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Honerlaw J, Ho YL, Fontin F, Murray M, Galloway A, Heise D, Connatser K, Davies L, Gosian J, Maripuri M, Russo J, Sangar R, Tanukonda V, Zielinski E, Dubreuil M, Zimolzak AJ, Panickan VA, Cheng SC, Whitbourne SB, Gagnon DR, Cai T, Liao KP, Ramoni RB, Gaziano JM, Muralidhar S, Cho K. Centralized Interactive Phenomics Resource: an integrated online phenomics knowledgebase for health data users. J Am Med Inform Assoc 2024; 31:1126-1134. [PMID: 38481028 PMCID: PMC11031216 DOI: 10.1093/jamia/ocae042] [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] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/21/2024] [Indexed: 04/21/2024] Open
Abstract
OBJECTIVE Development of clinical phenotypes from electronic health records (EHRs) can be resource intensive. Several phenotype libraries have been created to facilitate reuse of definitions. However, these platforms vary in target audience and utility. We describe the development of the Centralized Interactive Phenomics Resource (CIPHER) knowledgebase, a comprehensive public-facing phenotype library, which aims to facilitate clinical and health services research. MATERIALS AND METHODS The platform was designed to collect and catalog EHR-based computable phenotype algorithms from any healthcare system, scale metadata management, facilitate phenotype discovery, and allow for integration of tools and user workflows. Phenomics experts were engaged in the development and testing of the site. RESULTS The knowledgebase stores phenotype metadata using the CIPHER standard, and definitions are accessible through complex searching. Phenotypes are contributed to the knowledgebase via webform, allowing metadata validation. Data visualization tools linking to the knowledgebase enhance user interaction with content and accelerate phenotype development. DISCUSSION The CIPHER knowledgebase was developed in the largest healthcare system in the United States and piloted with external partners. The design of the CIPHER website supports a variety of front-end tools and features to facilitate phenotype development and reuse. Health data users are encouraged to contribute their algorithms to the knowledgebase for wider dissemination to the research community, and to use the platform as a springboard for phenotyping. CONCLUSION CIPHER is a public resource for all health data users available at https://phenomics.va.ornl.gov/ which facilitates phenotype reuse, development, and dissemination of phenotyping knowledge.
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Affiliation(s)
- Jacqueline Honerlaw
- Centralized Interactive Phenomics Resource (CIPHER), Office of Research and Development, Veterans Health Administration, Washington, DC 20002, United States
- VA Boston Healthcare System, Boston, MA 02111, United States
| | - Yuk-Lam Ho
- Centralized Interactive Phenomics Resource (CIPHER), Office of Research and Development, Veterans Health Administration, Washington, DC 20002, United States
- VA Boston Healthcare System, Boston, MA 02111, United States
| | - Francesca Fontin
- Centralized Interactive Phenomics Resource (CIPHER), Office of Research and Development, Veterans Health Administration, Washington, DC 20002, United States
- VA Boston Healthcare System, Boston, MA 02111, United States
| | - Michael Murray
- Centralized Interactive Phenomics Resource (CIPHER), Office of Research and Development, Veterans Health Administration, Washington, DC 20002, United States
- VA Boston Healthcare System, Boston, MA 02111, United States
| | - Ashley Galloway
- Centralized Interactive Phenomics Resource (CIPHER), Office of Research and Development, Veterans Health Administration, Washington, DC 20002, United States
- VA Boston Healthcare System, Boston, MA 02111, United States
| | - David Heise
- Oak Ridge National Laboratory (ORNL), Oak Ridge, TN 37830, United States
| | - Keith Connatser
- Oak Ridge National Laboratory (ORNL), Oak Ridge, TN 37830, United States
| | - Laura Davies
- Oak Ridge National Laboratory (ORNL), Oak Ridge, TN 37830, United States
| | - Jeffrey Gosian
- Centralized Interactive Phenomics Resource (CIPHER), Office of Research and Development, Veterans Health Administration, Washington, DC 20002, United States
- VA Boston Healthcare System, Boston, MA 02111, United States
| | - Monika Maripuri
- Centralized Interactive Phenomics Resource (CIPHER), Office of Research and Development, Veterans Health Administration, Washington, DC 20002, United States
- VA Boston Healthcare System, Boston, MA 02111, United States
| | - John Russo
- Centralized Interactive Phenomics Resource (CIPHER), Office of Research and Development, Veterans Health Administration, Washington, DC 20002, United States
- VA Boston Healthcare System, Boston, MA 02111, United States
- Department of Computer Science, Landmark College, Putney, VT 05346, United States
| | - Rahul Sangar
- Centralized Interactive Phenomics Resource (CIPHER), Office of Research and Development, Veterans Health Administration, Washington, DC 20002, United States
- VA Boston Healthcare System, Boston, MA 02111, United States
| | - Vidisha Tanukonda
- Centralized Interactive Phenomics Resource (CIPHER), Office of Research and Development, Veterans Health Administration, Washington, DC 20002, United States
- VA Atlanta Healthcare System, Decatur, GA 30033, United States
| | - Edward Zielinski
- Centralized Interactive Phenomics Resource (CIPHER), Office of Research and Development, Veterans Health Administration, Washington, DC 20002, United States
- VA Boston Healthcare System, Boston, MA 02111, United States
| | - Maureen Dubreuil
- VA Boston Healthcare System, Boston, MA 02111, United States
- Section of Rheumatology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, United States
| | - Andrew J Zimolzak
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX 77030, United States
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, United States
| | - Vidul A Panickan
- VA Boston Healthcare System, Boston, MA 02111, United States
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA 02115, United States
| | - Su-Chun Cheng
- VA Boston Healthcare System, Boston, MA 02111, United States
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA 02115, United States
| | - Stacey B Whitbourne
- VA Boston Healthcare System, Boston, MA 02111, United States
- Million Veteran Program (MVP) Coordinating Center, VA Boston, Boston, MA 02111, United States
- Division of Aging, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, United States
- Department of Medicine, Harvard Medical School, Boston, MA 02115, United States
| | - David R Gagnon
- VA Boston Healthcare System, Boston, MA 02111, United States
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, United States
| | - Tianxi Cai
- VA Boston Healthcare System, Boston, MA 02111, United States
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA 02115, United States
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA 02115, United States
| | - Katherine P Liao
- VA Boston Healthcare System, Boston, MA 02111, United States
- Department of Medicine, Harvard Medical School, Boston, MA 02115, United States
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, MA 02115, United States
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA 02115, United States
| | - Rachel B Ramoni
- Office of Research and Development, Veterans Health Administration, Washington, DC 20002, United States
| | - J Michael Gaziano
- VA Boston Healthcare System, Boston, MA 02111, United States
- Million Veteran Program (MVP) Coordinating Center, VA Boston, Boston, MA 02111, United States
- Division of Aging, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, United States
- Department of Medicine, Harvard Medical School, Boston, MA 02115, United States
| | - Sumitra Muralidhar
- Office of Research and Development, Veterans Health Administration, Washington, DC 20002, United States
| | - Kelly Cho
- Centralized Interactive Phenomics Resource (CIPHER), Office of Research and Development, Veterans Health Administration, Washington, DC 20002, United States
- VA Boston Healthcare System, Boston, MA 02111, United States
- Million Veteran Program (MVP) Coordinating Center, VA Boston, Boston, MA 02111, United States
- Division of Aging, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, United States
- Department of Medicine, Harvard Medical School, Boston, MA 02115, United States
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Brunette CA, Yi T, Danowski ME, Cardellino M, Harrison A, Assimes TL, Knowles JW, Christensen KD, Sturm AC, Sun YV, Hui Q, Pyarajan S, Shi Y, Whitbourne SB, Gaziano JM, Muralidhar S, Vassy JL. Development and utility of a clinical research informatics application for participant recruitment and workflow management for a return of results pilot trial in familial hypercholesterolemia in the Million Veteran Program. JAMIA Open 2024; 7:ooae020. [PMID: 38464744 PMCID: PMC10923213 DOI: 10.1093/jamiaopen/ooae020] [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: 03/10/2023] [Revised: 06/26/2023] [Accepted: 02/14/2024] [Indexed: 03/12/2024] Open
Abstract
Objective The development of clinical research informatics tools and workflow processes associated with re-engaging biobank participants has become necessary as genomic repositories increasingly consider the return of actionable research results. Materials and Methods Here we describe the development and utility of an informatics application for participant recruitment and enrollment management for the Veterans Affairs Million Veteran Program Return Of Actionable Results Study, a randomized controlled pilot trial returning individual genetic results associated with familial hypercholesterolemia. Results The application is developed in Python-Flask and was placed into production in November 2021. The application includes modules for chart review, medication reconciliation, participant contact and biospecimen logging, survey recording, randomization, and documentation of genetic counseling and result disclosure. Three primary users, a genetic counselor and two research coordinators, and 326 Veteran participants have been integrated into the system as of February 23, 2023. The application has successfully handled 3367 task requests involving greater than 95 000 structured data points. Specifically, application users have recorded 326 chart reviews, 867 recruitment telephone calls, 158 telephone-based surveys, and 61 return of results genetic counseling sessions, among other available study tasks. Conclusion The development of usable, customizable, and secure informatics tools will become increasingly important as large genomic repositories begin to return research results at scale. Our work provides a proof-of-concept for developing and using such tools to aid in managing the return of results process within a national biobank.
