederdeppe
- Department of Communication, Cornell University, Ithaca, NY, USA; Jeb E. Brooks School of Public policy, Cornell University, Ithaca, NY, USA
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Chen X, Porter A, Abdur Rehman N, Morris SK, Saif U, Chunara R. Area-based determinants of outreach vaccination for reaching vulnerable populations: A cross-sectional study in Pakistan. PLOS Glob Public Health 2023; 3:e0001703. [PMID: 37756308 PMCID: PMC10529552 DOI: 10.1371/journal.pgph.0001703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 08/16/2023] [Indexed: 09/29/2023]
Abstract
The objective of this study is to gain a comparative understanding of spatial determinants for outreach and clinic vaccination, which is critical for operationalizing efforts and breaking down structural biases; particularly relevant in countries where resources are low, and sub-region variance is high. Leveraging a massive effort to digitize public system reporting by Lady and Community Health Workers (CHWs) with geo-located data on over 4 million public-sector vaccinations from September 2017 through 2019, understanding health service operations in relation to vulnerable spatial determinants were made feasible. Location and type of vaccinations (clinic or outreach) were compared to regional spatial attributes where they were performed. Important spatial attributes were assessed using three modeling approaches (ridge regression, gradient boosting, and a generalized additive model). Consistent predictors for outreach, clinic, and proportion of third dose pentavalent vaccinations by region were identified. Of all Penta-3 vaccination records, 86.3% were performed by outreach efforts. At the tehsil level (fourth-order administrative unit), controlling for child population, population density, proportion of population in urban areas, distance to cities, average maternal education, and other relevant factors, increased poverty was significantly associated with more in-clinic vaccinations (β = 0.077), and lower proportion of outreach vaccinations by region (β = -0.083). Analyses at the union council level (fifth-administrative unit) showed consistent results for the differential importance of poverty for outreach versus clinic vaccination. Relevant predictors for each type of vaccination (outreach vs. in-clinic) show how design of outreach vaccination can effectively augment vaccination efforts beyond healthcare services through clinics. As Pakistan is third among countries with the most unvaccinated and under-vaccinated children, understanding barriers and factors associated with vaccination can be demonstrative for other national and sub-national regions facing challenges and also inform guidelines on supporting CHWs in health systems.
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Affiliation(s)
- Xiaoting Chen
- Department of Biostatistics, New York University, New York, New York, United States of America
| | - Allan Porter
- Department of Computer Science Engineering, New York University, Brooklyn, New York, United States of America
| | - Nabeel Abdur Rehman
- Department of Computer Science Engineering, New York University, Brooklyn, New York, United States of America
| | - Shaun K. Morris
- Division of Infectious Diseases and Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Umar Saif
- UNESCO Chair for ICTD, Lahore, Pakistan
| | - Rumi Chunara
- Department of Biostatistics, New York University, New York, New York, United States of America
- Department of Computer Science Engineering, New York University, Brooklyn, New York, United States of America
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Farhad A, Noorali AA, Tajuddin S, Khan SD, Ali M, Chunara R, Khan AH, Zafar A, Merchant A, Bokhari SS, Virani SS, Samad Z. Prevalence of familial hypercholesterolemia in a country-wide laboratory network in Pakistan: 10-year data from 988, 306 patients. Prog Cardiovasc Dis 2023; 79:19-27. [PMID: 37516262 DOI: 10.1016/j.pcad.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 07/26/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION Familial hypercholesterolemia (FH) is a modifiable risk factor for premature coronary heart disease but is poorly diagnosed and treated. We leveraged a large laboratory network in Pakistan to study the prevalence, gender and geographic distribution of FH. METHODOLOGY Data were curated from the Aga Khan University Hospital clinical laboratories, which comprises of 289 laboratories and collection points spread over 94 districts. Clinically ordered lipid profiles from 1st January 2009 to 30th June 2018 were included and data on 1,542,281 LDL-C values was extracted. We used the Make Early Diagnosis to Prevent Early Death (MEDPED) criteria to classify patients as FH and reported data on patients with low-density liporotein -cholesterol (LDL-C) ≥ 190 mg/dL. FH cases were also examined by their spatial distribution. RESULTS After applying exclusions, the final sample included 988,306 unique individuals, of which 24,273 individuals (1:40) had LDL-C values of ≥190 mg/dL. Based on the MEDPED criteria, 2416 individuals (1:409) had FH. FH prevalence was highest in individuals 10-19 years (1:40) and decreased as the patient age increased. Among individuals ≥40 years, the prevalence of FH was higher for females compared with males (1:755 vs 1:1037, p < 0.001). Median LDL-C for the overall population was 112 mg/dL (IQR = 88-136 mg/dL). The highest prevalence after removing outliers was observed in Rajan Pur district (1.23% [0.70-2.10%]) in Punjab province, followed by Mardan (1.18% [0.80-1.70%]) in Khyber Pakhtunkhwa province, and Okara (0.99% [0.50-1.80%]) in Punjab province. CONCLUSION There is high prevalence of actionable LDL-C values in lipid samples across a large network of laboratories in Pakistan. Variable FH prevalence across geographic locations in Pakistan may need to be explored at the population level for intervention and management of contributory factors. Efforts at early diagnosis and treatment of FH are urgently needed.
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Affiliation(s)
- Awais Farhad
- Department of Medical Specialties, Khyber Medical College, Peshawar, Pakistan
| | - Ali Aahil Noorali
- Department of Medicine, Medical College, Aga Khan University, Karachi, Pakistan; Health Data Science Centre, Clinical and Translational Research Incubator, Medical College, Aga Khan University, Karachi, Pakistan
| | - Salma Tajuddin
- Department of Medicine, Medical College, Aga Khan University, Karachi, Pakistan; Health Data Science Centre, Clinical and Translational Research Incubator, Medical College, Aga Khan University, Karachi, Pakistan
| | - Sarim Dawar Khan
- Department of Medicine, Medical College, Aga Khan University, Karachi, Pakistan; Health Data Science Centre, Clinical and Translational Research Incubator, Medical College, Aga Khan University, Karachi, Pakistan
| | - Mushyada Ali
- Department of Medicine, Medical College, Aga Khan University, Karachi, Pakistan; Health Data Science Centre, Clinical and Translational Research Incubator, Medical College, Aga Khan University, Karachi, Pakistan
| | - Rumi Chunara
- Health Data Science Centre, Clinical and Translational Research Incubator, Medical College, Aga Khan University, Karachi, Pakistan; Department of Biostatistics, School of Global Public Health, New York University, NY, USA; Department of Computer Science and Engineering, Tandon School of Engineering, New York University, NY, USA
| | - Aysha Habib Khan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Afia Zafar
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Anwar Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, SC, USA
| | | | - Salim S Virani
- Department of Medicine, Medical College, Aga Khan University, Karachi, Pakistan; Division of Cardiology, Department of Medicine, Baylor College of Medicine; Michael E. DeBakey Veterans Affairs Medical Centre, Houston, TX, USA
| | - Zainab Samad
- Department of Medicine, Medical College, Aga Khan University, Karachi, Pakistan; Health Data Science Centre, Clinical and Translational Research Incubator, Medical College, Aga Khan University, Karachi, Pakistan; Division of Cardiology, Department of Medicine, Duke University, Duke Global Health Institute, Duke Clinical Research Institute, Durham, NC, USA.
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Chughtai N, Perveen K, Gillani SR, Abbas A, Chunara R, Manji AA, Karani S, Noorali AA, Zakaria M, Shamsi U, Chishti U, Khan AA, Soofi S, Pervez S, Samad Z. National cervical cancer burden estimation through systematic review and analysis of publicly available data in Pakistan. BMC Public Health 2023; 23:834. [PMID: 37147640 PMCID: PMC10163779 DOI: 10.1186/s12889-023-15531-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 03/27/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Cervical cancer is a major cause of cancer-related deaths among women worldwide. Paucity of data on cervical cancer burden in countries like Pakistan hamper requisite resource allocation. OBJECTIVE To estimate the burden of cervical cancer in Pakistan using available data sources. METHODS We performed a systematic review to identify relevant data on Pakistan between 1995 to 2022. Study data identified through the systematic review that provided enough information to allow age specific incidence rates and age standardized incidence rates (ASIR) calculations for cervical cancer were merged. Population at risk estimates were derived and adjusted for important variables in the care-seeking pathway. The calculated ASIRs were applied to 2020 population estimates to estimate the number of cervical cancer cases in Pakistan. RESULTS A total of 13 studies reported ASIRs for cervical cancer for Pakistan. Among the studies selected, the Karachi Cancer Registry reported the highest disease burden estimates for all reported time periods: 1995-1997 ASIR = 6.81, 1998-2002 ASIR = 7.47, and 2017-2019 ASIR = 6.02 per 100,000 women. Using data from Karachi, Punjab and Pakistan Atomic Energy Cancer Registries from 2015-2019, we derived an unadjusted ASIR for cervical cancer of 4.16 per 100,000 women (95% UI 3.28, 5.28). Varying model assumptions produced adjusted ASIRs ranging from 5.2 to 8.4 per 100,000 women. We derived an adjusted ASIR of 7.60, (95% UI 5.98, 10.01) and estimated 6166 (95% UI 4833, 8305) new cases of cervical cancer per year. CONCLUSION The estimated cervical cancer burden in Pakistan is higher than the WHO target. Estimates are sensitive to health seeking behavior, and appropriate physician diagnostic intervention, factors that are relevant to the case of cervical cancer, a stigmatized disease in a low-lower middle income country setting. These estimates make the case for approaching cervical cancer elimination through a multi-pronged strategy.
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Affiliation(s)
- Novera Chughtai
- Department of Obstetrics and Gynecology, Aga Khan University, Karachi, Pakistan
| | - Kausar Perveen
- Department of Medicine, CITRIC Health Data Science Center, Aga Khan University, 1st Floor Faculty Office Building, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | | | - Aamir Abbas
- Department of Medicine, CITRIC Health Data Science Center, Aga Khan University, 1st Floor Faculty Office Building, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Rumi Chunara
- Department of Biostatistics, School of Global Public Health, New York University, New York, USA
- Department of Computer Science and Engineering, Tandon School of Engineering, New York University, New York, USA
| | - Afshan Ali Manji
- Department of Medicine, CITRIC Health Data Science Center, Aga Khan University, 1st Floor Faculty Office Building, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan
| | - Salima Karani
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Maheen Zakaria
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Uzma Shamsi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Uzma Chishti
- Department of Obstetrics and Gynecology, Aga Khan University, Karachi, Pakistan
| | - Adnan A Khan
- Research and Development Solutions, Islamabad, Pakistan
| | - Sajid Soofi
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Shahid Pervez
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Zainab Samad
- Department of Medicine, CITRIC Health Data Science Center, Aga Khan University, 1st Floor Faculty Office Building, Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
- Department of Medicine, Aga Khan University, Karachi, Pakistan.
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10
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Duncan DT, Cook SH, Wood EP, Regan SD, Chaix B, Tian Y, Chunara R. Structural racism and homophobia evaluated through social media sentiment combined with activity spaces and associations with mental health among young sexual minority men. Soc Sci Med 2023; 320:115755. [PMID: 36739708 PMCID: PMC10014849 DOI: 10.1016/j.socscimed.2023.115755] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/20/2023] [Accepted: 01/29/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Research suggests that structural racism and homophobia are associated with mental well-being. However, structural discrimination measures which are relevant to lived experiences and that evade self-report biases are needed. Social media and global-positioning systems (GPS) offer opportunity to measure place-based negative racial sentiment linked to relevant locations via precise geo-coding of activity spaces. This is vital for young sexual minority men (YSMM) of color who may experience both racial and sexual minority discrimination and subsequently poorer mental well-being. METHODS P18 Neighborhood Study (n = 147) data were used. Measures of place-based negative racial and sexual-orientation sentiment were created using geo-located social media as a proxy for racial climate via socially-meaningfully-defined places. Exposure to place-based negative sentiment was computed as an average of discrimination by places frequented using activity space measures per person. Outcomes were number of days of reported poor mental health in last 30 days. Zero-inflated Poisson regression analyses were used to assess influence of and type of relationship between place-based negative racial or sexual-orientation sentiment exposure and mental well-being, including the moderating effect of race/ethnicity. RESULTS We found evidence for a non-linear relationship between place-based negative racial sentiment and mental well-being among our racially and ethnically diverse sample of YSMM (p < .05), and significant differences in the relationship for different race/ethnicity groups (p < .05). The most pronounced differences were detected between Black and White non-Hispanic vs. Hispanic sexual minority men. At two standard deviations above the overall mean of negative racial sentiment exposure based on activity spaces, Black and White YSMM reported significantly more poor mental health days in comparison to Hispanic YSMM. CONCLUSIONS Effects of discrimination can vary by race/ethnicity and discrimination type. Experiencing place-based negative racial sentiment may have implications for mental well-being among YSMM regardless of race/ethnicity, which should be explored in future research including with larger samples sizes.
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Affiliation(s)
- Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, NewYork, NY, USA
| | - Stephanie H Cook
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA; Department of Biostatistics, New York University School of Global Public Health, New York, NY, USA
| | - Erica P Wood
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA
| | - Seann D Regan
- Department of Epidemiology, Columbia University Mailman School of Public Health, NewYork, NY, USA
| | - Basile Chaix
- French National Institute of Health and Medical Research (INSERM), Sorbonne Université, Institut Pierre Louis D'Epidémiologie et de Santé Publique IPLESP, Nemesis Team, F75012, Paris, France
| | - Yijun Tian
- Department of Computer Science and Engineering, New York University Tandon School of Engineering, New York, NY, USA
| | - Rumi Chunara
- Department of Biostatistics, New York University School of Global Public Health, New York, NY, USA; Department of Computer Science and Engineering, New York University Tandon School of Engineering, New York, NY, USA.
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11
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Hoodbhoy Z, Chunara R, Waljee A, AbuBakr A, Samad Z. Is there a need for graduate-level programmes in health data science? A perspective from Pakistan. Lancet Glob Health 2023; 11:e23-e25. [PMID: 36521946 DOI: 10.1016/s2214-109x(22)00459-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/01/2022] [Accepted: 10/14/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Zahra Hoodbhoy
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Rumi Chunara
- Department of Biostatistics, School of Global Public Health, New York University, New York, NY, USA; Department of Computer Science & Engineering, Tandon School of Engineering, New York University, New York, NY, USA
| | - Akbar Waljee
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | - Amina AbuBakr
- Aga Khan University Institute for Human Development, Aga Khan University Hospital, Nairobi, Kenya
| | - Zainab Samad
- CITRIC Health Data Science Center, Aga Khan University, Karachi 74800, Pakistan; Department of Medicine, Aga Khan University, Karachi, Pakistan.
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12
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Mukhopadhyay A, Adhikari S, Li X, Dodson JA, Kronish IM, Shah B, Ramatowski M, Chunara R, Kozloff S, Blecker S. Association Between Copayment Amount and Filling of Medications for Angiotensin Receptor Neprilysin Inhibitors in Patients With Heart Failure. J Am Heart Assoc 2022; 11:e027662. [PMID: 36453634 PMCID: PMC9798787 DOI: 10.1161/jaha.122.027662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/19/2022] [Indexed: 12/03/2022]
Abstract
Background Angiotensin receptor neprilysin inhibitors (ARNI) reduce mortality and hospitalization for patients with heart failure. However, relatively high copayments for ARNI may contribute to suboptimal adherence, thus potentially limiting their benefits. Methods and Results We conducted a retrospective cohort study within a large, multi-site health system. We included patients with: ARNI prescription between November 20, 2020 and June 30, 2021; diagnosis of heart failure or left ventricular ejection fraction ≤40%; and available pharmacy or pharmacy benefit manager copayment data. The primary exposure was copayment, categorized as $0, $0.01 to $10, $10.01 to $100, and >$100. The primary outcome was prescription fill nonadherence, defined as the proportion of days covered <80% over 6 months. We assessed the association between copayment and nonadherence using multivariable logistic regression, and nonbinarized proportion of days covered using multivariable Poisson regression, adjusting for demographic, clinical, and neighborhood-level covariates. A total of 921 patients met inclusion criteria, with 192 (20.8%) having $0 copayment, 228 (24.8%) with $0.01 to $10 copayment, 206 (22.4%) with $10.01 to $100, and 295 (32.0%) with >$100. Patients with higher copayments had higher rates of nonadherence, ranging from 17.2% for $0 copayment to 34.2% for copayment >$100 (P<0.001). After multivariable adjustment, odds of nonadherence were significantly higher for copayment of $10.01 to $100 (odds ratio [OR], 1.93 [95% CI, 1.15-3.27], P=0.01) or >$100 (OR, 2.58 [95% CI, 1.63-4.18], P<0.001), as compared with $0 copayment. Similar associations were seen when assessing proportion of days covered as a proportion. Conclusions We found higher rates of not filling ARNI prescriptions among patients with higher copayments, which persisted after multivariable adjustment. Our findings support future studies to assess whether reducing copayments can increase adherence to ARNI and improve outcomes for heart failure.
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Affiliation(s)
- Amrita Mukhopadhyay
- Department of Medicine (Cardiology)New York University School of MedicineNew YorkNY
| | - Samrachana Adhikari
- Department of Population HealthNew York University School of MedicineNew YorkNY
| | - Xiyue Li
- Department of Population HealthNew York University School of MedicineNew YorkNY
| | - John A. Dodson
- Department of Medicine (Cardiology)New York University School of MedicineNew YorkNY
| | - Ian M. Kronish
- Center for Behavioral Cardiovascular HealthColumbia University Irving Medical CenterNew YorkNY
| | - Binita Shah
- Department of Medicine (Cardiology)VA New York Harbor Healthcare SystemNew YorkNY
| | - Maggie Ramatowski
- Department of Population HealthNew York University School of MedicineNew YorkNY
| | - Rumi Chunara
- New York University School of Computer Science & Engineering and School of Global Public HealthNew YorkNY
| | - Sam Kozloff
- Department of MedicineUniversity of UtahSalt Lake CityNY
| | - Saul Blecker
- Department of Population HealthNew York University School of MedicineNew YorkNY
- Department of MedicineNew York University School of MedicineNew YorkNY
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13
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Mirin N, Chunara R. Data Science in Public Health: Building Next Generation Capacity. Harvard Data Science Review 2022. [DOI: 10.1162/99608f92.18da72db] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Nicholas Mirin
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York City, New York, United States of America
| | - Rumi Chunara
- Department of Biostatistics, School of Global Public Health, New York University, New York City, New York, United States of America; Department of Computer Science and Engineering, Tandon School of Engineering, New York University, Brooklyn, New York, United States of America
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14
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Thorpe LE, Chunara R, Roberts T, Pantaleo N, Irvine C, Conderino S, Li Y, Hsieh PY, Gourevitch MN, Levine S, Ofrane R, Spoer B. Building Public Health Surveillance 3.0: Emerging Timely Measures of Physical, Economic, and Social Environmental Conditions Affecting Health. Am J Public Health 2022; 112:1436-1445. [PMID: 35926162 PMCID: PMC9480477 DOI: 10.2105/ajph.2022.306917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 11/04/2022]
Abstract
In response to rapidly changing societal conditions stemming from the COVID-19 pandemic, we summarize data sources with potential to produce timely and spatially granular measures of physical, economic, and social conditions relevant to public health surveillance, and we briefly describe emerging analytic methods to improve small-area estimation. To inform this article, we reviewed published systematic review articles set in the United States from 2015 to 2020 and conducted unstructured interviews with senior content experts in public heath practice, academia, and industry. We identified a modest number of data sources with high potential for generating timely and spatially granular measures of physical, economic, and social determinants of health. We also summarized modeling and machine-learning techniques useful to support development of time-sensitive surveillance measures that may be critical for responding to future major events such as the COVID-19 pandemic. (Am J Public Health. 2022;112(10):1436-1445. https://doi.org/10.2105/AJPH.2022.306917).
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Affiliation(s)
- Lorna E Thorpe
- Lorna E. Thorpe, Nicholas Pantaleo, Sarah Conderino, Yuruo Li, Marc N. Gourevitch, Shoshanna Levine, Rebecca Ofrane, and Benjamin Spoer are with the Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY. Rumi Chunara is with the Department of Computer Science and Engineering, NYU Tandon School of Engineering, New York, NY. Tim Roberts is with the Medical Library, NYU Grossman School of Medicine. Caleb Irvine is with the Department of Medicine, NYU Grossman School of Medicine. Pei Yang Hsieh was with the Department of Population Health, NYU Grossman School of Medicine at the time of writing this article
| | - Rumi Chunara
- Lorna E. Thorpe, Nicholas Pantaleo, Sarah Conderino, Yuruo Li, Marc N. Gourevitch, Shoshanna Levine, Rebecca Ofrane, and Benjamin Spoer are with the Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY. Rumi Chunara is with the Department of Computer Science and Engineering, NYU Tandon School of Engineering, New York, NY. Tim Roberts is with the Medical Library, NYU Grossman School of Medicine. Caleb Irvine is with the Department of Medicine, NYU Grossman School of Medicine. Pei Yang Hsieh was with the Department of Population Health, NYU Grossman School of Medicine at the time of writing this article
| | - Tim Roberts
- Lorna E. Thorpe, Nicholas Pantaleo, Sarah Conderino, Yuruo Li, Marc N. Gourevitch, Shoshanna Levine, Rebecca Ofrane, and Benjamin Spoer are with the Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY. Rumi Chunara is with the Department of Computer Science and Engineering, NYU Tandon School of Engineering, New York, NY. Tim Roberts is with the Medical Library, NYU Grossman School of Medicine. Caleb Irvine is with the Department of Medicine, NYU Grossman School of Medicine. Pei Yang Hsieh was with the Department of Population Health, NYU Grossman School of Medicine at the time of writing this article
| | - Nicholas Pantaleo
- Lorna E. Thorpe, Nicholas Pantaleo, Sarah Conderino, Yuruo Li, Marc N. Gourevitch, Shoshanna Levine, Rebecca Ofrane, and Benjamin Spoer are with the Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY. Rumi Chunara is with the Department of Computer Science and Engineering, NYU Tandon School of Engineering, New York, NY. Tim Roberts is with the Medical Library, NYU Grossman School of Medicine. Caleb Irvine is with the Department of Medicine, NYU Grossman School of Medicine. Pei Yang Hsieh was with the Department of Population Health, NYU Grossman School of Medicine at the time of writing this article
| | - Caleb Irvine
- Lorna E. Thorpe, Nicholas Pantaleo, Sarah Conderino, Yuruo Li, Marc N. Gourevitch, Shoshanna Levine, Rebecca Ofrane, and Benjamin Spoer are with the Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY. Rumi Chunara is with the Department of Computer Science and Engineering, NYU Tandon School of Engineering, New York, NY. Tim Roberts is with the Medical Library, NYU Grossman School of Medicine. Caleb Irvine is with the Department of Medicine, NYU Grossman School of Medicine. Pei Yang Hsieh was with the Department of Population Health, NYU Grossman School of Medicine at the time of writing this article
| | - Sarah Conderino
- Lorna E. Thorpe, Nicholas Pantaleo, Sarah Conderino, Yuruo Li, Marc N. Gourevitch, Shoshanna Levine, Rebecca Ofrane, and Benjamin Spoer are with the Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY. Rumi Chunara is with the Department of Computer Science and Engineering, NYU Tandon School of Engineering, New York, NY. Tim Roberts is with the Medical Library, NYU Grossman School of Medicine. Caleb Irvine is with the Department of Medicine, NYU Grossman School of Medicine. Pei Yang Hsieh was with the Department of Population Health, NYU Grossman School of Medicine at the time of writing this article
| | - Yuruo Li
- Lorna E. Thorpe, Nicholas Pantaleo, Sarah Conderino, Yuruo Li, Marc N. Gourevitch, Shoshanna Levine, Rebecca Ofrane, and Benjamin Spoer are with the Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY. Rumi Chunara is with the Department of Computer Science and Engineering, NYU Tandon School of Engineering, New York, NY. Tim Roberts is with the Medical Library, NYU Grossman School of Medicine. Caleb Irvine is with the Department of Medicine, NYU Grossman School of Medicine. Pei Yang Hsieh was with the Department of Population Health, NYU Grossman School of Medicine at the time of writing this article
| | - Pei Yang Hsieh