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Affiliation(s)
- Charles A Brunette
- Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Thomas Yi
- Veterans Affairs Boston Healthcare System, Boston, MA, United States
| | - Morgan E Danowski
- Veterans Affairs Boston Healthcare System, Boston, MA, United States
| | - Mark Cardellino
- Veterans Affairs Boston Healthcare System, Boston, MA, United States
| | - Alicia Harrison
- Genetic Counseling Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Themistocles L Assimes
- VA Palo Alto Health Care System, Palo Alto, CA, United States
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Stanford Cardiovascular Institute, Stanford University, Palo Alto, CA, United States
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Joshua W Knowles
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Stanford Cardiovascular Institute, Stanford University, Palo Alto, CA, United States
- Family Heart Foundation, Pasadena, CA, United States
| | - Kurt D Christensen
- PRecisiOn Medicine Translational Research (PROMoTeR) Center, Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA, United States
- Department of Population Medicine, Harvard Medical School, Boston, MA, United States
| | | | - Yan V Sun
- Atlanta VA Health Care System, Decatur, GA, United States
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Qin Hui
- Atlanta VA Health Care System, Decatur, GA, United States
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Saiju Pyarajan
- Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Yunling Shi
- Veterans Affairs Boston Healthcare System, Boston, MA, United States
| | - Stacey B Whitbourne
- Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Division of Aging, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - J Michael Gaziano
- Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Division of Aging, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Sumitra Muralidhar
- Office of Research and Development, Veterans Health Administration, Washington, DC, United States
| | - Jason L Vassy
- Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, United States
- Population Precision Health, Ariadne Labs, Boston, MA, United States
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3
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Nguyen XMT, Li Y, Ivey KL, Whitbourne SB, Willett WC, Hu FB, Cho K, Gaziano M, Djousse L. Data resource profile: nutrition data in the VA million veteran program. Int J Popul Data Sci 2024; 8:2366. [PMID: 38476344 PMCID: PMC10930149 DOI: 10.23889/ijpds.v8i6.2366] [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: 03/14/2024] Open
Abstract
Introduction The Department of Veterans Affairs (VA) Million Veteran Program (MVP) nutrition data is derived from dietary food/beverage intake information collected through a semiquantitative food frequency questionnaire (SFFQ). Methods Estimates of dietary energy, nutrient, and non-nutritive food components intakes data were derived from an extensively validated SFFQ, which assessed the habitual frequency of consumption of 61 food items, added sugar, fried food frequency, and 21 nutritional supplements over the 12 months preceding questionnaire administration. Results Complete nutrition data was available for 353,418 MVP participants as of 30th September 2021. Overall, 91.5% of MVP participants with nutrition data were male with an average age of 65.7 years at enrollment. Participants who completed the SFFQ were primarily White (82.5%), and Blacks accounted for 13.2% of the responders. Mean ± SD energy intake for 353, 418 MVP participants was 1428 ± 616 kcal/day, which was 1434 ± 617 kcal/day for males and 1364 ± 601 kcal/day for females. Energy intake and information on 322 nutrients and non-nutritive food components is available through contact with MVP for research collaborations at www.research.va.gov/mvp. Conclusions The energy and nutrient data derived from MVP SFFQ are an invaluable resource for Veteran health and research. In conjunction with the MVP Lifestyle Survey, electronic health records, and genomic data, MVP nutrition data may be used to assess nutritional status and related risk factors, disease prevalence, and determinants of health that can provide scientific support for the development of evidence-based public health policy and health promotion programs and services for Veterans and general population.
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Affiliation(s)
- Xuan-Mai T. Nguyen
- Million Veteran Program Boston Coordinating Center, VA Boston Healthcare System, Boston, MA 02111, USA
- Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL 61820, USA
| | - Yanping Li
- Million Veteran Program Boston Coordinating Center, VA Boston Healthcare System, Boston, MA 02111, USA
- Harvard T.H. Chan School of Public Health, Department of Nutrition, Boston, MA 02115, USA
| | - Kerry L. Ivey
- Million Veteran Program Boston Coordinating Center, VA Boston Healthcare System, Boston, MA 02111, USA
- Harvard T.H. Chan School of Public Health, Department of Nutrition, Boston, MA 02115, USA
| | - Stacey B. Whitbourne
- Million Veteran Program Boston Coordinating Center, VA Boston Healthcare System, Boston, MA 02111, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Walter C. Willett
- Harvard T.H. Chan School of Public Health, Department of Nutrition, Boston, MA 02115, USA
| | - Frank B. Hu
- Harvard T.H. Chan School of Public Health, Department of Nutrition, Boston, MA 02115, USA
| | - Kelly Cho
- Million Veteran Program Boston Coordinating Center, VA Boston Healthcare System, Boston, MA 02111, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Michael Gaziano
- Million Veteran Program Boston Coordinating Center, VA Boston Healthcare System, Boston, MA 02111, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Luc Djousse
- Million Veteran Program Boston Coordinating Center, VA Boston Healthcare System, Boston, MA 02111, USA
- Harvard T.H. Chan School of Public Health, Department of Nutrition, Boston, MA 02115, USA
- Department of Medicine, Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA 02130, USA
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4
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Harrington KM, Quaden R, Steele L, Helmer DA, Hauser ER, Ahmed ST, Aslan M, Radhakrishnan K, Honerlaw J, Nguyen XMT, Muralidhar S, Concato J, Cho K, Gaziano JM, Whitbourne SB. The Million Veteran Program 1990-1991 Gulf War Era Survey: An Evaluation of Veteran Response, Characteristics, and Representativeness of the Gulf War Era Veteran Population. Int J Environ Res Public Health 2024; 21:72. [PMID: 38248536 PMCID: PMC10815483 DOI: 10.3390/ijerph21010072] [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] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/22/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024]
Abstract
To address gaps in understanding the pathophysiology of Gulf War Illness (GWI), the VA Million Veteran Program (MVP) developed and implemented a survey to MVP enrollees who served in the U.S. military during the 1990-1991 Persian Gulf War (GW). Eligible Veterans were invited via mail to complete a survey assessing health conditions as well as GW-specific deployment characteristics and exposures. We evaluated the representativeness of this GW-era cohort relative to the broader population by comparing demographic, military, and health characteristics between respondents and non-respondents, as well as with all GW-era Veterans who have used Veterans Health Administration (VHA) services and the full population of U.S. GW-deployed Veterans. A total of 109,976 MVP GW-era Veterans were invited to participate and 45,270 (41%) returned a completed survey. Respondents were 84% male, 72% White, 8% Hispanic, with a mean age of 61.6 years (SD = 8.5). Respondents were more likely to be older, White, married, better educated, slightly healthier, and have higher socioeconomic status than non-respondents, but reported similar medical conditions and comparable health status. Although generally similar to all GW-era Veterans using VHA services and the full population of U.S. GW Veterans, respondents included higher proportions of women and military officers, and were slightly older. In conclusion, sample characteristics of the MVP GW-era cohort can be considered generally representative of the broader GW-era Veteran population. The sample represents the largest research cohort of GW-era Veterans established to date and provides a uniquely valuable resource for conducting in-depth studies to evaluate health conditions affecting 1990-1991 GW-era Veterans.
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Affiliation(s)
- Kelly M. Harrington
- Million Veteran Program (MVP) Coordinating Center, VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (J.H.); (X.-M.T.N.); (K.C.); (J.M.G.); (S.B.W.)
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| | - Rachel Quaden
- Million Veteran Program (MVP) Coordinating Center, VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (J.H.); (X.-M.T.N.); (K.C.); (J.M.G.); (S.B.W.)
| | - Lea Steele
- Veterans Health Research Program, Yudofsky Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Drew A. Helmer
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; (D.A.H.); (S.T.A.)
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Elizabeth R. Hauser
- VA Cooperative Studies Program Epidemiology Center-Durham, Department of Veterans Affairs, Durham, NC 27705, USA;
- Department of Biostatistics and Bioinformatics, Duke Molecular Physiology Institute, Duke University, Durham, NC 27705, USA
| | - Sarah T. Ahmed
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA; (D.A.H.); (S.T.A.)
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
| | - Mihaela Aslan
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (M.A.)
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06511, USA;
| | - Krishnan Radhakrishnan
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (M.A.)
- National Mental Health and Substance Use Policy Laboratory, Substance Abuse and Mental Health Services Administration, Rockville, MD 20857, USA
| | - Jacqueline Honerlaw
- Million Veteran Program (MVP) Coordinating Center, VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (J.H.); (X.-M.T.N.); (K.C.); (J.M.G.); (S.B.W.)
| | - Xuan-Mai T. Nguyen
- Million Veteran Program (MVP) Coordinating Center, VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (J.H.); (X.-M.T.N.); (K.C.); (J.M.G.); (S.B.W.)
- Carle Illinois College of Medicine, University of Illinois, Champaign, IL 61820, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Sumitra Muralidhar
- Office of Research and Development, Veterans Health Administration, Washington, DC 20420, USA;
| | - John Concato
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06511, USA;
- Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Kelly Cho
- Million Veteran Program (MVP) Coordinating Center, VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (J.H.); (X.-M.T.N.); (K.C.); (J.M.G.); (S.B.W.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Division of Aging, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - J. Michael Gaziano
- Million Veteran Program (MVP) Coordinating Center, VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (J.H.); (X.-M.T.N.); (K.C.); (J.M.G.); (S.B.W.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Division of Aging, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Stacey B. Whitbourne
- Million Veteran Program (MVP) Coordinating Center, VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (J.H.); (X.-M.T.N.); (K.C.); (J.M.G.); (S.B.W.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Division of Aging, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA
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5
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Nguyen XMT, Li Y, Wang DD, Whitbourne SB, Houghton SC, Hu FB, Willett WC, Sun YV, Djousse L, Gaziano JM, Cho K, Wilson PW. Impact of 8 lifestyle factors on mortality and life expectancy among United States veterans: The Million Veteran Program. Am J Clin Nutr 2024; 119:127-135. [PMID: 38065710 DOI: 10.1016/j.ajcnut.2023.10.032] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/26/2023] [Accepted: 10/31/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Lifestyle medicine has been proposed as a way to address the root causes of chronic disease and their associated health care costs. OBJECTIVE This study aimed to estimate mortality risk and longevity associated with individual lifestyle factors and comprehensive lifestyle therapy. METHODS Age- and sex-specific mortality rates were calculated on the basis of 719,147 veterans aged 40-99 y enrolled in the Veteran Affairs Million Veteran Program (2011-2019). Hazard ratios and estimated increase in life expectancy were examined among a subgroup of 276,132 veterans with complete data on 8 lifestyle factors at baseline. The 8 lifestyle factors included never smoking, physical activity, no excessive alcohol consumption, restorative sleep, nutrition, stress management, social connections, and no opioid use disorder. RESULTS On the basis of 1.12 million person-years of follow-up, 34,247 deaths were recorded. Among veterans who adopted 1, 2, 3, 4, 5, 6, 7, and 8 lifestyle factors, the adjusted hazard ratios for mortality were 0.74 (0.60-0.90), 0.60 (95% CI: 0.49, 0.73), 0.50 (95% CI: 0.41, 0.61), 0.43 (95% CI: 0.35, 0.52), 0.35 (95% CI: 0.29, 0.43), 0.27 (95% CI: 0.22, 0.33), 0.21 (95% CI: 0.17, 0.26), and 0.13 (95% CI: 0.10, 0.16), respectively, as compared with veterans with no adopted lifestyle factors. The estimated life expectancy at age 40 y was 23.0, 26.5, 28.8, 30.8, 32.7, 35.1, 38.3, 41.3, and 47.0 y among males and 27.0, 28.8, 33.1, 38.0, 39.2, 41.4, 43.8, 46.3, and 47.5 y for females who adopted 0, 1, 2, 3, 4, 5, 6, 7, and 8 lifestyle factors, respectively. The difference in life expectancy at age 40 y was 24.0 y for male veterans and 20.5 y for female veterans when comparing adoption of 8-9 lifestyle factors. CONCLUSIONS A combination of 8 lifestyle factors is associated with a significantly lower risk of premature mortality and an estimated prolonged life expectancy.