- Lorna E. Thorpe, Nicholas Pantaleo, Sarah Conderino, Yuruo Li, Marc N. Gourevitch, Shoshanna Levine, Rebecca Ofrane, and Benjamin Spoer are with the Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY. Rumi Chunara is with the Department of Computer Science and Engineering, NYU Tandon School of Engineering, New York, NY. Tim Roberts is with the Medical Library, NYU Grossman School of Medicine. Caleb Irvine is with the Department of Medicine, NYU Grossman School of Medicine. Pei Yang Hsieh was with the Department of Population Health, NYU Grossman School of Medicine at the time of writing this article
| | - Marc N Gourevitch
- Lorna E. Thorpe, Nicholas Pantaleo, Sarah Conderino, Yuruo Li, Marc N. Gourevitch, Shoshanna Levine, Rebecca Ofrane, and Benjamin Spoer are with the Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY. Rumi Chunara is with the Department of Computer Science and Engineering, NYU Tandon School of Engineering, New York, NY. Tim Roberts is with the Medical Library, NYU Grossman School of Medicine. Caleb Irvine is with the Department of Medicine, NYU Grossman School of Medicine. Pei Yang Hsieh was with the Department of Population Health, NYU Grossman School of Medicine at the time of writing this article
| | - Shoshanna Levine
- Lorna E. Thorpe, Nicholas Pantaleo, Sarah Conderino, Yuruo Li, Marc N. Gourevitch, Shoshanna Levine, Rebecca Ofrane, and Benjamin Spoer are with the Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY. Rumi Chunara is with the Department of Computer Science and Engineering, NYU Tandon School of Engineering, New York, NY. Tim Roberts is with the Medical Library, NYU Grossman School of Medicine. Caleb Irvine is with the Department of Medicine, NYU Grossman School of Medicine. Pei Yang Hsieh was with the Department of Population Health, NYU Grossman School of Medicine at the time of writing this article
| | - Rebecca Ofrane
- Lorna E. Thorpe, Nicholas Pantaleo, Sarah Conderino, Yuruo Li, Marc N. Gourevitch, Shoshanna Levine, Rebecca Ofrane, and Benjamin Spoer are with the Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY. Rumi Chunara is with the Department of Computer Science and Engineering, NYU Tandon School of Engineering, New York, NY. Tim Roberts is with the Medical Library, NYU Grossman School of Medicine. Caleb Irvine is with the Department of Medicine, NYU Grossman School of Medicine. Pei Yang Hsieh was with the Department of Population Health, NYU Grossman School of Medicine at the time of writing this article
| | - Benjamin Spoer
- Lorna E. Thorpe, Nicholas Pantaleo, Sarah Conderino, Yuruo Li, Marc N. Gourevitch, Shoshanna Levine, Rebecca Ofrane, and Benjamin Spoer are with the Department of Population Health, New York University (NYU) Grossman School of Medicine, New York, NY. Rumi Chunara is with the Department of Computer Science and Engineering, NYU Tandon School of Engineering, New York, NY. Tim Roberts is with the Medical Library, NYU Grossman School of Medicine. Caleb Irvine is with the Department of Medicine, NYU Grossman School of Medicine. Pei Yang Hsieh was with the Department of Population Health, NYU Grossman School of Medicine at the time of writing this article
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15
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Al Rifai M, Kianoush S, Jain V, Joshi PH, Cainzos-Achirica M, Nasir K, Merchant AT, Dodani S, Wong SS, Samad Z, Mehta A, Chunara R, Kalra A, Virani SS. Association of U.S. birth, duration of residence in the U.S., and atherosclerotic cardiovascular disease risk factors among Asian adults. Prev Med Rep 2022; 29:101916. [PMID: 35898194 PMCID: PMC9309422 DOI: 10.1016/j.pmedr.2022.101916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/07/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Prior studies have shown a direct association between U.S. birth and duration of residence with atherosclerotic cardiovascular disease (ASCVD) though, few have specifically focused on Asian Americans. Methods We utilized cross-sectional data from the 2006 to 2015 National Health Interview Survey. We compared prevalent cardiovascular risk factors and ASCVD among Asian American individuals by U.S. birth and duration of time spent in the U.S. Results The study sample consisted of 18,150 Asian individuals of whom 20.5 % were Asian Indian, 20.5 % were Chinese, 23.4 % were Filipino, and 35.6 % were of other Asian ethnic groups. The mean (standard error) age was 43.8 (0.21) years and 53 % were women. In multivariable-adjusted logistic regression models, U.S. birth was associated with a higher prevalence odds ratio (95 % confidence interval) of current smoking 1.31 (1.07,1.60), physical inactivity 0.62 (0.54,0.72), obesity 2.26 (1.91,2.69), hypertension 1.33 (1.12,1.58), and CAD 1.96 (1.24,3.11), but lower prevalence of stroke 0.28 (0.11,0.71). Spending greater than 15 years in the U.S. was associated with a higher prevalence of current smoking 1.65 (1.24,2.21), obesity 2.33 (1.57,3.47), diabetes 2.68 (1.17,6.15), and hyperlipidemia 1.72 (1.09,2.71). Conclusion Heterogeneity exists in cardiovascular risk factor burden among Asian Americans according to Asian ethnicity, U.S. birth, and duration of time living in the U.S.
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Affiliation(s)
- Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Sina Kianoush
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Vardhmaan Jain
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Parag H Joshi
- Department of Medicine, Division of Cardiology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Sunita Dodani
- Section of Cardiology, Department of Internal Medicine, Eastern Virginia Medical School (EVMS), Norfolk, VA, United States.,EVMS-Sentara Healthcare Analytics and Delivery Science Institute, Norfolk, VA, United States
| | - Sally S Wong
- Office of Science, Medicine and Health, The American Heart Association, Dallas, TX, United States
| | | | - Anurag Mehta
- Division of Cardiology, Department of Medicine, Virginia Commonwealth University Medical Center, Richmond, VA, United States
| | - Rumi Chunara
- Department of Biostatistics, School of Global Public Health, New York University & Department of Computer Science and Engineering, Tandon School of Engineering, New York University, New York, NY, United States
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular, & Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States.,Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States.,Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, United States.,Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
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16
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Tong C, Margolin D, Chunara R, Niederdeppe J, Taylor T, Dunbar N, King AJ. Search Term Identification Methods for Computational Health Communication: Word Embedding and Network Approach for Health Content on YouTube. JMIR Med Inform 2022; 10:e37862. [PMID: 36040760 PMCID: PMC9472050 DOI: 10.2196/37862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/13/2022] [Accepted: 07/22/2022] [Indexed: 12/02/2022] Open
Abstract
Background Common methods for extracting content in health communication research typically involve using a set of well-established queries, often names of medical procedures or diseases, that are often technical or rarely used in the public discussion of health topics. Although these methods produce high recall (ie, retrieve highly relevant content), they tend to overlook health messages that feature colloquial language and layperson vocabularies on social media. Given how such messages could contain misinformation or obscure content that circumvents official medical concepts, correctly identifying (and analyzing) them is crucial to the study of user-generated health content on social media platforms. Objective Health communication scholars would benefit from a retrieval process that goes beyond the use of standard terminologies as search queries. Motivated by this, this study aims to put forward a search term identification method to improve the retrieval of user-generated health content on social media. We focused on cancer screening tests as a subject and YouTube as a platform case study. Methods We retrieved YouTube videos using cancer screening procedures (colonoscopy, fecal occult blood test, mammogram, and pap test) as seed queries. We then trained word embedding models using text features from these videos to identify the nearest neighbor terms that are semantically similar to cancer screening tests in colloquial language. Retrieving more YouTube videos from the top neighbor terms, we coded a sample of 150 random videos from each term for relevance. We then used text mining to examine the new content retrieved from these videos and network analysis to inspect the relations between the newly retrieved videos and videos from the seed queries. Results The top terms with semantic similarities to cancer screening tests were identified via word embedding models. Text mining analysis showed that the 5 nearest neighbor terms retrieved content that was novel and contextually diverse, beyond the content retrieved from cancer screening concepts alone. Results from network analysis showed that the newly retrieved videos had at least one total degree of connection (sum of indegree and outdegree) with seed videos according to YouTube relatedness measures. Conclusions We demonstrated a retrieval technique to improve recall and minimize precision loss, which can be extended to various health topics on YouTube, a popular video-sharing social media platform. We discussed how health communication scholars can apply the technique to inspect the performance of the retrieval strategy before investing human coding resources and outlined suggestions on how such a technique can be extended to other health contexts.
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Affiliation(s)
- Chau Tong
- Department of Communication, Cornell University, Ithaca, NY, United States
| | - Drew Margolin
- Department of Communication, Cornell University, Ithaca, NY, United States
| | - Rumi Chunara
- Department of Biostatistics, School of Global Public Health, New York University, New York, NY, United States.,Department of Computer Science & Engineering, Tandon School of Engineering, New York University, New York, NY, United States
| | - Jeff Niederdeppe
- Department of Communication, Cornell University, Ithaca, NY, United States.,Jeb E Brooks School of Public Policy, Cornell University, Ithaca, NY, United States
| | - Teairah Taylor
- Department of Communication, Cornell University, Ithaca, NY, United States
| | - Natalie Dunbar
- Greenlee School of Journalism and Communication, Iowa State University, Ames, IA, United States
| | - Andy J King
- Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, United States.,Department of Communication, University of Utah, Salt Lake City, UT, United States
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17
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Mukhopadhyay A, Adhikari S, Li X, Dodson JA, Kronish IM, Ramatowski M, Chunara R, Blecker S. Abstract 39: Association Between Copay Amount And Medication Adherence For Angiotensin Receptor Neprilysin Inhibitors In Patients With Heart Failure. Circ Cardiovasc Qual Outcomes 2022. [DOI: 10.1161/circoutcomes.15.suppl_1.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Angiotensin receptor neprilysin inhibitors (ARNI) can significantly reduce mortality and hospitalization for patients with heart failure (HF). However, relatively high copayment costs for ARNI may contribute to shortfalls in adherence.
Methods:
We conducted a retrospective cohort study of patients within a large, diverse, multi-site health system. We included patients with: an active diagnosis of HF or ejection fraction (EF) ≤ 40% on echocardiogram; a prescription for ARNI between 11/20/2020-3/31/2021; and available pharmacy or pharmacy benefit manager copayment data. Our primary exposure variable was copay amount, categorized as: $0, $0.01-$10, $10.01-$100, >$100. Our primary outcome was adherence to ARNI, defined as the proportion of days covered (PDC) ≥ 80% over 6 months. We assessed the association between copay amount and PDC using multivariable logistic regression, adjusting for the following: age, sex, race, ethnicity, insurance type, socioeconomic status (based on AHRQ SES index), EF, prior hospitalizations, and prior emergency visits.
Results:
A total of 567 patients met inclusion criteria. Low copay amounts ($0.01-$10), as opposed to no copay or higher copay amounts ($10.01-$100, >$100), were more common for patients who were younger, of Black race, Hispanic/Latinx ethnicity, with Medicaid insurance, lower SES index, and lower EF (all p<0.01). Unadjusted rates of ARNI adherence varied significantly by copay amount (Figure 1A: p<0.01), and adjusted odds of ARNI adherence was significantly lower for patients with copay over $100 as compared to no copay (Figure 1B: OR 0.33, 95% CI 0.14-0.71, p<0.01). There was a graded association between copay amount and ARNI non-adherence.
Conclusions:
We found lower rates of ARNI adherence for patients with higher copay amount, which persisted after multivariable adjustment. Our findings support policy-level interventions to reduce copay amounts for ARNI.
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Mandal S, Wiesenfeld BM, Mann D, Lawrence K, Chunara R, Testa P, Nov O. Evidence for telemedicine’s ongoing transformation of healthcare delivery since the onset of COVID-19: A retrospective observational study (Preprint). JMIR Form Res 2022; 6:e38661. [PMID: 36103553 PMCID: PMC9578517 DOI: 10.2196/38661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/14/2022] [Accepted: 09/02/2022] [Indexed: 01/19/2023] Open
Abstract
Background The surge of telemedicine use during the early stages of the COVID-19 pandemic has been well documented. However, scarce evidence considers the use of telemedicine in the subsequent period. Objective This study aims to evaluate use patterns of video-based telemedicine visits for ambulatory care and urgent care provision over the course of recurring pandemic waves in 1 large health system in New York City (NYC) and what this means for health care delivery. Methods Retrospective electronic health record (EHR) data of patients from January 1, 2020, to February 28, 2022, were used to longitudinally track and analyze telemedicine and in-person visit volumes across ambulatory care specialties and urgent care, as well as compare them to a prepandemic baseline (June-November 2019). Diagnosis codes to differentiate suspected COVID-19 visits from non–COVID-19 visits, as well as evaluating COVID-19–based telemedicine use over time, were compared to the total number of COVID-19–positive cases in the same geographic region (city level). The time series data were segmented based on change-point analysis, and variances in visit trends were compared between the segments. Results The emergence of COVID-19 prompted an early increase in the number of telemedicine visits across the urgent care and ambulatory care settings. This use continued throughout the pandemic at a much higher level than the prepandemic baseline for both COVID-19 and non–COVID-19 suspected visits, despite the fluctuation in COVID-19 cases throughout the pandemic and the resumption of in-person clinical services. The use of telemedicine-based urgent care services for COVID-19 suspected visits showed more variance in response to each pandemic wave, but telemedicine visits for ambulatory care have remained relatively steady after the initial crisis period. During the Omicron wave, the use of all visit types, including in-person activities, decreased. Patients between 25 and 34 years of age were the largest users of telemedicine-based urgent care. Patient satisfaction with telemedicine-based urgent care remained high despite the rapid scaling of services to meet increased demand. Conclusions The trend of the increased use of telemedicine as a means of health care delivery relative to the pre–COVID-19 baseline has been maintained throughout the later pandemic periods despite fluctuating COVID-19 cases and the resumption of in-person care delivery. Overall satisfaction with telemedicine-based care is also high. The trends in telemedicine use suggest that telemedicine-based health care delivery has become a mainstream and sustained supplement to in-person-based ambulatory care, particularly for younger patients, for both urgent and nonurgent care needs. These findings have implications for the health care delivery system, including practice leaders, insurers, and policymakers. Further investigation is needed to evaluate telemedicine adoption by key demographics, identify ongoing barriers to adoption, and explore the impacts of sustained use of telemedicine on health care outcomes and experience.
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Affiliation(s)
- Soumik Mandal
- Department of Population Health, New York University Grossman School of Medicine, New York University, New York, NY, United States
- Department of Technology Management & Innovation, New York University Tandon School of Engineering, New York University, New York, NY, United States
| | - Batia M Wiesenfeld
- New York University Leonard N Stern School of Business, New York University, New York, NY, United States
| | - Devin Mann
- Department of Population Health, New York University Grossman School of Medicine, New York University, New York, NY, United States
- Medical Center Information Technology, New York University Langone Health, New York University, New York, NY, United States
| | - Katharine Lawrence
- Department of Population Health, New York University Grossman School of Medicine, New York University, New York, NY, United States
- Medical Center Information Technology, New York University Langone Health, New York University, New York, NY, United States
| | - Rumi Chunara
- Computer Science & Engineering, New York University Tandon School of Engineering, New York University, New York, NY, United States
- Biostatistics, New York University School of Global Public Health, New York University, New York, NY, United States
| | - Paul Testa
- Medical Center Information Technology, New York University Langone Health, New York University, New York, NY, United States
| | - Oded Nov
- Department of Population Health, New York University Grossman School of Medicine, New York University, New York, NY, United States
- Department of Technology Management & Innovation, New York University Tandon School of Engineering, New York University, New York, NY, United States
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19
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Singh H, Mhasawade V, Chunara R. Generalizability challenges of mortality risk prediction models: A retrospective analysis on a multi-center database. PLOS Digit Health 2022; 1:e0000023. [PMID: 36812510 PMCID: PMC9931319 DOI: 10.1371/journal.pdig.0000023] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 02/17/2022] [Indexed: 12/23/2022]
Abstract
Modern predictive models require large amounts of data for training and evaluation, absence of which may result in models that are specific to certain locations, populations in them and clinical practices. Yet, best practices for clinical risk prediction models have not yet considered such challenges to generalizability. Here we ask whether population- and group-level performance of mortality prediction models vary significantly when applied to hospitals or geographies different from the ones in which they are developed. Further, what characteristics of the datasets explain the performance variation? In this multi-center cross-sectional study, we analyzed electronic health records from 179 hospitals across the US with 70,126 hospitalizations from 2014 to 2015. Generalization gap, defined as difference between model performance metrics across hospitals, is computed for area under the receiver operating characteristic curve (AUC) and calibration slope. To assess model performance by the race variable, we report differences in false negative rates across groups. Data were also analyzed using a causal discovery algorithm "Fast Causal Inference" that infers paths of causal influence while identifying potential influences associated with unmeasured variables. When transferring models across hospitals, AUC at the test hospital ranged from 0.777 to 0.832 (1st-3rd quartile or IQR; median 0.801); calibration slope from 0.725 to 0.983 (IQR; median 0.853); and disparity in false negative rates from 0.046 to 0.168 (IQR; median 0.092). Distribution of all variable types (demography, vitals, and labs) differed significantly across hospitals and regions. The race variable also mediated differences in the relationship between clinical variables and mortality, by hospital/region. In conclusion, group-level performance should be assessed during generalizability checks to identify potential harms to the groups. Moreover, for developing methods to improve model performance in new environments, a better understanding and documentation of provenance of data and health processes are needed to identify and mitigate sources of variation.
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Affiliation(s)
| | | | - Rumi Chunara
- New York University, Tandon School of Engineering,New York University, School of Global Public Health
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20
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Davis BD, McKnight DE, Teodorescu D, Quan-Haase A, Chunara R, Fyshe A, Lizotte DJ. Quantifying depression-related language on social media during the COVID-19 pandemic. Int J Popul Data Sci 2022; 5:1716. [PMID: 35516163 PMCID: PMC9052361 DOI: 10.23889/ijpds.v5i4.1716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Introduction The COVID-19 pandemic had clear impacts on mental health. Social media presents an opportunity for assessing mental health at the population level. Objectives 1) Identify and describe language used on social media that is associated with discourse about depression. 2) Describe the associations between identified language and COVID-19 incidence over time across several geographies. Methods We create a word embedding based on the posts in Reddit's /r/Depression and use this word embedding to train representations of active authors. We contrast these authors against a control group and extract keywords that capture differences between the two groups. We filter these keywords for face validity and to match character limits of an information retrieval system, Elasticsearch. We retrieve all geo-tagged posts on Twitter from April 2019 to June 2021 from Seattle, Sydney, Mumbai, and Toronto. The tweets are scored with BM25 using the keywords. We call this score rDD. We compare changes in average score over time with case counts from the pandemic's beginning through June 2021. Results We observe a pattern in rDD across all cities analyzed: There is an increase in rDD near the start of the pandemic which levels off over time. However, in Mumbai we also see an increase aligned with a second wave of cases. Conclusions Our results are concordant with other studies which indicate that the impact of the pandemic on mental health was highest initially and was followed by recovery, largely unchanged by subsequent waves. However, in the Mumbai data we observed a substantial rise in rDD with a large second wave. Our results indicate possible un-captured heterogeneity across geographies, and point to a need for a better understanding of this differential impact on mental health.
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Affiliation(s)
- Brent D. Davis
- Department of Computer Science, Western University, London, ON, Canada, N6A 3K7
| | - Dawn Estes McKnight
- Department of Computing Science, University of Alberta, Edmonton, AB, T6G 2R3
| | - Daniela Teodorescu
- Department of Computing Science, University of Alberta, Edmonton, AB, T6G 2R3
| | - Anabel Quan-Haase
- Department of Sociology, Western University, London, ON, Canada, N6A 3K7
- Faculty of Information and Media Studies, Western University, London, ON, Canada, N6A 3K7
| | - Rumi Chunara
- Department of Computer Science & Engineering, New York University, New York, NY, 10003
- Department of Biostatistics, New York University, New York, NY, 10003
| | - Alona Fyshe
- Department of Computing Science, University of Alberta, Edmonton, AB, T6G 2R3
- Department of Psychology, University of Alberta, Edmonton, AB, Canada, T6G2R3
| | - Daniel J. Lizotte
- Department of Computer Science, Western University, London, ON, Canada, N6A 3K7
- Department of Epidemiology and Biostatistics, Western University, London, ON,N6A 3K7
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21
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22
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Chunara R, Zhao Y, Chen J, Lawrence K, Testa PA, Nov O, Mann DM. Telemedicine and healthcare disparities: a cohort study in a large healthcare system in New York City during COVID-19. J Am Med Inform Assoc 2021; 28:33-41. [PMID: 32866264 PMCID: PMC7499631 DOI: 10.1093/jamia/ocaa217] [Citation(s) in RCA: 167] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/20/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Through the coronavirus disease 2019 (COVID-19) pandemic, telemedicine became a necessary entry point into the process of diagnosis, triage, and treatment. Racial and ethnic disparities in healthcare have been well documented in COVID-19 with respect to risk of infection and in-hospital outcomes once admitted, and here we assess disparities in those who access healthcare via telemedicine for COVID-19. MATERIALS AND METHODS Electronic health record data of patients at New York University Langone Health between March 19th and April 30, 2020 were used to conduct descriptive and multilevel regression analyses with respect to visit type (telemedicine or in-person), suspected COVID diagnosis, and COVID test results. RESULTS Controlling for individual and community-level attributes, Black patients had 0.6 times the adjusted odds (95% CI: 0.58-0.63) of accessing care through telemedicine compared to white patients, though they are increasingly accessing telemedicine for urgent care, driven by a younger and female population. COVID diagnoses were significantly more likely for Black versus white telemedicine patients. DISCUSSION There are disparities for Black patients accessing telemedicine, however increased uptake by young, female Black patients. Mean income and decreased mean household size of a zip code were also significantly related to telemedicine use. CONCLUSION Telemedicine access disparities reflect those in in-person healthcare access. Roots of disparate use are complex and reflect individual, community, and structural factors, including their intersection-many of which are due to systemic racism. Evidence regarding disparities that manifest through telemedicine can be used to inform tool design and systemic efforts to promote digital health equity.