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Affiliation(s)
- Xuan-Mai T Nguyen
- Million Veteran Program Boston Coordinating Center, VA Boston Healthcare System, Boston, MA 02111, United States; Carle Illinois College of Medicine, University of Illinois Urbana Champaign, Champaign, IL, United States
| | - Yanping Li
- Million Veteran Program Boston Coordinating Center, VA Boston Healthcare System, Boston, MA 02111, United States; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States.
| | - Dong D Wang
- Million Veteran Program Boston Coordinating Center, VA Boston Healthcare System, Boston, MA 02111, United States; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States; The Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Stacey B Whitbourne
- Million Veteran Program Boston Coordinating Center, VA Boston Healthcare System, Boston, MA 02111, United States; Division of Aging, Brigham and Women's Hospital, Boston, MA, United States; Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Serena C Houghton
- Million Veteran Program Boston Coordinating Center, VA Boston Healthcare System, Boston, MA 02111, United States
| | - Frank B Hu
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States; The Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Walter C Willett
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Yan V Sun
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Department of Medicine, Atlanta VA Health Care System, Decatur, GA 30033, United States
| | - Luc Djousse
- Million Veteran Program Boston Coordinating Center, VA Boston Healthcare System, Boston, MA 02111, United States; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States; Division of Aging, Brigham and Women's Hospital, Boston, MA, United States; Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - John Michael Gaziano
- Million Veteran Program Boston Coordinating Center, VA Boston Healthcare System, Boston, MA 02111, United States; Division of Aging, Brigham and Women's Hospital, Boston, MA, United States; Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Kelly Cho
- Million Veteran Program Boston Coordinating Center, VA Boston Healthcare System, Boston, MA 02111, United States; Division of Aging, Brigham and Women's Hospital, Boston, MA, United States; Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Peter Wf Wilson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States; Department of Medicine, Atlanta VA Health Care System, Decatur, GA 30033, United States; Cardiology Division, Emory Clinical Cardiovascular Research Institute, Atlanta, GA 30033, United States
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Whitbourne SB, Moser J, Cho K, Deen J, Churby LL, Justice AC, Casas JP, Pyarajan S, Tsao PS, Gaziano JM, Muralidhar S. Leveraging the Million Veteran Program Infrastructure and Data for a Rapid Research Response to COVID-19. Fed Pract 2023; 40:S23-S28. [PMID: 38577307 PMCID: PMC10988626 DOI: 10.12788/fp.0416] [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] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Background The Veterans Health Administration Office of Research and Development (ORD) played a key role in the federal government's response to the COVID-19 pandemic. The ORD effectively leveraged existing resources to answer questions related to the SARS-CoV-2 virus and COVID-19. Observations When the COVID-19 pandemic hit in 2020, the Million Veteran Program (MVP), one of the largest genomic cohorts in the world, extended the centralized recruitment and enrollment infrastructure to develop a COVID-19 research volunteer registry to assist enrollment in the vaccine and treatment trials in which the US Department of Veterans Affairs (VA) participated. In addition, the MVP allowed for new data collection and a large genomic cohort to understand host contributions to COVID-19. This article describes ways the MVP contributed to the VA's rapid research response to COVID-19. Several host genetic factors believed to play a role in the development and severity of COVID-19 were identified. Furthermore, existing MVP partnerships with other federal agencies, particularly with the Department of Energy, were leveraged to improve understanding and management of COVID-19. Conclusions A previously established enterprise approach and research infrastructure were essential to the VA's successful and timely COVID-19 research response. This infrastructure not only supported rapid recruitment in vaccine and treatment trials, but also leveraged the unique MVP and VA electronic health record data to drive rapid scientific discovery and inform clinical operations. Extending the models that VA research applied to the federal government at large and establishing centralized resources for shared or federated data analyses across federal agencies will better equip the nation to respond to future public health crises.
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Affiliation(s)
- Stacey B. Whitbourne
- Veterans Affairs Boston Healthcare System, Massachusetts
- Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Jennifer Moser
- Office of Research and Development, Department of Veterans Affairs, Washington, DC
| | - Kelly Cho
- Veterans Affairs Boston Healthcare System, Massachusetts
- Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Jennifer Deen
- Office of Research and Development, Department of Veterans Affairs, Washington, DC
| | - Lori L. Churby
- Veterans Affairs Palo Alto Healthcare System, California
| | - Amy C. Justice
- Veterans Affairs Connecticut Healthcare System, West Haven
- Yale University School of Medicine and School of Public Health, New Haven, Connecticut
| | - Juan P. Casas
- Novartis Institute for Biomedical Research, Cambridge, Massachusetts
| | - Saiju Pyarajan
- Veterans Affairs Boston Healthcare System, Massachusetts
| | - Phil S. Tsao
- Veterans Affairs Palo Alto Healthcare System, California
- Stanford University School of Medicine, Palo Alto, California
| | - J. Michael Gaziano
- Veterans Affairs Boston Healthcare System, Massachusetts
- Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Sumitra Muralidhar
- Office of Research and Development, Department of Veterans Affairs, Washington, DC
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7
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Whitbourne SB, Li Y, Brewer JV, Deen J, Gutierrez C, Murphy SA, Lord E, Yan J, Nguyen XMT, Tsao PS, Gaziano JM, Muralidhar S. Overview of Efforts to Increase Women Enrollment in the Veterans Affairs Million Veteran Program. Health Equity 2023; 7:324-332. [PMID: 37284530 PMCID: PMC10240313 DOI: 10.1089/heq.2023.0006] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 06/08/2023] Open
Abstract
Background Ensuring enhanced delivery of care to women Veterans is a top Veterans Affairs (VA) priority; however, women are historically underrepresented in research that informs evidence-based health care. A primary barrier to women's participation is the inability to engage with research in person due to a number of documented challenges. The VA Million Veteran Program (MVP) is committed to increasing access for women Veterans to participate in research, thereby better understanding conditions specific to this population and how disease manifests differently in women compared to men. The goal of this work is to describe the results of the MVP Women's Campaign, an effort designed to increase outreach to and awareness of remote enrollment options for women Veterans. Materials and Methods The MVP Women's Campaign launched two phases between March 2021 and April 2022: the Multimedia Phase leveraged a variety of strategic multichannel communication tactics and the Email Phase focused on direct email communication to women Veterans. The effect of the Multimedia Phase was determined using t-tests and chi-square tests, as well as logistic regression models to compare demographic subgroups. The Email Phase was evaluated using comparisons of the enrollment rate across demographic groups through a multivariate adjusted logistic regression model. Results Overall, 4694 women Veterans enrolled during the MVP Women's Campaign (54% during the Multimedia Phase and 46% during the Email Phase). For the Multimedia Phase, the percentage of older women online enrollees increased, along with women from the southwest and western regions of the United States. Differences for women Veteran online enrollment across different ethnicity and race groups were not observed. During the Email Phase, the enrollment rate increased with age. Compared to White women Veterans, Blacks, Asians, and Native Americans were significantly less likely to enroll while Veterans with multiple races were more likely to enroll. Conclusion The MVP Women's Campaign is the first large-scale outreach effort focusing on recruitment of women Veterans into MVP. The combination of print and digital outreach tactics and direct email recruitment resulted in over a fivefold increase in women Veteran enrollees during a 7-month period. Attention to messaging and communication channels, combined with a better understanding of effective recruitment methods for certain Veteran populations, allows MVP the opportunity to advance health and health care not only for women Veterans, but beyond. Lessons learned will be applied to increase other populations in MVP such as Blacks, Hispanics, Asians, Native Americans, younger Veterans, and Veterans with certain health conditions.
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Affiliation(s)
- Stacey B. Whitbourne
- Million Veteran Program Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yanping Li
- Million Veteran Program Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Jessica V.V. Brewer
- Million Veteran Program Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Jennifer Deen
- Office of Research and Development, Veterans Health Administration, Washington, District of Columbia, USA
| | - Claudia Gutierrez
- Million Veteran Program Coordinating Center, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Sybil A. Murphy
- Million Veteran Program Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Emily Lord
- Million Veteran Program Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Joseph Yan
- Million Veteran Program Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Xuan-Mai T. Nguyen
- Million Veteran Program Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Carle Illinois College of Medicine, University of Illinois, Champaign, Illinois, USA
| | - Philip S. Tsao
- Million Veteran Program Coordinating Center, VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
| | - J. Michael Gaziano
- Million Veteran Program Coordinating Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sumitra Muralidhar
- Office of Research and Development, Veterans Health Administration, Washington, District of Columbia, USA
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8
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Honerlaw J, Ho YL, Fontin F, Gosian J, Maripuri M, Murray M, Sangar R, Galloway A, Zimolzak AJ, Whitbourne SB, Casas JP, Ramoni RB, Gagnon DR, Cai T, Liao KP, Gaziano JM, Muralidhar S, Cho K. Framework of the Centralized Interactive Phenomics Resource (CIPHER) standard for electronic health data-based phenomics knowledgebase. J Am Med Inform Assoc 2023; 30:958-964. [PMID: 36882092 PMCID: PMC10114031 DOI: 10.1093/jamia/ocad030] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/14/2023] [Accepted: 02/23/2023] [Indexed: 03/09/2023] Open
Abstract
The development of phenotypes using electronic health records is a resource-intensive process. Therefore, the cataloging of phenotype algorithm metadata for reuse is critical to accelerate clinical research. The Department of Veterans Affairs (VA) has developed a standard for phenotype metadata collection which is currently used in the VA phenomics knowledgebase library, CIPHER (Centralized Interactive Phenomics Resource), to capture over 5000 phenotypes. The CIPHER standard improves upon existing phenotype library metadata collection by capturing the context of algorithm development, phenotyping method used, and approach to validation. While the standard was iteratively developed with VA phenomics experts, it is applicable to the capture of phenotypes across healthcare systems. We describe the framework of the CIPHER standard for phenotype metadata collection, the rationale for its development, and its current application to the largest healthcare system in the United States.