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Affiliation(s)
- Rumi Chunara
- NYU Tandon School of Engineering, Department of Computer Science and Engineering, Brooklyn, New York, USA.,NYU School of Global Public Health, Department of Biostatistics, New York, New York, USA
| | - Yuan Zhao
- NYU School of Global Public Health, Department of Epidemiology, New York, New York, USA
| | - Ji Chen
- NYU Grossman School of Medicine, Department of Population Health, New York, New York, USA
| | - Katharine Lawrence
- NYU Grossman School of Medicine, Department of Population Health, New York, New York, USA.,Medical Center Information Technology, NYU Langone Health, New York, New York, USA
| | - Paul A Testa
- Medical Center Information Technology, NYU Langone Health, New York, New York, USA
| | - Oded Nov
- Department of Technology Management & Innovation, NYU Tandon School of Engineering, Brooklyn, New York, USA
| | - Devin M Mann
- NYU Grossman School of Medicine, Department of Population Health, New York, New York, USA.,Medical Center Information Technology, NYU Langone Health, New York, New York, USA
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23
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Mann DM, Chen J, Chunara R, Testa PA, Nov O. COVID-19 transforms health care through telemedicine: Evidence from the field. J Am Med Inform Assoc 2020; 27:1132-1135. [PMID: 32324855 PMCID: PMC7188161 DOI: 10.1093/jamia/ocaa072] [Citation(s) in RCA: 764] [Impact Index Per Article: 191.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 12/13/2022] Open
Abstract
This study provides data on the feasibility and impact of video-enabled telemedicine use among patients and providers and its impact on urgent and nonurgent healthcare delivery from one large health system (NYU Langone Health) at the epicenter of the coronavirus disease 2019 (COVID-19) outbreak in the United States. Between March 2nd and April 14th 2020, telemedicine visits increased from 102.4 daily to 801.6 daily. (683% increase) in urgent care after the system-wide expansion of virtual urgent care staff in response to COVID-19. Of all virtual visits post expansion, 56.2% and 17.6% urgent and nonurgent visits, respectively, were COVID-19-related. Telemedicine usage was highest by patients 20 to 44 years of age, particularly for urgent care. The COVID-19 pandemic has driven rapid expansion of telemedicine use for urgent care and nonurgent care visits beyond baseline periods. This reflects an important change in telemedicine that other institutions facing the COVID-19 pandemic should anticipate.
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Affiliation(s)
- Devin M Mann
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA.,Medical Center Information Technology, NYU Langone Health, New York, New York, USA
| | - Ji Chen
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA.,Medical Center Information Technology, NYU Langone Health, New York, New York, USA
| | - Rumi Chunara
- Department of Computer Science & Engineering, NYU Tandon School of Engineering, Brooklyn, New York, USA.,Department of Biostatistics, NYU School of Global Public Health, New York, New York, USA
| | - Paul A Testa
- Medical Center Information Technology, NYU Langone Health, New York, New York, USA
| | - Oded Nov
- Department of Technology Management and Innovation, NYU Tandon School of Engineering, Brooklyn, New York, USA
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24
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Chunara R, Cook SH. Using Digital Data to Protect and Promote the Most Vulnerable in the Fight Against COVID-19. Front Public Health 2020; 8:296. [PMID: 32596201 PMCID: PMC7303333 DOI: 10.3389/fpubh.2020.00296] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/04/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rumi Chunara
- Department of Biostatistics, New York University School of Global Public Health, New York, NY, United States.,Department of Computer Science & Engineering, New York University Tandon School of Engineering, New York, NY, United States
| | - Stephanie H Cook
- Department of Biostatistics, New York University School of Global Public Health, New York, NY, United States
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25
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Abdur Rehman N, Salje H, Kraemer MUG, Subramanian L, Saif U, Chunara R. Quantifying the localized relationship between vector containment activities and dengue incidence in a real-world setting: A spatial and time series modelling analysis based on geo-located data from Pakistan. PLoS Negl Trop Dis 2020; 14:e0008273. [PMID: 32392225 PMCID: PMC7241855 DOI: 10.1371/journal.pntd.0008273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 05/21/2020] [Accepted: 04/07/2020] [Indexed: 11/19/2022] Open
Abstract
Increasing urbanization is having a profound effect on infectious disease risk, posing significant challenges for governments to allocate limited resources for their optimal control at a sub-city scale. With recent advances in data collection practices, empirical evidence about the efficacy of highly localized containment and intervention activities, which can lead to optimal deployment of resources, is possible. However, there are several challenges in analyzing data from such real-world observational settings. Using data on 3.9 million instances of seven dengue vector containment activities collected between 2012 and 2017, here we develop and assess two frameworks for understanding how the generation of new dengue cases changes in space and time with respect to application of different types of containment activities. Accounting for the non-random deployment of each containment activity in relation to dengue cases and other types of containment activities, as well as deployment of activities in different epidemiological contexts, results from both frameworks reinforce existing knowledge about the efficacy of containment activities aimed at the adult phase of the mosquito lifecycle. Results show a 10% (95% CI: 1-19%) and 20% reduction (95% CI: 4-34%) reduction in probability of a case occurring in 50 meters and 30 days of cases which had Indoor Residual Spraying (IRS) and fogging performed in the immediate vicinity, respectively, compared to cases of similar epidemiological context and which had no containment in their vicinity. Simultaneously, limitations due to the real-world nature of activity deployment are used to guide recommendations for future deployment of resources during outbreaks as well as data collection practices. Conclusions from this study will enable more robust and comprehensive analyses of localized containment activities in resource-scarce urban settings and lead to improved allocation of resources of government in an outbreak setting.
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Affiliation(s)
- Nabeel Abdur Rehman
- Computer Science and Engineering, Tandon School of Engineering, New York University, Brooklyn, New York, United States of America
| | | | | | | | - Umar Saif
- UNESCO Chair for ICTD, Lahore, Pakistan
| | - Rumi Chunara
- Computer Science and Engineering, Tandon School of Engineering, New York University, Brooklyn, New York, United States of America
- Department of Biostatistics, School of Global Public Health, New York University, New York, New York, United States of America
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26
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Daughton AR, Chunara R, Paul MJ. Comparison of Social Media, Syndromic Surveillance, and Microbiologic Acute Respiratory Infection Data: Observational Study. JMIR Public Health Surveill 2020; 6:e14986. [PMID: 32329741 PMCID: PMC7210500 DOI: 10.2196/14986] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/27/2019] [Accepted: 02/09/2020] [Indexed: 11/30/2022] Open
Abstract
Background Internet data can be used to improve infectious disease models. However, the representativeness and individual-level validity of internet-derived measures are largely unexplored as this requires ground truth data for study. Objective This study sought to identify relationships between Web-based behaviors and/or conversation topics and health status using a ground truth, survey-based dataset. Methods This study leveraged a unique dataset of self-reported surveys, microbiological laboratory tests, and social media data from the same individuals toward understanding the validity of individual-level constructs pertaining to influenza-like illness in social media data. Logistic regression models were used to identify illness in Twitter posts using user posting behaviors and topic model features extracted from users’ tweets. Results Of 396 original study participants, only 81 met the inclusion criteria for this study. Of these participants’ tweets, we identified only two instances that were related to health and occurred within 2 weeks (before or after) of a survey indicating symptoms. It was not possible to predict when participants reported symptoms using features derived from topic models (area under the curve [AUC]=0.51; P=.38), though it was possible using behavior features, albeit with a very small effect size (AUC=0.53; P≤.001). Individual symptoms were also generally not predictable either. The study sample and a random sample from Twitter are predictably different on held-out data (AUC=0.67; P≤.001), meaning that the content posted by people who participated in this study was predictably different from that posted by random Twitter users. Individuals in the random sample and the GoViral sample used Twitter with similar frequencies (similar @ mentions, number of tweets, and number of retweets; AUC=0.50; P=.19). Conclusions To our knowledge, this is the first instance of an attempt to use a ground truth dataset to validate infectious disease observations in social media data. The lack of signal, the lack of predictability among behaviors or topics, and the demonstrated volunteer bias in the study population are important findings for the large and growing body of disease surveillance using internet-sourced data.
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Affiliation(s)
- Ashlynn R Daughton
- Analytics, Intelligence and Technology, Los Alamos National Laboratory, Los Alamos, NM, United States
| | - Rumi Chunara
- Biostatistics, School of Global Public Health, New York University, New York, NY, United States.,Computer Science and Engineering, Tandon School of Engineering, New York University, Brooklyn, NY, United States
| | - Michael J Paul
- Information Science Department, University of Colorado Boulder, Boulder, CO, United States
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27
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Mhasawade V, Elghafari A, Duncan DT, Chunara R. Role of the Built and Online Social Environments on Expression of Dining on Instagram. Int J Environ Res Public Health 2020; 17:E735. [PMID: 31979291 PMCID: PMC7037839 DOI: 10.3390/ijerph17030735] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 11/17/2022]
Abstract
Online social communities are becoming windows for learning more about the health of populations, through information about our health-related behaviors and outcomes from daily life. At the same time, just as public health data and theory has shown that aspects of the built environment can affect our health-related behaviors and outcomes, it is also possible that online social environments (e.g., posts and other attributes of our online social networks) can also shape facets of our life. Given the important role of the online environment in public health research and implications, factors which contribute to the generation of such data must be well understood. Here we study the role of the built and online social environments in the expression of dining on Instagram in Abu Dhabi; a ubiquitous social media platform, city with a vibrant dining culture, and a topic (food posts) which has been studied in relation to public health outcomes. Our study uses available data on user Instagram profiles and their Instagram networks, as well as the local food environment measured through the dining types (e.g., casual dining restaurants, food court restaurants, lounges etc.) by neighborhood. We find evidence that factors of the online social environment (profiles that post about dining versus profiles that do not post about dining) have different influences on the relationship between a user's built environment and the social dining expression, with effects also varying by dining types in the environment and time of day. We examine the mechanism of the relationships via moderation and mediation analyses. Overall, this study provides evidence that the interplay of online and built environments depend on attributes of said environments and can also vary by time of day. We discuss implications of this synergy for precisely-targeting public health interventions, as well as on using online data for public health research.
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Affiliation(s)
- Vishwali Mhasawade
- Department of Computer Science & Engineering, Tandon School of Engineering, New York University, Brooklyn, NY 11201, USA; (V.M.); (A.E.)
| | - Anas Elghafari
- Department of Computer Science & Engineering, Tandon School of Engineering, New York University, Brooklyn, NY 11201, USA; (V.M.); (A.E.)
| | - Dustin T. Duncan
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA;
| | - Rumi Chunara
- Department of Computer Science & Engineering, Tandon School of Engineering, New York University, Brooklyn, NY 11201, USA; (V.M.); (A.E.)
- Department of Biostatistics, College of Global Public Health, New York University, New York, NY 10003, USA
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28
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Alburez-Gutierrez D, Chandrasekharan E, Chunara R, Gil-Clavel S, Hannak A, Interdonato R, Joseph K, Kalimeri K, Malik M, Mayer K, Mejova Y, Paolotti D, Zagheni E. Reports of the Workshops Held at the 2019 International AAAI Conference on Web and Social Media. AI MAG 2019. [DOI: 10.1609/aimag.v40i4.5287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The workshop program of the Association for the Advancement of Artificial Intelligence’s 13th International Conference on Web and Social Media was held at the Bavarian School of Public Policy in Munich, Germany on June 11, 2019. There were five full-day workshops, one half-day workshop, and the annual evening Science Slam in the program. The proceedings of the workshops were published in Research Topic of the Frontiers in Big Data. This report contains summaries of those workshops.
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29
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Editor M, An J, Chunara R, Crandall DJ, Frajberg D, French M, Jansen BJ, Kulshrestha J, Mejova Y, Romero DM, Salminen J, Sharma A, Sheth A, Tan C, Taylor SH, Wijeratne S. Reports of the Workshops Held at the 2018 International AAAI Conference on Web and Social Media. AI MAG 2018. [DOI: 10.1609/aimag.v39i4.2835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The Workshop Program of the Association for the Advancement of Artificial Intelligence’s 12th International Conference on Web and Social Media (AAAI-18) was held at Stanford University, Stanford, California USA, on Monday, June 25, 2018. There were fourteen workshops in the program: Algorithmic Personalization and News: Risks and Opportunities; Beyond Online Data: Tackling Challenging Social Science Questions; Bridging the Gaps: Social Media, Use and Well-Being; Chatbot; Data-Driven Personas and Human-Driven Analytics: Automating Customer Insights in the Era of Social Media; Designed Data for Bridging the Lab and the Field: Tools, Methods, and Challenges in Social Media Experiments; Emoji Understanding and Applications in Social Media; Event Analytics Using Social Media Data; Exploring Ethical Trade-Offs in Social Media Research; Making Sense of Online Data for Population Research; News and Public Opinion; Social Media and Health: A Focus on Methods for Linking Online and Offline Data; Social Web for Environmental and Ecological Monitoring and The ICWSM Science Slam. Workshops were held on the first day of the conference. Workshop participants met and discussed issues with a selected focus — providing an informal setting for active exchange among researchers, developers, and users on topics of current interest. Organizers from nine of the workshops submitted reports, which are reproduced in this report. Brief summaries of the other five workshops have been reproduced from their website descriptions.