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Affiliation(s)
- Jacqueline Honerlaw
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Yuk-Lam Ho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Francesca Fontin
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Jeffrey Gosian
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Monika Maripuri
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Michael Murray
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Rahul Sangar
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Ashley Galloway
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Andrew J Zimolzak
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, USA.,Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Stacey B Whitbourne
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Juan P Casas
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Rachel B Ramoni
- Office of Research and Development, Veterans Health Administration, Washington, District of Columbia, USA
| | - David R Gagnon
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Tianxi Cai
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.,Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Katherine P Liao
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA.,Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - J Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sumitra Muralidhar
- Office of Research and Development, Veterans Health Administration, Washington, District of Columbia, USA
| | - Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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9
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Nguyen XMT, Whitbourne SB, Li Y, Quaden RM, Song RJ, Nguyen HNA, Harrington K, Djousse L, Brewer JVV, Deen J, Muralidhar S, Ramoni RB, Cho K, Casas JP, Tsao PS, Gaziano JM. Data Resource Profile: Self-reported data in the Million Veteran Program: survey development and insights from the first 850 736 participants. Int J Epidemiol 2023; 52:e1-e17. [PMID: 35748351 DOI: 10.1093/ije/dyac133] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Xuan-Mai T Nguyen
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA.,Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign, IL, USA
| | - Stacey B Whitbourne
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
| | - Yanping Li
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
| | - Rachel M Quaden
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
| | - Rebecca J Song
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
| | - Hai-Nam A Nguyen
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
| | - Kelly Harrington
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
| | - Luc Djousse
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA.,New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, USA
| | - Jessica V V Brewer
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
| | - Jennifer Deen
- Office of Research and Development, Veterans Health Administration, Washington, DC, USA
| | - Sumitra Muralidhar
- Office of Research and Development, Veterans Health Administration, Washington, DC, USA
| | - Rachel B Ramoni
- Office of Research and Development, Veterans Health Administration, Washington, DC, USA
| | - Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
| | - Juan P Casas
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
| | - Philip S Tsao
- VA Palo Alto Epidemiology Research and Information Center for Genomics, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - John M Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
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10
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Kimbrel NA, Ashley-Koch AE, Qin XJ, Lindquist JH, Garrett ME, Dennis MF, Hair LP, Huffman JE, Jacobson DA, Madduri RK, Trafton JA, Coon H, Docherty AR, Mullins N, Ruderfer DM, Harvey PD, McMahon BH, Oslin DW, Beckham JC, Hauser ER, Hauser MA, Ashley-Koch AE, Aslan M, Beckham JC, Begoli E, Bhattacharya T, Brown B, Calhoun PS, Cheung KH, Choudhury S, Cliff AM, Cohn JD, Crivelli S, Cuellar-Hengartner L, Deangelis HE, Dennis MF, Dhaubhadel S, Finley PD, Ganguly K, Garvin MR, Gelernter JE, Hair LP, Harvey PD, Hauser ER, Hauser MA, Hengartner NW, Jacobson DA, Jones PC, Kainer D, Kaplan AD, Katz IR, Kember RL, Kimbrel NA, Kirby AC, Ko JC, Kolade B, Lagergren JH, Lane MJ, Levey DF, Levin D, Lindquist JH, Liu X, Madduri RK, Manore C, Martins SB, McCarthy JF, McDevitt-Cashman M, McMahon BH, Miller I, Morrow D, Oslin DW, Pavicic-Venegas M, Pestian J, Pyarajan S, Qin XJ, Rajeevan N, Ramsey CM, Ribeiro R, Rodriguez A, Romero J, Santel D, Schaefferkoetter N, Shi Y, Stein MB, Sullivan K, Sun N, Tamang SR, Townsend A, Trafton JA, Walker A, Wang X, Wangia-Anderson V, Yang R, Yoon HJ, Yoo S, Zamora-Resendiz R, Zhao H, Docherty AR, Mullins N, Coleman JRI, Shabalin A, Kang J, Murnyak B, Wendt F, Adams M, Campos AI, DiBlasi E, Fullerton JM, Kranzler HR, Bakian A, Monson ET, Rentería ME, Andreassen OA, Bulik CM, Edenberg HJ, Kessler RC, Mann JJ, Nurnberger JI, Pistis G, Streit F, Ursano RJ, Awasthi S, Bergen AW, Berrettini WH, Bohus M, Brandt H, Chang X, Chen HC, Chen WJ, Christensen ED, Crawford S, Crow S, Duriez P, Edwards AC, Fernández-Aranda F, Fichter MM, Galfalvy H, Gallinger S, Gandal M, Gorwood P, Guo Y, Hafferty JD, Hakonarson H, Halmi KA, Hishimoto A, Jain S, Jamain S, Jiménez-Murcia S, Johnson C, Kaplan AS, Kaye WH, Keel PK, Kennedy JL, Kim M, Klump KL, Levey DF, Li D, Liao SC, Lieb K, Lilenfeld L, Lori A, Magistretti PJ, Marshall CR, Mitchell JE, Myers RM, Okazaki S, Otsuka I, Pinto D, Powers A, Ramoz N, Ripke S, Roepke S, Rozanov V, Scherer SW, Schmahl C, Sokolowski M, Starnawska A, Strober M, Su MH, Thornton LM, Treasure J, Ware EB, Watson HJ, Witt SH, Woodside DB, Yilmaz Z, Zillich L, Agerbo E, Børglum AD, Breen G, Demontis D, Erlangsen A, Esko T, Gelernter J, Glatt SJ, Hougaard DM, Hwu HG, Kuo PH, Lewis CM, Li QS, Liu CM, Martin NG, McIntosh AM, Medland SE, Mors O, Nordentoft M, Nurnberger JI, Olsen C, Porteous D, Smith DJ, Stahl EA, Stein MB, Wasserman D, Werge T, Whiteman DC, Willour V, Coon H, Ruderfer DM, Dedert E, Elbogen EB, Fairbank JA, Hurley RA, Kilts JD, Martindale SL, Marx CE, McDonald SD, Moore SD, Morey RA, Naylor JC, Rowland J, Shura RD, Swinkels C, Tupler LA, Van Voorhees EE, Yoash-Gantz R, Gaziano JM, Muralidhar S, Ramoni R, Chang KM, O’Donnell CJ, Tsao PS, Breeling J, Hauser E, Sun Y, Huang G, Casas JP, Moser J, Whitbourne SB, Brewer JV, Conner T, Argyres DP, Stephens B, Brophy MT, Humphries DE, Selva LE, Do N, Shayan S(A, Cho K, Churby L, Wilson P, McArdle R, Dellitalia L, Mattocks K, Harley J, Whittle J, Jacono F, Wells J, Gutierrez S, Gibson G, Hammer K, Kaminsky L, Villareal G, Kinlay S, Xu J, Hamner M, Mathew R, Bhushan S, Iruvanti P, Godschalk M, Ballas Z, Ivins D, Mastorides S, Moorman J, Gappy S, Klein J, Ratcliffe N, Florez H, Okusaga O, Murdoch M, Sriram P, Yeh SS, Tandon N, Jhala D, Liangpunsakul S, Oursler KA, Whooley M, Ahuja S, Constans J, Meyer P, Greco J, Rauchman M, Servatius R, Gaddy M, Wallbom A, Morgan T, Stapley T, Sherman S, Ross G, Strollo P, Boyko E, Meyer L, Gupta S, Huq M, Fayad J, Hung A, Lichy J, Hurley R, Robey B, Striker R. Identification of Novel, Replicable Genetic Risk Loci for Suicidal Thoughts and Behaviors Among US Military Veterans. JAMA Psychiatry 2023; 80:135-145. [PMID: 36515925 PMCID: PMC9857322 DOI: 10.1001/jamapsychiatry.2022.3896] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 12/15/2022]
Abstract
Importance Suicide is a leading cause of death; however, the molecular genetic basis of suicidal thoughts and behaviors (SITB) remains unknown. Objective To identify novel, replicable genomic risk loci for SITB. Design, Setting, and Participants This genome-wide association study included 633 778 US military veterans with and without SITB, as identified through electronic health records. GWAS was performed separately by ancestry, controlling for sex, age, and genetic substructure. Cross-ancestry risk loci were identified through meta-analysis. Study enrollment began in 2011 and is ongoing. Data were analyzed from November 2021 to August 2022. Main Outcome and Measures SITB. Results A total of 633 778 US military veterans were included in the analysis (57 152 [9%] female; 121 118 [19.1%] African ancestry, 8285 [1.3%] Asian ancestry, 452 767 [71.4%] European ancestry, and 51 608 [8.1%] Hispanic ancestry), including 121 211 individuals with SITB (19.1%). Meta-analysis identified more than 200 GWS (P < 5 × 10-8) cross-ancestry risk single-nucleotide variants for SITB concentrated in 7 regions on chromosomes 2, 6, 9, 11, 14, 16, and 18. Top single-nucleotide variants were largely intronic in nature; 5 were independently replicated in ISGC, including rs6557168 in ESR1, rs12808482 in DRD2, rs77641763 in EXD3, rs10671545 in DCC, and rs36006172 in TRAF3. Associations for FBXL19 and AC018880.2 were not replicated. Gene-based analyses implicated 24 additional GWS cross-ancestry risk genes, including FURIN, TSNARE1, and the NCAM1-TTC12-ANKK1-DRD2 gene cluster. Cross-ancestry enrichment analyses revealed significant enrichment for expression in brain and pituitary tissue, synapse and ubiquitination processes, amphetamine addiction, parathyroid hormone synthesis, axon guidance, and dopaminergic pathways. Seven other unique European ancestry-specific GWS loci were identified, 2 of which (POM121L2 and METTL15/LINC02758) were replicated. Two additional GWS ancestry-specific loci were identified within the African ancestry (PET112/GATB) and Hispanic ancestry (intergenic locus on chromosome 4) subsets, both of which were replicated. No GWS loci were identified within the Asian ancestry subset; however, significant enrichment was observed for axon guidance, cyclic adenosine monophosphate signaling, focal adhesion, glutamatergic synapse, and oxytocin signaling pathways across all ancestries. Within the European ancestry subset, genetic correlations (r > 0.75) were observed between the SITB phenotype and a suicide attempt-only phenotype, depression, and posttraumatic stress disorder. Additionally, polygenic risk score analyses revealed that the Million Veteran Program polygenic risk score had nominally significant main effects in 2 independent samples of veterans of European and African ancestry. Conclusions and Relevance The findings of this analysis may advance understanding of the molecular genetic basis of SITB and provide evidence for ESR1, DRD2, TRAF3, and DCC as cross-ancestry candidate risk genes. More work is needed to replicate these findings and to determine if and how these genes might impact clinical care.