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Relia K, Akbari M, Duncan D, Chunara R. Socio-spatial Self-organizing Maps: Using Social Media to Assess Relevant Geographies for Exposure to Social Processes. Proc ACM Hum Comput Interact 2018; 2:145. [PMID: 30957076 PMCID: PMC6448781 DOI: 10.1145/3274414] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Social media offers a unique window into attitudes like racism and homophobia, exposure to which are important, hard to measure and understudied social determinants of health. However, individual geo-located observations from social media are noisy and geographically inconsistent. Existing areas by which exposures are measured, like Zip codes, average over irrelevant administratively-defined boundaries. Hence, in order to enable studies of online social environmental measures like attitudes on social media and their possible relationship to health outcomes, first there is a need for a method to define the collective, underlying degree of social media attitudes by region. To address this, we create the Socio-spatial-Self organizing map, "SS-SOM" pipeline to best identify regions by their latent social attitude from Twitter posts. SS-SOMs use neural embedding for text-classification, and augment traditional SOMs to generate a controlled number of nonoverlapping, topologically-constrained and topically-similar clusters. We find that not only are SS-SOMs robust to missing data, the exposure of a cohort of men who are susceptible to multiple racism and homophobia-linked health outcomes, changes by up to 42% using SS-SOM measures as compared to using Zip code-based measures.
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Kolawole O, Oguntoye M, Dam T, Chunara R. Etiology of respiratory tract infections in the community and clinic in Ilorin, Nigeria. BMC Res Notes 2017; 10:712. [PMID: 29212531 PMCID: PMC5719735 DOI: 10.1186/s13104-017-3063-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/02/2017] [Indexed: 01/30/2023] Open
Abstract
Objective Recognizing increasing interest in community disease surveillance globally, the goal of this study was to investigate whether respiratory viruses circulating in the community may be represented through clinical (hospital) surveillance in Nigeria. Results Children were selected via convenience sampling from communities and a tertiary care center (n = 91) during spring 2017 in Ilorin, Nigeria. Nasal swabs were collected and tested using polymerase chain reaction. The majority (79.1%) of subjects were under 6 years old, of whom 46 were infected (63.9%). A total of 33 of the 91 subjects had one or more respiratory tract virus; there were 10 cases of triple infection and 5 of quadruple. Parainfluenza virus 4, respiratory syncytial virus B and enterovirus were the most common viruses in the clinical sample; present in 93.8% (15/16) of clinical subjects, and 6.7% (5/75) of community subjects (significant difference, p < 0.001). Coronavirus OC43 was the most common virus detected in community members (13.3%, 10/75). A different strain, Coronavirus OC 229 E/NL63 was detected among subjects from the clinic (2/16) and not detected in the community. This pilot study provides evidence that data from the community can potentially represent different information than that sourced clinically, suggesting the need for community surveillance to enhance public health efforts and scientific understanding of respiratory infections.
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Affiliation(s)
- Olatunji Kolawole
- UNILORIN Institute of Molecular Science and Biotechnology, Infectious Diseases and Environmental Health Research Group, University of Ilorin, Ilorin, Nigeria
| | - Michael Oguntoye
- Kwara State Primary Health Care Development Agency, Ilorin, Nigeria
| | - Tina Dam
- Mailman School of Public Health, Columbia University, New York, USA.,Computer Science & Engineering and College of Global Public Health, New York University, New York, NY, USA
| | - Rumi Chunara
- Computer Science & Engineering and College of Global Public Health, New York University, New York, NY, USA.
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Huang T, Elghafari A, Relia K, Chunara R. High-resolution Temporal Representations of Alcohol and Tobacco Behaviors from Social Media Data. Proc ACM Hum Comput Interact 2017; 1:54. [PMID: 29264592 PMCID: PMC5734092 DOI: 10.1145/3134689] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Understanding tobacco- and alcohol-related behavioral patterns is critical for uncovering risk factors and potentially designing targeted social computing intervention systems. Given that we make choices multiple times per day, hourly and daily patterns are critical for better understanding behaviors. Here, we combine natural language processing, machine learning and time series analyses to assess Twitter activity specifically related to alcohol and tobacco consumption and their sub-daily, daily and weekly cycles. Twitter self-reports of alcohol and tobacco use are compared to other data streams available at similar temporal resolution. We assess if discussion of drinking by inferred underage versus legal age people or discussion of use of different types of tobacco products can be differentiated using these temporal patterns. We find that time and frequency domain representations of behaviors on social media can provide meaningful and unique insights, and we discuss the types of behaviors for which the approach may be most useful.
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Affiliation(s)
- Tom Huang
- Department of Statistics and Actuarial Science, University of Waterloo
| | | | - Kunal Relia
- Tandon School of Engineering, New York University
| | - Rumi Chunara
- Tandon School of Engineering and College of Global Public Health, New York University
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Abstract
Important work rooted in psychological theory posits that health behavior change occurs through a series of discrete stages. Our work builds on the field of social computing by identifying how social media data can be used to resolve behavior stages at high resolution (e.g. hourly/daily) for key population subgroups and times. In essence this approach opens new opportunities to advance psychological theories and better understand how our health is shaped based on the real, dynamic, and rapid actions we make every day. To do so, we bring together domain knowledge and machine learning methods to form a hierarchical classification of Twitter data that resolves different stages of behavior. We identify and examine temporal patterns of the identified stages, with alcohol as a use case (planning or looking to drink, currently drinking, and reflecting on drinking). Known seasonal trends are compared with findings from our methods. We discuss the potential health policy implications of detecting high frequency behavior stages.
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Baltrusaitis K, Santillana M, Crawley AW, Chunara R, Smolinski M, Brownstein JS. Determinants of Participants' Follow-Up and Characterization of Representativeness in Flu Near You, A Participatory Disease Surveillance System. JMIR Public Health Surveill 2017; 3:e18. [PMID: 28389417 PMCID: PMC5400887 DOI: 10.2196/publichealth.7304] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/03/2017] [Accepted: 03/16/2017] [Indexed: 12/02/2022] Open
Abstract
Background Flu Near You (FNY) is an Internet-based participatory surveillance system in the United States and Canada that allows volunteers to report influenza-like symptoms using a brief weekly symptom report. Objective Our objective was to evaluate the representativeness of the FNY population compared with the general population of the United States, explore the demographic and behavioral characteristics associated with FNY’s high-participation users, and summarize results from a user survey of a cohort of FNY participants. Methods We compared (1) the representativeness of sex and age groups of FNY participants during the 2014-2015 flu season versus the general US population and (2) the distribution of Human Development Index (HDI) scores of FNY participants versus that of the general US population. We analyzed associations between demographic and behavioral factors and the level of participant follow-up (ie, high vs low). Finally, descriptive statistics of responses from FNY’s 2015 and 2016 end-of-season user surveys were calculated. Results During the 2014-2015 influenza season, 47,234 unique participants had at least one FNY symptom report that was either self-reported (users) or submitted on their behalf (household members). The proportion of female FNY participants was significantly higher than that of the general US population (n=28,906, 61.2% vs 51.1%, P<.001). Although each age group was represented in the FNY population, the age distribution was significantly different from that of the US population (P<.001). Compared with the US population, FNY had a greater proportion of individuals with HDI >5.0, signaling that the FNY user distribution was more affluent and educated than the US population baseline. We found that high-participation use (ie, higher participation in follow-up symptom reports) was associated with sex (females were 25% less likely than men to be high-participation users), higher HDI, not reporting an influenza-like illness at the first symptom report, older age, and reporting for household members (all differences between high- and low-participation users P<.001). Approximately 10% of FNY users completed an additional survey at the end of the flu season that assessed detailed user characteristics (3217/33,324 in 2015; 4850/44,313 in 2016). Of these users, most identified as being either retired or employed in the health, education, and social services sectors and indicated that they achieved a bachelor’s degree or higher. Conclusions The representativeness of the FNY population and characteristics of its high-participation users are consistent with what has been observed in other Internet-based influenza surveillance systems. With targeted recruitment of underrepresented populations, FNY may improve as a complementary system to timely tracking of flu activity, especially in populations that do not seek medical attention and in areas with poor official surveillance data.
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Affiliation(s)
- Kristin Baltrusaitis
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, United States.,Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States
| | - Mauricio Santillana
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States.,Harvard School of Engineering and Applied Sciences, Cambridge, MA, United States
| | - Adam W Crawley
- Skoll Global Threats Fund, San Francisco, CA, United States
| | - Rumi Chunara
- The Global Institute of Public Health, New York University, New York, NY, United States.,Computer Science & Engineering, New York University, New York, NY, United States
| | - Mark Smolinski
- Skoll Global Threats Fund, San Francisco, CA, United States
| | - John S Brownstein
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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Chunara R, Wisk LE, Weitzman ER. Denominator Issues for Personally Generated Data in Population Health Monitoring. Am J Prev Med 2017; 52:549-553. [PMID: 28012811 PMCID: PMC5362284 DOI: 10.1016/j.amepre.2016.10.038] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 10/13/2016] [Accepted: 10/31/2016] [Indexed: 01/14/2023]
Affiliation(s)
- Rumi Chunara
- Department of Computer Science and Engineering, New York University Tandon School of Engineering, Brooklyn, New York; College of Global Public Health, New York University, New York, New York.
| | - Lauren E Wisk
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Elissa R Weitzman
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts; Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts
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Ray B, Ghedin E, Chunara R. Network inference from multimodal data: A review of approaches from infectious disease transmission. J Biomed Inform 2016; 64:44-54. [PMID: 27612975 PMCID: PMC7106161 DOI: 10.1016/j.jbi.2016.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 07/10/2016] [Accepted: 09/03/2016] [Indexed: 02/02/2023]
Abstract
Networks inference problems are commonly found in multiple biomedical subfields such as genomics, metagenomics, neuroscience, and epidemiology. Networks are useful for representing a wide range of complex interactions ranging from those between molecular biomarkers, neurons, and microbial communities, to those found in human or animal populations. Recent technological advances have resulted in an increasing amount of healthcare data in multiple modalities, increasing the preponderance of network inference problems. Multi-domain data can now be used to improve the robustness and reliability of recovered networks from unimodal data. For infectious diseases in particular, there is a body of knowledge that has been focused on combining multiple pieces of linked information. Combining or analyzing disparate modalities in concert has demonstrated greater insight into disease transmission than could be obtained from any single modality in isolation. This has been particularly helpful in understanding incidence and transmission at early stages of infections that have pandemic potential. Novel pieces of linked information in the form of spatial, temporal, and other covariates including high-throughput sequence data, clinical visits, social network information, pharmaceutical prescriptions, and clinical symptoms (reported as free-text data) also encourage further investigation of these methods. The purpose of this review is to provide an in-depth analysis of multimodal infectious disease transmission network inference methods with a specific focus on Bayesian inference. We focus on analytical Bayesian inference-based methods as this enables recovering multiple parameters simultaneously, for example, not just the disease transmission network, but also parameters of epidemic dynamics. Our review studies their assumptions, key inference parameters and limitations, and ultimately provides insights about improving future network inference methods in multiple applications.
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Affiliation(s)
- Bisakha Ray
- Center for Health Informatics and Bioinformatics, New York University School of Medicine, USA.
| | - Elodie Ghedin
- Department of Biology, Center for Genomics & Systems Biology, USA; College of Global Public Health, New York University, USA
| | - Rumi Chunara
- Dept. of Computer Science and Engineering, Tandon School of Engineering, USA; College of Global Public Health, New York University, USA
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Smolinski MS, Crawley AW, Baltrusaitis K, Chunara R, Olsen JM, Wójcik O, Santillana M, Nguyen A, Brownstein JS. Flu Near You: Crowdsourced Symptom Reporting Spanning 2 Influenza Seasons. Am J Public Health 2015; 105:2124-30. [PMID: 26270299 DOI: 10.2105/ajph.2015.302696] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES We summarized Flu Near You (FNY) data from the 2012-2013 and 2013-2014 influenza seasons in the United States. METHODS FNY collects limited demographic characteristic information upon registration, and prompts users each Monday to report symptoms of influenza-like illness (ILI) experienced during the previous week. We calculated the descriptive statistics and rates of ILI for the 2012-2013 and 2013-2014 seasons. We compared raw and noise-filtered ILI rates with ILI rates from the Centers for Disease Control and Prevention ILINet surveillance system. RESULTS More than 61 000 participants submitted at least 1 report during the 2012-2013 season, totaling 327 773 reports. Nearly 40 000 participants submitted at least 1 report during the 2013-2014 season, totaling 336 933 reports. Rates of ILI as reported by FNY tracked closely with ILINet in both timing and magnitude. CONCLUSIONS With increased participation, FNY has the potential to serve as a viable complement to existing outpatient, hospital-based, and laboratory surveillance systems. Although many established systems have the benefits of specificity and credibility, participatory systems offer advantages in the areas of speed, sensitivity, and scalability.
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Affiliation(s)
- Mark S Smolinski
- Mark S. Smolinski, Adam W. Crawley, and Jennifer M. Olsen are with the Skoll Global Threats Fund, San Francisco, CA. At the time of study, Rumi Chunara was with and Kristin Baltrusaitis, Oktawia Wójcik, Mauricio Santillana and John S. Brownstein are currently with the Boston Children's Hospital Informatics Program, Boston, MA. Andre Nguyen is with the Harvard School of Engineering and Applied Sciences, Harvard University, Cambridge, MA
| | - Adam W Crawley
- Mark S. Smolinski, Adam W. Crawley, and Jennifer M. Olsen are with the Skoll Global Threats Fund, San Francisco, CA. At the time of study, Rumi Chunara was with and Kristin Baltrusaitis, Oktawia Wójcik, Mauricio Santillana and John S. Brownstein are currently with the Boston Children's Hospital Informatics Program, Boston, MA. Andre Nguyen is with the Harvard School of Engineering and Applied Sciences, Harvard University, Cambridge, MA
| | - Kristin Baltrusaitis
- Mark S. Smolinski, Adam W. Crawley, and Jennifer M. Olsen are with the Skoll Global Threats Fund, San Francisco, CA. At the time of study, Rumi Chunara was with and Kristin Baltrusaitis, Oktawia Wójcik, Mauricio Santillana and John S. Brownstein are currently with the Boston Children's Hospital Informatics Program, Boston, MA. Andre Nguyen is with the Harvard School of Engineering and Applied Sciences, Harvard University, Cambridge, MA
| | - Rumi Chunara
- Mark S. Smolinski, Adam W. Crawley, and Jennifer M. Olsen are with the Skoll Global Threats Fund, San Francisco, CA. At the time of study, Rumi Chunara was with and Kristin Baltrusaitis, Oktawia Wójcik, Mauricio Santillana and John S. Brownstein are currently with the Boston Children's Hospital Informatics Program, Boston, MA. Andre Nguyen is with the Harvard School of Engineering and Applied Sciences, Harvard University, Cambridge, MA
| | - Jennifer M Olsen
- Mark S. Smolinski, Adam W. Crawley, and Jennifer M. Olsen are with the Skoll Global Threats Fund, San Francisco, CA. At the time of study, Rumi Chunara was with and Kristin Baltrusaitis, Oktawia Wójcik, Mauricio Santillana and John S. Brownstein are currently with the Boston Children's Hospital Informatics Program, Boston, MA. Andre Nguyen is with the Harvard School of Engineering and Applied Sciences, Harvard University, Cambridge, MA
| | - Oktawia Wójcik
- Mark S. Smolinski, Adam W. Crawley, and Jennifer M. Olsen are with the Skoll Global Threats Fund, San Francisco, CA. At the time of study, Rumi Chunara was with and Kristin Baltrusaitis, Oktawia Wójcik, Mauricio Santillana and John S. Brownstein are currently with the Boston Children's Hospital Informatics Program, Boston, MA. Andre Nguyen is with the Harvard School of Engineering and Applied Sciences, Harvard University, Cambridge, MA
| | - Mauricio Santillana
- Mark S. Smolinski, Adam W. Crawley, and Jennifer M. Olsen are with the Skoll Global Threats Fund, San Francisco, CA. At the time of study, Rumi Chunara was with and Kristin Baltrusaitis, Oktawia Wójcik, Mauricio Santillana and John S. Brownstein are currently with the Boston Children's Hospital Informatics Program, Boston, MA. Andre Nguyen is with the Harvard School of Engineering and Applied Sciences, Harvard University, Cambridge, MA
| | - Andre Nguyen
- Mark S. Smolinski, Adam W. Crawley, and Jennifer M. Olsen are with the Skoll Global Threats Fund, San Francisco, CA. At the time of study, Rumi Chunara was with and Kristin Baltrusaitis, Oktawia Wójcik, Mauricio Santillana and John S. Brownstein are currently with the Boston Children's Hospital Informatics Program, Boston, MA. Andre Nguyen is with the Harvard School of Engineering and Applied Sciences, Harvard University, Cambridge, MA
| | - John S Brownstein
- Mark S. Smolinski, Adam W. Crawley, and Jennifer M. Olsen are with the Skoll Global Threats Fund, San Francisco, CA. At the time of study, Rumi Chunara was with and Kristin Baltrusaitis, Oktawia Wójcik, Mauricio Santillana and John S. Brownstein are currently with the Boston Children's Hospital Informatics Program, Boston, MA. Andre Nguyen is with the Harvard School of Engineering and Applied Sciences, Harvard University, Cambridge, MA
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McIver DJ, Hawkins JB, Chunara R, Chatterjee AK, Bhandari A, Fitzgerald TP, Jain SH, Brownstein JS. Characterizing Sleep Issues Using Twitter. J Med Internet Res 2015; 17:e140. [PMID: 26054530 PMCID: PMC4526927 DOI: 10.2196/jmir.4476] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 04/29/2015] [Accepted: 05/24/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sleep issues such as insomnia affect over 50 million Americans and can lead to serious health problems, including depression and obesity, and can increase risk of injury. Social media platforms such as Twitter offer exciting potential for their use in studying and identifying both diseases and social phenomenon. OBJECTIVE Our aim was to determine whether social media can be used as a method to conduct research focusing on sleep issues. METHODS Twitter posts were collected and curated to determine whether a user exhibited signs of sleep issues based on the presence of several keywords in tweets such as insomnia, "can't sleep", Ambien, and others. Users whose tweets contain any of the keywords were designated as having self-identified sleep issues (sleep group). Users who did not have self-identified sleep issues (non-sleep group) were selected from tweets that did not contain pre-defined words or phrases used as a proxy for sleep issues. RESULTS User data such as number of tweets, friends, followers, and location were collected, as well as the time and date of tweets. Additionally, the sentiment of each tweet and average sentiment of each user were determined to investigate differences between non-sleep and sleep groups. It was found that sleep group users were significantly less active on Twitter (P=.04), had fewer friends (P<.001), and fewer followers (P<.001) compared to others, after adjusting for the length of time each user's account has been active. Sleep group users were more active during typical sleeping hours than others, which may suggest they were having difficulty sleeping. Sleep group users also had significantly lower sentiment in their tweets (P<.001), indicating a possible relationship between sleep and pyschosocial issues. CONCLUSIONS We have demonstrated a novel method for studying sleep issues that allows for fast, cost-effective, and customizable data to be gathered.
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Affiliation(s)
- David J McIver
- Boston Children's Hospital, Harvard Medical School, Boston, MA, United States.
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Chunara R, Goldstein E, Patterson-Lomba O, Brownstein JS. Estimating influenza attack rates in the United States using a participatory cohort. Sci Rep 2015; 5:9540. [PMID: 25835538 PMCID: PMC4894435 DOI: 10.1038/srep09540] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/09/2015] [Indexed: 11/09/2022] Open
Abstract
We considered how participatory syndromic surveillance data can be used to estimate influenza attack rates during the 2012-2013 and 2013-2014 seasons in the United States. Our inference is based on assessing the difference in the rates of self-reported influenza-like illness (ILI, defined as presence of fever and cough/sore throat) among the survey participants during periods of active vs. low influenza circulation as well as estimating the probability of self-reported ILI for influenza cases. Here, we combined Flu Near You data with additional sources (Hong Kong household studies of symptoms of influenza cases and the U.S. Centers for Disease Control and Prevention estimates of vaccine coverage and effectiveness) to estimate influenza attack rates. The estimated influenza attack rate for the early vaccinated Flu Near You members (vaccination reported by week 45) aged 20-64 between calendar weeks 47-12 was 14.7%(95% CI(5.9%,24.1%)) for the 2012-2013 season and 3.6%(-3.3%,10.3%) for the 2013-2014 season. The corresponding rates for the US population aged 20-64 were 30.5% (4.4%, 49.3%) in 2012-2013 and 7.1%(-5.1%, 32.5%) in 2013-2014. The attack rates in women and men were similar each season. Our findings demonstrate that participatory syndromic surveillance data can be used to gauge influenza attack rates during future influenza seasons.
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Affiliation(s)
- Rumi Chunara
- The Global Institute of Public Health, New york University and Computer science &Engineering, New york University
| | - Edward Goldstein
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Oscar Patterson-Lomba
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - John S Brownstein
- 1] Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America [2] Informatics Program, Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, United States of America
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Nagar R, Yuan Q, Freifeld CC, Santillana M, Nojima A, Chunara R, Brownstein JS. A case study of the New York City 2012-2013 influenza season with daily geocoded Twitter data from temporal and spatiotemporal perspectives. J Med Internet Res 2014; 16:e236. [PMID: 25331122 PMCID: PMC4259880 DOI: 10.2196/jmir.3416] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 08/08/2014] [Accepted: 08/30/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Twitter has shown some usefulness in predicting influenza cases on a weekly basis in multiple countries and on different geographic scales. Recently, Broniatowski and colleagues suggested Twitter's relevance at the city-level for New York City. Here, we look to dive deeper into the case of New York City by analyzing daily Twitter data from temporal and spatiotemporal perspectives. Also, through manual coding of all tweets, we look to gain qualitative insights that can help direct future automated searches. OBJECTIVE The intent of the study was first to validate the temporal predictive strength of daily Twitter data for influenza-like illness emergency department (ILI-ED) visits during the New York City 2012-2013 influenza season against other available and established datasets (Google search query, or GSQ), and second, to examine the spatial distribution and the spread of geocoded tweets as proxies for potential cases. METHODS From the Twitter Streaming API, 2972 tweets were collected in the New York City region matching the keywords "flu", "influenza", "gripe", and "high fever". The tweets were categorized according to the scheme developed by Lamb et al. A new fourth category was added as an evaluator guess for the probability of the subject(s) being sick to account for strength of confidence in the validity of the statement. Temporal correlations were made for tweets against daily ILI-ED visits and daily GSQ volume. The best models were used for linear regression for forecasting ILI visits. A weighted, retrospective Poisson model with SaTScan software (n=1484), and vector map were used for spatiotemporal analysis. RESULTS Infection-related tweets (R=.763) correlated better than GSQ time series (R=.683) for the same keywords and had a lower mean average percent error (8.4 vs 11.8) for ILI-ED visit prediction in January, the most volatile month of flu. SaTScan identified primary outbreak cluster of high-probability infection tweets with a 2.74 relative risk ratio compared to medium-probability infection tweets at P=.001 in Northern Brooklyn, in a radius that includes Barclay's Center and the Atlantic Avenue Terminal. CONCLUSIONS While others have looked at weekly regional tweets, this study is the first to stress test Twitter for daily city-level data for New York City. Extraction of personal testimonies of infection-related tweets suggests Twitter's strength both qualitatively and quantitatively for ILI-ED prediction compared to alternative daily datasets mixed with awareness-based data such as GSQ. Additionally, granular Twitter data provide important spatiotemporal insights. A tweet vector-map may be useful for visualization of city-level spread when local gold standard data are otherwise unavailable.