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Affiliation(s)
- Nathan A. Kimbrel
- Durham Veterans Affairs Health Care System, Durham, North Carolina,Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina,Veterans Affairs Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Allison E. Ashley-Koch
- Duke Molecular Physiology Institute, Durham, North Carolina,Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Xue J. Qin
- Durham Veterans Affairs Health Care System, Durham, North Carolina,Duke Molecular Physiology Institute, Durham, North Carolina
| | - Jennifer H. Lindquist
- Veterans Affairs Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina
| | | | - Michelle F. Dennis
- Durham Veterans Affairs Health Care System, Durham, North Carolina,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Lauren P. Hair
- Durham Veterans Affairs Health Care System, Durham, North Carolina,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Jennifer E. Huffman
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts
| | - Daniel A. Jacobson
- Biosciences, Oak Ridge National Laboratory, Oak Ridge, Tennessee,Bredesen Center for Interdisciplinary Research and Graduate Education, University of Tennessee, Knoxville,Department of Psychology, NeuroNet Research Center, University of Tennessee Knoxville
| | - Ravi K. Madduri
- Consortium for Advanced Science and Engineering, The University of Chicago, Chicago, Illinois,Data Science and Learning Division, Argonne National Laboratory, Lemont, Illinois
| | - Jodie A. Trafton
- Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Affairs Palo Alto Health Care System, Menlo Park, California
| | - Hilary Coon
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City,Biomedical Informatics, University of Utah School of Medicine, Salt Lake City
| | - Anna R. Docherty
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City,Department of Psychiatry, Virginia Commonwealth University, Richmond
| | - Niamh Mullins
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Douglas M. Ruderfer
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, Tennessee,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida,Research Service, Bruce W. Carter VA Medical Center, Miami, Florida
| | - Benjamin H. McMahon
- Theoretical Biology and Biophysics, Los Alamos National Laboratory, Los Alamos, New Mexico
| | - David W. Oslin
- Veterans Integrated Service Networks 4 Mental Illness Research, Education, and Clinical Center, Center of Excellence, Corporal Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jean C. Beckham
- Durham Veterans Affairs Health Care System, Durham, North Carolina,Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham, North Carolina,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Elizabeth R. Hauser
- Durham Veterans Affairs Health Care System, Durham, North Carolina,Duke Molecular Physiology Institute, Durham, North Carolina,Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Michael A. Hauser
- Duke Molecular Physiology Institute, Durham, North Carolina,Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | | | - Allison E. Ashley-Koch
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Mihaela Aslan
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jean C. Beckham
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Edmond Begoli
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| | - Tanmoy Bhattacharya
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| | - Ben Brown
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| | - Patrick S. Calhoun
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| | - Kei-Hoi Cheung
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| | - Sutanay Choudhury
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| | - Ashley M. Cliff
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| | - Judith D. Cohn
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| | - Silvia Crivelli
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| | - Leticia Cuellar-Hengartner
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| | - Haedi E. Deangelis
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| | - Michelle F. Dennis
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| | - Sayera Dhaubhadel
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| | - Patrick D. Finley
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| | - Kumkum Ganguly
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| | - Michael R. Garvin
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| | - Joel E. Gelernter
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| | - Lauren P. Hair
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| | - Phillip D. Harvey
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| | - Elizabeth R. Hauser
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| | - Michael A. Hauser
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| | - Nick W. Hengartner
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| | - Daniel A. Jacobson
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| | - Piet C. Jones
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| | - David Kainer
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| | - Alan D. Kaplan
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| | - Ira R. Katz
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| | - Rachel L. Kember
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| | - Nathan A. Kimbrel
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| | - Angela C. Kirby
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| | - John C. Ko
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| | - Beauty Kolade
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| | - John H. Lagergren
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| | - Matthew J. Lane
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| | - Daniel F. Levey
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| | - Drew Levin
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| | - Jennifer H. Lindquist
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| | - Xianlian Liu
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| | - Ravi K. Madduri
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| | - Carrie Manore
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| | - Susana B. Martins
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| | - John F. McCarthy
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| | - Mikaela McDevitt-Cashman
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| | - Benjamin H. McMahon
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| | - Izaak Miller
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| | - Destinee Morrow
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| | - David W. Oslin
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| | - Mirko Pavicic-Venegas
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| | - John Pestian
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| | - Saiju Pyarajan
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| | - Xue J. Qin
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| | - Nallakkandi Rajeevan
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| | - Christine M. Ramsey
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| | - Ruy Ribeiro
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| | - Alex Rodriguez
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| | - Jonathan Romero
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| | - Daniel Santel
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| | - Noah Schaefferkoetter
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| | - Yunling Shi
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| | - Murray B. Stein
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| | - Kyle Sullivan
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| | - Ning Sun
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| | - Suzanne R. Tamang
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| | - Alice Townsend
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| | - Jodie A. Trafton
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| | - Angelica Walker
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| | - Xiange Wang
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| | - Victoria Wangia-Anderson
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| | - Renji Yang
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| | - Hong-Jun Yoon
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| | - Shinjae Yoo
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| | - Rafael Zamora-Resendiz
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| | - Hongyu Zhao
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| | - Anna R Docherty
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| | - Niamh Mullins
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| | - Jonathan R I Coleman
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| | - Andrey Shabalin
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| | - JooEun Kang
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| | - Balasz Murnyak
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| | - Frank Wendt
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| | - Mark Adams
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| | - Adrian I Campos
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| | - Emily DiBlasi
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| | - Janice M Fullerton
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| | - Henry R Kranzler
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| | - Amanda Bakian
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| | - Eric T Monson
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| | - Miguel E Rentería
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| | - Ole A Andreassen
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| | - Cynthia M Bulik
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| | - Howard J Edenberg
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| | - Ronald C Kessler
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| | - J John Mann
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| | - John I. Nurnberger
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| | - Giorgio Pistis
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| | - Fabian Streit
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| | - Robert J Ursano
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| | - Swapnil Awasthi
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| | - Andrew W Bergen
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| | - Wade H Berrettini
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| | - Martin Bohus
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| | - Harry Brandt
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| | - Xiao Chang
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| | - Hsi-Chung Chen
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| | - Wei J Chen
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| | - Erik D Christensen
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| | - Steven Crawford
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| | - Scott Crow
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| | - Philibert Duriez
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| | - Alexis C Edwards
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| | - Fernando Fernández-Aranda
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| | - Manfred M Fichter
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| | - Hanga Galfalvy
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| | - Steven Gallinger
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| | - Michael Gandal
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| | - Philip Gorwood
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| | - Yiran Guo
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| | - Jonathan D Hafferty
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| | - Hakon Hakonarson
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| | - Katherine A Halmi
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| | - Akitoyo Hishimoto
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| | - Sonia Jain
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| | - Stéphane Jamain
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| | - Susana Jiménez-Murcia
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| | - Craig Johnson
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| | - Allan S Kaplan
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| | - Walter H Kaye
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| | - Pamela K Keel
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| | - James L Kennedy
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| | - Minsoo Kim
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| | - Kelly L Klump
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| | - Daniel F Levey
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| | - Dong Li
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| | - Shih-Cheng Liao
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Klaus Lieb
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Lisa Lilenfeld
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Adriana Lori
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Pierre J Magistretti
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Christian R Marshall
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - James E Mitchell
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Richard M Myers
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Satoshi Okazaki
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Ikuo Otsuka
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Dalila Pinto
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Abigail Powers
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Nicolas Ramoz
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Stephan Ripke
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Stefan Roepke
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Vsevolod Rozanov
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Stephen W Scherer
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Christian Schmahl
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Marcus Sokolowski
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Anna Starnawska
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Michael Strober
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Mei-Hsin Su
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Laura M Thornton
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Janet Treasure
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Erin B Ware
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Hunna J Watson
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Stephanie H Witt
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - D Blake Woodside
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Zeynep Yilmaz
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Lea Zillich
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Esben Agerbo
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Anders D Børglum
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Gerome Breen
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Ditte Demontis
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Annette Erlangsen
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Tõnu Esko
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Joel Gelernter
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Stephen J Glatt
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - David M Hougaard
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Hai-Gwo Hwu
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Po-Hsiu Kuo
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Cathryn M Lewis
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Qingqin S Li
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Chih-Min Liu
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Nicholas G Martin
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Andrew M McIntosh
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Sarah E Medland
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Ole Mors
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Merete Nordentoft
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - John I Nurnberger
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Catherine Olsen
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - David Porteous
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Daniel J Smith
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Eli A Stahl
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Murray B Stein
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Danuta Wasserman
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Thomas Werge
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - David C Whiteman
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Virginia Willour
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Hilary Coon
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Douglas M Ruderfer
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Eric Dedert
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Eric B. Elbogen
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - John A. Fairbank
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Robin A. Hurley
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jason D. Kilts
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Sarah L. Martindale
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Christine E. Marx
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Scott D. McDonald
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Scott D. Moore
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Rajendra A. Morey
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jennifer C. Naylor
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jared Rowland
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Robert D. Shura
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Cindy Swinkels
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Larry A. Tupler
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Elizabeth E. Van Voorhees
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Ruth Yoash-Gantz
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - J. Michael Gaziano
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Sumitra Muralidhar
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Rachel Ramoni
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Kyong-Mi Chang
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Christopher J. O’Donnell
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Philip S. Tsao
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - James Breeling
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Elizabeth Hauser
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Yan Sun
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Grant Huang
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Juan P. Casas
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jennifer Moser
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Stacey B. Whitbourne
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jessica V. Brewer
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Todd Conner
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Dean P. Argyres
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Brady Stephens
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Mary T. Brophy
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Donald E. Humphries
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Luis E. Selva
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Nhan Do
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Shahpoor (Alex) Shayan
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Kelly Cho
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Lori Churby
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Peter Wilson
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Rachel McArdle
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Louis Dellitalia
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Kristin Mattocks
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - John Harley
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jeffrey Whittle
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Frank Jacono
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - John Wells
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Salvador Gutierrez
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Gretchen Gibson
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Kimberly Hammer
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Laurence Kaminsky
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Gerardo Villareal
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Scott Kinlay
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Junzhe Xu
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Mark Hamner
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Roy Mathew
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Sujata Bhushan
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Pran Iruvanti
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Michael Godschalk
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Zuhair Ballas
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Douglas Ivins
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Stephen Mastorides
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jonathan Moorman
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Saib Gappy
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jon Klein
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Nora Ratcliffe
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Hermes Florez
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Olaoluwa Okusaga
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Maureen Murdoch
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Peruvemba Sriram
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Shing Shing Yeh
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Neeraj Tandon
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Darshana Jhala
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Suthat Liangpunsakul
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Kris Ann Oursler
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Mary Whooley
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Sunil Ahuja
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Joseph Constans
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Paul Meyer
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jennifer Greco
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Michael Rauchman
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Richard Servatius
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Melinda Gaddy
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Agnes Wallbom
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Timothy Morgan
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Todd Stapley
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Scott Sherman
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - George Ross
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Patrick Strollo
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Edward Boyko
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Laurence Meyer
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Samir Gupta
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Mostaqul Huq
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Joseph Fayad
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Adriana Hung
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Jack Lichy
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Robin Hurley
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Brooks Robey
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
| | - Robert Striker
- for the Million Veteran Program Suicide Exemplar Workgroup, the International Suicide Genetics Consortium, the Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center Workgroup, and the Veterans Affairs Million Veteran Program
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11
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Mohammed T, Brewer JVV, Pyatt M, Whitbourne SB, Gaziano JM, Edson C, Holodniy M. Evaluation of Independent Self-Collected Blood Specimens for COVID-19 Antibody Detection among the US Veteran Population. Diagn Microbiol Infect Dis 2022; 104:115770. [PMID: 35985109 PMCID: PMC9287846 DOI: 10.1016/j.diagmicrobio.2022.115770] [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: 04/22/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 11/25/2022]
Abstract
Feasibility of home blood sample collection methods for the presence of SARS-CoV-2 antibodies from VA Million Veteran Program (MVP) participants was tested to determine COVID-19 infection or vaccination status. Participants (n = 312) were randomly assigned to self-collect blood specimens using the Neoteryx Mitra Clamshell (n = 136) or Tasso-SST (n = 176) and asked to rate their experience. Mitra tip blood was eluted and Tasso tubes were centrifuged. All samples were stored at -80 °C until tested with InBios SCoV-2 Detect™ IgG ELISA, BioRad Platelia SARS-CoV-2 Total Ab Assay, Abbott SARS-CoV-2 IgG and AdviseDx SARS-CoV-2 IgG II assays. Participants rated both devices equally. The Abbott assay had the highest sensitivity (87% Mitra, 98% Tasso-SST) for detecting known COVID infection and/or vaccination. The InBios assay with Tasso-SST had the best sensitivity (97%) and specificity (80%) for detecting known COVID-19 infection and/or vaccination. Veterans successfully collected their own specimens with no strong preference for either device.
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Affiliation(s)
- Tseli Mohammed
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA.
| | - Jessica V V Brewer
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
| | - Mary Pyatt
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA
| | - Stacey B Whitbourne
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
| | - J Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, MA, USA
| | - Connor Edson
- VHA Public Health Reference Laboratory (PHRL), Palo Alto, CA, USA
| | - Mark Holodniy
- VHA Public Health Reference Laboratory (PHRL), Palo Alto, CA, USA; Department of Medicine, Stanford University, Stanford, CA, USA
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12
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Whitbourne SB, Nguyen XMT, Song RJ, Lord E, Lyden M, Harrington KM, Ward R, Li Y, Brewer JVV, Cho KM, Djousse L, Muralidhar S, Tsao PS, Gaziano JM, Casas JP. Million Veteran Program’s response to COVID-19: Survey development and preliminary findings. PLoS One 2022; 17:e0266381. [PMID: 35468170 PMCID: PMC9037905 DOI: 10.1371/journal.pone.0266381] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 03/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background In response to the novel Coronavirus Disease 2019 (COVID-19) pandemic, the Department of Veterans Affairs (VA) Million Veteran Program (MVP) organized efforts to better understand the impact of COVID-19 on Veterans by developing and deploying a self-reported survey. Methods The MVP COVID-19 Survey was developed to collect COVID-19 specific elements including symptoms, diagnosis, hospitalization, behavioral and psychosocial factors and to augment existing MVP data with longitudinal collection of key domains in physical and mental health. Due to the rapidly evolving nature of the pandemic, a multipronged strategy was implemented to widely disseminate the COVID-19 Survey and capture data using both the online platform and mailings. Results We limited the findings of this paper to the initial phase of survey dissemination which began in May 2020. A total of 729,625 eligible MVP Veterans were invited to complete version 1 of the COVID-19 Survey. As of October 31, 2020, 58,159 surveys have been returned. The mean and standard deviation (SD) age of responders was 71 (11) years, 8.6% were female, 8.2% were Black, 5.6% were Hispanic, and 446 (0.8%) self-reported a COVID-19 diagnosis. Over 90% of responders reported wearing masks, practicing social distancing, and frequent hand washing. Conclusion The MVP COVID-19 Survey provides a systematic collection of data regarding COVID-19 behaviors among Veterans and represents one of the first large-scale, national surveillance efforts of COVID-19 in the Veteran population. Continued work will examine the overall response to the survey with comparison to available VA health record data.
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Affiliation(s)
- Stacey B. Whitbourne
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, United States of America
- Department of Medicine, Harvard Medical School, Boston, MA, United States of America
- Division of Aging, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
- * E-mail:
| | - Xuan-Mai T. Nguyen
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, United States of America
- Carle Illinois College of Medicine, University of Illinois, Champaign, IL, United States of America
| | - Rebecca J. Song
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America
| | - Emily Lord
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, United States of America
| | - Michelle Lyden
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, United States of America
| | - Kelly M. Harrington
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, United States of America
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States of America
| | - Rachel Ward
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, United States of America
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, United States of America
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States of America
| | - Yanping Li
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, United States of America
| | - Jessica V. V. Brewer
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, United States of America
| | - Kelly M. Cho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, United States of America
- Department of Medicine, Harvard Medical School, Boston, MA, United States of America
- Division of Aging, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Luc Djousse
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, United States of America
- Department of Medicine, Harvard Medical School, Boston, MA, United States of America
- Division of Aging, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, United States of America
| | - Sumitra Muralidhar
- Office of Research and Development, Veterans Health Administration, Washington, D.C., United States of America
| | - Philip S. Tsao
- VA Palo Alto Epidemiology Research and Information Center for Genomics, VA Palo Alto Health Care System, Palo Alto, CA, United States of America
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States of America
| | - J. Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, United States of America
- Department of Medicine, Harvard Medical School, Boston, MA, United States of America
- Division of Aging, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Juan P. Casas
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA, United States of America
- Department of Medicine, Harvard Medical School, Boston, MA, United States of America
- Division of Aging, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States of America
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13
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Djousse L, Schubert P, Ho YL, Whitbourne SB, Cho K, Gaziano JM. Leisure time physical activity, sedentary behavior, and risk of cardiovascular disease and mortality among US Veterans. J Nov Physiother Phys Rehabil 2021; 8:33-39. [PMID: 35098260 PMCID: PMC8793724] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) remains the leading cause of death in the US. Although physical activity (PA) has been inversely associated with the risk of CVD, few studies have examined whether sedentary behaviors modify such association. Our goal was to examine associations of leisure time PA with risk of CVD and mortality and the role of sedentary behavior as potential effect modifier among US veterans. METHODS We analyzed self-reported data on leisure time PA, television watching, and time spent on the computer among 438,364 participants of the Veterans Affairs Million Veteran Program from 2011 to 2018. We calculated metabolic equivalent of task-hours per week (MET-h/week) for each person and used electronic health record data to ascertain CVD. RESULTS Mean age was 64.6 ± 12.6 years and 92% were men. During a mean follow up of 3.3 years, we observed 22,942 new cases of CVD and 48,325 deaths. There was an inverse relation of leisure time PA with CVD and total mortality [HR: 0.96 (0.95-0.97) and 0.91 (0.90-0.92) per 2 MET-h/week increment for CVD and total mortality, respectively]. The associations of PA with both incident CVD and mortality were stronger in participants who spent more time watching television or on computer (all p values for interaction < 0.01). No interaction of PA with time spent on video game was observed (p>0.05). CONCLUSIONS Leisure time PA is inversely associated with risk of CVD and mortality among US veterans and such relations were stronger in participants who spent more time watching television or on computer.