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Affiliation(s)
- Ruchit Nagar
- Children's Hospital Informatics Program, Boston Children's Hospital, Boston, MA, United States.
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41
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Abstract
Adolescents are developmentally sensitive to pathways that influence alcohol and other drug (AOD) use. In the absence of guidance, their routine engagement with social media may add a further layer of risk. There are several potential mechanisms for social media use to influence AOD risk, including exposure to peer portrayals of AOD use, socially amplified advertising, misinformation, and predatory marketing against a backdrop of lax regulatory systems and privacy controls. Here the authors summarize the influences of the social media world and suggest how pediatricians in everyday practice can alert youth and their parents to these risks to foster conversation, awareness, and harm reduction.
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Wójcik OP, Brownstein JS, Chunara R, Johansson MA. Public health for the people: participatory infectious disease surveillance in the digital age. Emerg Themes Epidemiol 2014; 11:7. [PMID: 24991229 PMCID: PMC4078360 DOI: 10.1186/1742-7622-11-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 06/09/2014] [Indexed: 11/20/2022] Open
Abstract
The 21st century has seen the rise of Internet-based participatory surveillance systems for infectious diseases. These systems capture voluntarily submitted symptom data from the general public and can aggregate and communicate that data in near real-time. We reviewed participatory surveillance systems currently running in 13 different countries. These systems have a growing evidence base showing a high degree of accuracy and increased sensitivity and timeliness relative to traditional healthcare-based systems. They have also proven useful for assessing risk factors, vaccine effectiveness, and patterns of healthcare utilization while being less expensive, more flexible, and more scalable than traditional systems. Nonetheless, they present important challenges including biases associated with the population that chooses to participate, difficulty in adjusting for confounders, and limited specificity because of reliance only on syndromic definitions of disease limits. Overall, participatory disease surveillance data provides unique disease information that is not available through traditional surveillance sources.
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Affiliation(s)
- Oktawia P Wójcik
- Harvard Medical School and Boston Children's Hospital, 1 Autumn St., Boston, MA 02215, USA
| | - John S Brownstein
- Harvard Medical School and Boston Children's Hospital, 1 Autumn St., Boston, MA 02215, USA
| | - Rumi Chunara
- Harvard Medical School and Boston Children's Hospital, 1 Autumn St., Boston, MA 02215, USA
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Abstract
Background Internet search query trends have been shown to correlate with incidence trends for select infectious diseases and countries. Herein, the first use of Google search queries for malaria surveillance is investigated. The research focuses on Thailand where real-time malaria surveillance is crucial as malaria is re-emerging and developing resistance to pharmaceuticals in the region. Methods Official Thai malaria case data was acquired from the World Health Organization (WHO) from 2005 to 2009. Using Google correlate, an openly available online tool, and by surveying Thai physicians, search queries potentially related to malaria prevalence were identified. Four linear regression models were built from different sub-sets of malaria-related queries to be used in future predictions. The models’ accuracies were evaluated by their ability to predict the malaria outbreak in 2009, their correlation with the entire available malaria case data, and by Akaike information criterion (AIC). Results Each model captured the bulk of the variability in officially reported malaria incidence. Correlation in the validation set ranged from 0.75 to 0.92 and AIC values ranged from 808 to 586 for the models. While models using malaria-related and general health terms were successful, one model using only microscopy-related terms obtained equally high correlations to malaria case data trends. The model built strictly of queries provided by Thai physicians was the only one that consistently captured the well-documented second seasonal malaria peak in Thailand. Conclusions Models built from Google search queries were able to adequately estimate malaria activity trends in Thailand, from 2005–2010, according to official malaria case counts reported by WHO. While presenting their own limitations, these search queries may be valid real-time indicators of malaria incidence in the population, as correlations were on par with those of related studies for other infectious diseases. Additionally, this methodology provides a cost-effective description of malaria prevalence that can act as a complement to traditional public health surveillance. This and future studies will continue to identify ways to leverage web-based data to improve public health.
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44
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Abstract
In infectious disease surveillance, public health data such as environmental, hospital, or census data have been extensively explored to create robust models of disease dynamics. However, this information is also subject to its own biases, including latency, high cost, contributor biases, and imprecise resolution. Simultaneously, new technologies including Internet and mobile phone based tools, now enable information to be garnered directly from individuals at the point of care. Here, we consider how these crowdsourced data offer the opportunity to fill gaps in and augment current epidemiological models. Challenges and methods for overcoming limitations of the data are also reviewed. As more new information sources become mature, incorporating these novel data into epidemiological frameworks will enable us to learn more about infectious disease dynamics.
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Affiliation(s)
- Rumi Chunara
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA,
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45
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Abstract
Immediately following the Boston Marathon attacks, individuals near the scene posted a deluge of data to social media sites. Previous work has shown that these data can be leveraged to provide rapid insight during natural disasters, disease outbreaks and ongoing conflicts that can assist in the public health and medical response. Here, we examine and discuss the social media messages posted immediately after and around the Boston Marathon bombings, and find that specific keywords appear frequently prior to official public safety and news media reports. Individuals immediately adjacent to the explosions posted messages within minutes via Twitter which identify the location and specifics of events, demonstrating a role for social media in the early recognition and characterization of emergency events.
*Christopher Cassa and Rumi Chunara contributed equally to this work.
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Chunara R, Aman S, Smolinski M, Brownstein JS. Flu Near You: An Online Self-reported Influenza Surveillance System in the USA. Online J Public Health Inform 2013. [PMCID: PMC3692780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objective Introduction Methods Results Conclusions
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Affiliation(s)
- Rumi Chunara
- Harvard Medical School, Boston, MA, USA;,Boston Children’s Hospital, Boston, MA, USA;,Rumi Chunara, E-mail:
| | - Susan Aman
- Boston Children’s Hospital, Boston, MA, USA
| | | | - John S. Brownstein
- Harvard Medical School, Boston, MA, USA;,Boston Children’s Hospital, Boston, MA, USA
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47
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Chunara R, Andrews JR, Brownstein JS. Social and news media enable estimation of epidemiological patterns early in the 2010 Haitian cholera outbreak. Am J Trop Med Hyg 2012; 86:39-45. [PMID: 22232449 DOI: 10.4269/ajtmh.2012.11-0597] [Citation(s) in RCA: 186] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
During infectious disease outbreaks, data collected through health institutions and official reporting structures may not be available for weeks, hindering early epidemiologic assessment. By contrast, data from informal media are typically available in near real-time and could provide earlier estimates of epidemic dynamics. We assessed correlation of volume of cholera-related HealthMap news media reports, Twitter postings, and government cholera cases reported in the first 100 days of the 2010 Haitian cholera outbreak. Trends in volume of informal sources significantly correlated in time with official case data and was available up to 2 weeks earlier. Estimates of the reproductive number ranged from 1.54 to 6.89 (informal sources) and 1.27 to 3.72 (official sources) during the initial outbreak growth period, and 1.04 to 1.51 (informal) and 1.06 to 1.73 (official) when Hurricane Tomas afflicted Haiti. Informal data can be used complementarily with official data in an outbreak setting to get timely estimates of disease dynamics.
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Affiliation(s)
- Rumi Chunara
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
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48
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Chunara R, Chhaya V, Bane S, Mekaru SR, Chan EH, Freifeld CC, Brownstein JS. Online reporting for malaria surveillance using micro-monetary incentives, in urban India 2010-2011. Malar J 2012; 11:43. [PMID: 22330227 PMCID: PMC3305483 DOI: 10.1186/1475-2875-11-43] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 02/13/2012] [Indexed: 11/16/2022] Open
Abstract
Background The objective of this study was to investigate the use of novel surveillance tools in a malaria endemic region where prevalence information is limited. Specifically, online reporting for participatory epidemiology was used to gather information about malaria spread directly from the public. Individuals in India were incentivized to self-report their recent experience with malaria by micro-monetary payments. Methods Self-reports about malaria diagnosis status and related information were solicited online via Amazon's Mechanical Turk. Responders were paid $0.02 to answer survey questions regarding their recent experience with malaria. Timing of the peak volume of weekly self-reported malaria diagnosis in 2010 was compared to other available metrics such as the volume over time of and information about the epidemic from media sources. Distribution of Plasmodium species reports were compared with values from the literature. The study was conducted in summer 2010 during a malaria outbreak in Mumbai and expanded to other cities during summer 2011, and prevalence from self-reports in 2010 and 2011 was contrasted. Results Distribution of Plasmodium species diagnosis through self-report in 2010 revealed 59% for Plasmodium vivax, which is comparable to literature reports of the burden of P. vivax in India (between 50 and 69%). Self-reported Plasmodium falciparum diagnosis was 19% and during the 2010 outbreak and the estimated burden was between 10 and 15%. Prevalence between 2010 and 2011 via self-reports decreased significantly from 36.9% to 19.54% in Mumbai (p = 0.001), and official reports also confirmed a prevalence decrease in 2011. Conclusions With careful study design, micro-monetary incentives and online reporting are a rapid way to solicit malaria, and potentially other public health information. This methodology provides a cost-effective way of executing a field study that can act as a complement to traditional public health surveillance methods, offering an opportunity to obtain information about malaria activity, temporal progression, demographics affected or Plasmodium-specific diagnosis at a finer resolution than official reports can provide. The recent adoption of technologies, such as the Internet supports self-reporting mediums, and self-reporting should continue to be studied as it can foster preventative health behaviours.
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Affiliation(s)
- Rumi Chunara
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
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49
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Abstract
Tiffany Bogich and colleagues find that breakdown or absence of public health infrastructure is most often the driver in pandemic outbreaks, whose prevention requires mainstream development funding rather than emergency funding.
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Affiliation(s)
- Tiffany L. Bogich
- Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
- Princeton University, Dept of Ecology & Evolutionary Biology, Princeton, New Jersey, United States of America
- EcoHealth Alliance, New York, New York, United States of America
- * E-mail: (TB); (JB)
| | - Rumi Chunara
- Children's Hospital Informatics Program, Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, United States of America
- Harvard Medical School, Department of Pediatrics, Boston, Massachusetts, United States of America
| | - David Scales
- Children's Hospital Informatics Program, Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, United States of America
- Harvard Medical School, Department of Pediatrics, Boston, Massachusetts, United States of America
| | - Emily Chan
- Children's Hospital Informatics Program, Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, United States of America
- Harvard Medical School, Department of Pediatrics, Boston, Massachusetts, United States of America
| | - Laura C. Pinheiro
- Children's Hospital Informatics Program, Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, United States of America
- Harvard Medical School, Department of Pediatrics, Boston, Massachusetts, United States of America
| | | | - Dennis Carroll
- Global Health Program, United States Agency for International Development (USAID), Washington (D.C.), United States of America
| | - Peter Daszak
- EcoHealth Alliance, New York, New York, United States of America
| | - John S. Brownstein
- Children's Hospital Informatics Program, Division of Emergency Medicine, Children's Hospital Boston, Boston, Massachusetts, United States of America
- Harvard Medical School, Department of Pediatrics, Boston, Massachusetts, United States of America
- * E-mail: (TB); (JB)
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Chunara R, Goetzke M, Brownstein J. Do geographic trends of social media indicate risk of secondary infectious disease outbreaks? Emerging Health Threats Journal 2011. [DOI: 10.3402/ehtj.v4i0.11110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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