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Affiliation(s)
- Luc Djousse
- Massachussets Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Medicine, Division of Aging, Brigham and Women's Hospital
| | - Petra Schubert
- Massachussets Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA
| | - Yuk-Lam Ho
- Massachussets Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA
| | - Stacey B Whitbourne
- Massachussets Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Medicine, Division of Aging, Brigham and Women's Hospital
| | - Kelly Cho
- Massachussets Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Medicine, Division of Aging, Brigham and Women's Hospital
| | - J Michael Gaziano
- Massachussets Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA
- Harvard Medical School, Boston, MA
- Department of Medicine, Division of Aging, Brigham and Women's Hospital
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14
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Radhakrishnan K, Hauser ER, Polimanti R, Helmer DA, Provenzale D, McNeil RB, Maffucci A, Quaden R, Zhao H, Whitbourne SB, Harrington KM, Vahey J, Gelernter J, Levey DF, Huang GD, Gaziano JM, Concato J, Aslan M. Genomics of Gulf War Illness in U.S. Veterans Who Served during the 1990-1991 Persian Gulf War: Methods and Rationale for Veterans Affairs Cooperative Study #2006. Brain Sci 2021; 11:brainsci11070845. [PMID: 34202057 PMCID: PMC8301942 DOI: 10.3390/brainsci11070845] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 01/11/2023] Open
Abstract
Background: Approximately 697,000 members of the U.S. Armed Forces were deployed to the Persian Gulf in support of the 1990–1991 Persian Gulf War (GW). Subsequently, many deployed and some non-deployed veterans developed a chronic multi-symptom illness, now named Gulf War Illness (GWI). This manuscript outlines the methods and rationale for studying the genomics of GWI within the Million Veteran Program (MVP), a VA-based national research program that has linked medical records, surveys, and genomic data, enabling genome-wide association studies (GWASs). Methods: MVP participants who served in the military during the GW era were contacted by mail and invited to participate in the GWI study. A structured health questionnaire, based on a previously tested instrument, was also included in the mailing. Data on deployment locations and exposures, symptoms associated with GWI, clinical diagnoses, personal habits, and health care utilization were collected. Self-reported data will be augmented with chart reviews and structured international classification of disease codes, to classify participants by GWI case status. We will develop a phenotyping algorithm, based on two commonly used case definitions, to determine GWI status, and then conduct a nested case-control GWAS. Genetic variants associated with GWI will be investigated, and gene–gene and gene–environment interactions studied. The genetic overlap of GWI with, and causative mechanisms linking this illness to, other health conditions and the effects of genomic regulatory mechanisms on GWI risk will also be explored. Conclusions: The proposed initial GWAS described in this report will investigate the genomic underpinnings of GWI with a large sample size and state-of-the-art genomic analyses and phenotyping. The data generated will provide a rich and expansive foundation on which to build additional analyses.
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Affiliation(s)
- Krishnan Radhakrishnan
- Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD 20857, USA;
- College of Medicine, University of Kentucky, Lexington, KY 40536, USA
| | - Elizabeth R. Hauser
- VA Cooperative Studies Program Epidemiology Center—Durham, Department of Veterans Affairs, Durham, NC 27705, USA; (E.R.H.); (D.P.); (R.B.M.); (J.V.)
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC 27705, USA
| | - Renato Polimanti
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (R.P.); (A.M.); (H.Z.); (J.G.); (M.A.)
- School of Medicine, Yale University, New Haven, CT 06511, USA;
| | - Drew A. Helmer
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence:
| | - Dawn Provenzale
- VA Cooperative Studies Program Epidemiology Center—Durham, Department of Veterans Affairs, Durham, NC 27705, USA; (E.R.H.); (D.P.); (R.B.M.); (J.V.)
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC 27705, USA
| | - Rebecca B. McNeil
- VA Cooperative Studies Program Epidemiology Center—Durham, Department of Veterans Affairs, Durham, NC 27705, USA; (E.R.H.); (D.P.); (R.B.M.); (J.V.)
| | - Alysia Maffucci
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (R.P.); (A.M.); (H.Z.); (J.G.); (M.A.)
| | - Rachel Quaden
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (S.B.W.); (K.M.H.); (J.M.G.)
| | - Hongyu Zhao
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (R.P.); (A.M.); (H.Z.); (J.G.); (M.A.)
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06520, USA
| | - Stacey B. Whitbourne
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (S.B.W.); (K.M.H.); (J.M.G.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Kelly M. Harrington
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (S.B.W.); (K.M.H.); (J.M.G.)
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
| | - Jacqueline Vahey
- VA Cooperative Studies Program Epidemiology Center—Durham, Department of Veterans Affairs, Durham, NC 27705, USA; (E.R.H.); (D.P.); (R.B.M.); (J.V.)
- Computational Biology and Bioinformatics Program, Duke University, Durham, NC 27705, USA
| | - Joel Gelernter
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (R.P.); (A.M.); (H.Z.); (J.G.); (M.A.)
- School of Medicine, Yale University, New Haven, CT 06511, USA;
| | - Daniel F. Levey
- Division of Human Genetics, Department of Psychiatry, School of Medicine, Yale University, New Haven, CT 06511, USA;
- Department of Psychiatry, Veterans Affairs Connecticut Healthcare Center, West Haven, CT 06516, USA
| | - Grant D. Huang
- Cooperative Studies Program, VA Office of Research and Development, Washington, DC 20420, USA;
| | - John Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (R.Q.); (S.B.W.); (K.M.H.); (J.M.G.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - John Concato
- School of Medicine, Yale University, New Haven, CT 06511, USA;
- Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Mihaela Aslan
- Cooperative Studies Program Clinical Epidemiology Research Center (CSP-CERC), VA Connecticut Healthcare System, West Haven, CT 06516, USA; (R.P.); (A.M.); (H.Z.); (J.G.); (M.A.)
- School of Medicine, Yale University, New Haven, CT 06511, USA;
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15
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Song RJ, Ho YL, Schubert P, Park Y, Posner D, Lord EM, Costa L, Gerlovin H, Kurgansky KE, Anglin-Foote T, DuVall S, Huffman JE, Pyarajan S, Beckham JC, Chang KM, Liao KP, Djousse L, Gagnon DR, Whitbourne SB, Ramoni R, Muralidhar S, Tsao PS, O’Donnell CJ, Gaziano JM, Casas JP, Cho K. Phenome-wide association of 1809 phenotypes and COVID-19 disease progression in the Veterans Health Administration Million Veteran Program. PLoS One 2021; 16:e0251651. [PMID: 33984066 PMCID: PMC8118298 DOI: 10.1371/journal.pone.0251651] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/30/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The risk factors associated with the stages of Coronavirus Disease-2019 (COVID-19) disease progression are not well known. We aim to identify risk factors specific to each state of COVID-19 progression from SARS-CoV-2 infection through death. METHODS AND RESULTS We included 648,202 participants from the Veteran Affairs Million Veteran Program (2011-). We identified characteristics and 1,809 ICD code-based phenotypes from the electronic health record. We used logistic regression to examine the association of age, sex, body mass index (BMI), race, and prevalent phenotypes to the stages of COVID-19 disease progression: infection, hospitalization, intensive care unit (ICU) admission, and 30-day mortality (separate models for each). Models were adjusted for age, sex, race, ethnicity, number of visit months and ICD codes, state infection rate and controlled for multiple testing using false discovery rate (≤0.1). As of August 10, 2020, 5,929 individuals were SARS-CoV-2 positive and among those, 1,463 (25%) were hospitalized, 579 (10%) were in ICU, and 398 (7%) died. We observed a lower risk in women vs. men for ICU and mortality (Odds Ratio (95% CI): 0.48 (0.30-0.76) and 0.59 (0.31-1.15), respectively) and a higher risk in Black vs. Other race patients for hospitalization and ICU (OR (95%CI): 1.53 (1.32-1.77) and 1.63 (1.32-2.02), respectively). We observed an increased risk of all COVID-19 disease states with older age and BMI ≥35 vs. 20-24 kg/m2. Renal failure, respiratory failure, morbid obesity, acid-base balance disorder, white blood cell diseases, hydronephrosis and bacterial infections were associated with an increased risk of ICU admissions; sepsis, chronic skin ulcers, acid-base balance disorder and acidosis were associated with mortality. CONCLUSIONS Older age, higher BMI, males and patients with a history of respiratory, kidney, bacterial or metabolic comorbidities experienced greater COVID-19 severity. Future studies to investigate the underlying mechanisms associated with these phenotype clusters and COVID-19 are warranted.
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Affiliation(s)
- Rebecca J. Song
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Yuk-Lam Ho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Petra Schubert
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Yojin Park
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Daniel Posner
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Emily M. Lord
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Lauren Costa
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Hanna Gerlovin
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Katherine E. Kurgansky
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Tori Anglin-Foote
- VA Salt Lake City Health Care System, Salt Lake City, Utah, United States of America
| | - Scott DuVall
- VA Salt Lake City Health Care System, Salt Lake City, Utah, United States of America
- Office of Research and Development, Veterans Health Administration, Washington, DC, United States of America
- Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Jennifer E. Huffman
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Saiju Pyarajan
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Medicine, Division of Aging, Brigham & Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jean C. Beckham
- Durham VA Medical Center, Durham, North Carolina, United States of America
- Department of Psychiatry and Behavioral Sciences, University Medical Center, Durham, North Carolina, United States of America
- VA Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham, North Carolina, United States of America
| | - Kyong-Mi Chang
- Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Katherine P. Liao
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Luc Djousse
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Medicine, Division of Aging, Brigham & Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - David R. Gagnon
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Stacey B. Whitbourne
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Rachel Ramoni
- Office of Research and Development, Veterans Health Administration, Washington, DC, United States of America
| | - Sumitra Muralidhar
- Office of Research and Development, Veterans Health Administration, Washington, DC, United States of America
| | - Philip S. Tsao
- Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- VA Palo Alto Health Care System, Palo Alto, California, United States of America
| | - Christopher J. O’Donnell
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - John Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Medicine, Division of Aging, Brigham & Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Juan P. Casas
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Medicine, Division of Aging, Brigham & Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Medicine, Division of Aging, Brigham & Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
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16
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Ward RE, Nguyen XMT, Li Y, Lord EM, Lecky V, Song RJ, Casas JP, Cho K, Gaziano JM, Harrington KM, Whitbourne SB. Racial and Ethnic Disparities in U.S. Veteran Health Characteristics. Int J Environ Res Public Health 2021; 18:ijerph18052411. [PMID: 33801200 PMCID: PMC7967786 DOI: 10.3390/ijerph18052411] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022]
Abstract
Racial/ethnic health disparities persist among veterans despite comparable access and quality of care. We describe racial/ethnic differences in self-reported health characteristics among 437,413 men and women (mean age (SD) = 64.5 (12.6), 91% men, 79% White) within the Million Veteran Program. The Cochran-Mantel-Haenszel test and linear mixed models were used to compare age-standardized frequencies and means across race/ethnicity groups, stratified by gender. Black, Hispanic, and Other race men and women reported worse self-rated health, greater VA healthcare utilization, and more combat exposure than Whites. Compared to White men, Black and Other men reported more circulatory, musculoskeletal, mental health, and infectious disease conditions while Hispanic men reported fewer circulatory and more mental health, infectious disease, kidney, and neurological conditions. Compared to White women, Black women reported more circulatory and infectious disease conditions and Other women reported more infectious disease conditions. Smoking rates were higher among Black men, but lower for other minority groups compared to Whites. Minority groups were less likely to drink alcohol and had lower physical fitness than Whites. By identifying differences in burden of various health conditions and risk factors across different racial/ethnic groups, our findings can inform future studies and ultimately interventions addressing disparities.
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Affiliation(s)
- Rachel E. Ward
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA 02130, USA
- Correspondence:
| | - Xuan-Mai T. Nguyen
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Carle Illinois College of Medicine, University of Illinois, Champaign, IL 61820, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Yanping Li
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
| | - Emily M. Lord
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
| | - Vanessa Lecky
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
| | - Rebecca J. Song
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Juan P. Casas
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - John Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Kelly M. Harrington
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
| | - Stacey B. Whitbourne
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
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17
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Fang H, Hui Q, Lynch J, Honerlaw J, Assimes TL, Huang J, Vujkovic M, Damrauer SM, Pyarajan S, Gaziano JM, DuVall SL, O’Donnell CJ, Cho K, Chang KM, Wilson PW, Tsao PS, Sun YV, Tang H, Gaziano JM, Ramoni R, Breeling J, Chang KM, Huang G, Muralidhar S, O’Donnell CJ, Tsao PS, Muralidhar S, Moser J, Whitbourne SB, Brewer JV, Concato J, Warren S, Argyres DP, Stephens B, Brophy MT, Humphries DE, Do N, Shayan S, Nguyen XMT, Pyarajan S, Cho K, Hauser E, Sun Y, Zhao H, Wilson P, McArdle R, Dellitalia L, Harley J, Whittle J, Beckham J, Wells J, Gutierrez S, Gibson G, Kaminsky L, Villareal G, Kinlay S, Xu J, Hamner M, Haddock KS, Bhushan S, Iruvanti P, Godschalk M, Ballas Z, Buford M, Mastorides S, Klein J, Ratcliffe N, Florez H, Swann A, Murdoch M, Sriram P, Yeh SS, Washburn R, Jhala D, Aguayo S, Cohen D, Sharma S, Callaghan J, Oursler KA, Whooley M, Ahuja S, Gutierrez A, Schifman R, Greco J, Rauchman M, Servatius R, Oehlert M, Wallbom A, Fernando R, Morgan T, Stapley T, Sherman S, Anderson G, Sonel E, Boyko E, Meyer L, Gupta S, Fayad J, Hung A, Lichy J, Hurley R, Robey B, Striker R. Harmonizing Genetic Ancestry and Self-identified Race/Ethnicity in Genome-wide Association Studies. Am J Hum Genet 2019; 105:763-772. [PMID: 31564439 DOI: 10.1016/j.ajhg.2019.08.012] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 08/28/2019] [Indexed: 02/08/2023] Open
Abstract
Large-scale multi-ethnic cohorts offer unprecedented opportunities to elucidate the genetic factors influencing complex traits related to health and disease among minority populations. At the same time, the genetic diversity in these cohorts presents new challenges for analysis and interpretation. We consider the utility of race and/or ethnicity categories in genome-wide association studies (GWASs) of multi-ethnic cohorts. We demonstrate that race/ethnicity information enhances the ability to understand population-specific genetic architecture. To address the practical issue that self-identified racial/ethnic information may be incomplete, we propose a machine learning algorithm that produces a surrogate variable, termed HARE. We use height as a model trait to demonstrate the utility of HARE and ethnicity-specific GWASs.
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18
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Harrington KM, Nguyen XMT, Song RJ, Hannagan K, Quaden R, Gagnon DR, Cho K, Deen JE, Muralidhar S, O'Leary TJ, Gaziano JM, Whitbourne SB. Gender Differences in Demographic and Health Characteristics of the Million Veteran Program Cohort. Womens Health Issues 2019; 29 Suppl 1:S56-S66. [PMID: 31253243 PMCID: PMC7061933 DOI: 10.1016/j.whi.2019.04.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 07/31/2018] [Revised: 04/13/2019] [Accepted: 04/19/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND The Department of Veterans Affairs Million Veteran Program (MVP) is the largest ongoing cohort program of its kind, with 654,903 enrollees as of June 2018. The objectives of this study were to examine gender differences in the MVP cohort with respect to response and enrollment rates; demographic, health, and health care characteristics; and prevalence of self-reported health conditions. METHODS The MVP Baseline Survey was completed by 415,694 veterans (8% women), providing self-report measures of demographic characteristics, health status, and medical history. RESULTS Relative to men, women demonstrated a higher positive responder rate (23.0% vs. 16.0%), slightly higher enrollment rate (13.5% vs. 12.9%), and, among enrollees, a lower survey completion rate (59.7% vs. 63.8%). Women were younger, more racially diverse, had higher educational attainment, and were less likely to be married or cohabitating with a partner than men. Women were more likely to report good to excellent health status but poorer physical fitness, and less likely to report lifetime smoking and drinking than men. Compared with men, women veterans showed an increased prevalence of musculoskeletal conditions, thyroid problems, gastrointestinal conditions, migraine headaches, and mental health disorders, as well as a decreased prevalence of gout, cardiovascular diseases, high cholesterol, diabetes, and hearing problems. CONCLUSIONS These results revealed some substantial gender differences in the research participation rates, demographic profile, health characteristics, and prevalence of health conditions for veterans in the MVP cohort. Findings highlight the need for tailoring recruitment efforts to ensure representation of the increasing women veteran population receiving care through the Veterans Health Administration.
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Affiliation(s)
- Kelly M Harrington
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts.
| | - Xuan-Mai T Nguyen
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Rebecca J Song
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Keri Hannagan
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts
| | - Rachel Quaden
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts
| | - David R Gagnon
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jennifer E Deen
- Office of Research and Development, Veterans Health Administration, Washington, District of Columbia
| | - Sumitra Muralidhar
- Office of Research and Development, Veterans Health Administration, Washington, District of Columbia
| | - Timothy J O'Leary
- Office of Research and Development, Veterans Health Administration, Washington, District of Columbia; Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - John Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Stacey B Whitbourne
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
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19
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Abstract
Memory is a salient area of functioning in adulthood known to be influenced by beliefs about performance. To date, individual variations in memory beliefs have not been systematically examined. The present study used hierarchical linear regressions to examine the relationship between Memory Controllability Index (MCI) subscales and identity processes in 250 adults ( M = 58.01, 40 to 91 years), controlling for age, gender, and self-rated health. The ability to integrate age-related changes into identity was positively related to MCI scales measuring assessment of ability, potential to improve memory, and belief in the value of using memory strategies. The identity scale measuring negative age-related changes was related to lower memory self-assessment, ability to improve, and the belief that memory decline is inevitable. Contrary to expectation, the tendency to resist making changes in identity was not related to controllability. Findings support the utility of understanding memory-related beliefs in middle and later adulthood in terms of identity processes.
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20
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Neupert SD, Lachman ME, Whitbourne SB. Exercise self-efficacy and control beliefs: effects on exercise behavior after an exercise intervention for older adults. J Aging Phys Act 2009; 17:1-16. [PMID: 19299835 PMCID: PMC3740728 DOI: 10.1123/japa.17.1.1] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [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] [Indexed: 09/10/2023]
Abstract
The current study examined exercise self-efficacy and exercise behavior during and after a strength-training intervention program with older adults. A model with cross-lagged and contemporaneous paths was tested with structural equations. Within testing occasions, higher physical resistance was related to greater beliefs in efficacy and control over exercise. At 3 months into the intervention, those who had higher physical resistance were less likely to show subsequent changes in beliefs. Those who had higher self-efficacy and control beliefs at 6 months were more likely to report that they were still exercising at 9 and 12 months after the intervention. Findings indicate that exercise self-efficacy and exercise behavior are associated with one another and that beliefs developed during an intervention are important for maintenance of an exercise regimen.
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Affiliation(s)
- Shevaun D Neupert
- Dept of Psychology, North Carolina State University, Raleigh, NC 27695-7650, USA
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21
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Abstract
We examined the relationship between daily physical activity and everyday memory using an eight-day diary design with young, middle-aged, and older adults. Contrary to expectations, age differences were not reported in the frequency of memory failures and daily physical activity at the between-person level. Multilevel modeling, however, indicated that on days when adults engaged in leisure exercise (physical activity performed during leisure or free time) they reported fewer memory failures, and this was most apparent for older adults. Lagged analyses indicated that when leisure activity was reported on one day, fewer memory failures were reported the next day, and this was especially true for older adults. Thus, findings demonstrate that the benefits of physical activity for memory in later life are observable on a short-term daily basis.
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