Publications by authors named "Jay S Kaufman"

363 Publications

A joint spatial marked point process model for dengue and severe dengue in Medellin, Colombia.

Spat Spatiotemporal Epidemiol 2022 Jun 3;41:100495. Epub 2022 Mar 3.

Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2, Canada.

The spatial distribution of surveillance-reported dengue cases and severity are usually analyzed separately, assuming independence between the spatial distribution of non-severe and severe cases. Given the availability of data for the individual geo-location of surveillance-notified dengue cases, we conducted a spatial analysis to model non-severe and severe dengue simultaneously, using a hierarchical Bayesian model. We fit a joint model to the spatial pattern formed by dengue cases as well as to the severity status of the cases. Results showed that age and socioeconomic status were associated with dengue presence, and there was evidence of clustering for overall cases but not for severity. Our findings inform decision making to address the preparedness or implementation of dengue control strategies at the local level.
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http://dx.doi.org/10.1016/j.sste.2022.100495DOI Listing
June 2022

Global, regional, and national burden of cancers attributable to tobacco smoking in 204 countries and territories, 1990-2019.

Cancer Med 2022 May 27. Epub 2022 May 27.

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Cancers are leading causes of mortality and morbidity, with smoking being recognized as a significant risk factor for many types of cancer. We aimed to report the cancer burden attributable to tobacco smoking by sex, age, socio-demographic index (SDI), and cancer type in 204 countries and territories from 1990 to 2019.

Methods: The burden of cancers attributable to smoking was reported between 1990 and 2019, based upon the Comparative Risk Assessment approach used in the Global Burden of Disease (GBD) study 2019.

Results: Globally, in 2019 there were an estimated 2.5 million cancer-related deaths (95% UI: 2.3 to 2.7) and 56.4 million DALYs (51.3 to 61.7) attributable to smoking. The global age-standardized death and DALY rates of cancers attributable to smoking per 100,000 decreased by 23.0% (-29.5 to -15.8) and 28.6% (-35.1 to -21.5), respectively, over the period 1990-2019. Central Europe (50.4 [44.4 to 57.6]) and Western Sub-Saharan Africa (6.7 [5.7 to 8.0]) had the highest and lowest age-standardized death rates, respectively, for cancers attributable to smoking. In 2019, the age-standardized DALY rate of cancers attributable to smoking was highest in Greenland (2224.0 [1804.5 to 2678.8]) and lowest in Ethiopia (72.2 [51.2 to 98.0]). Also in 2019, the global number of DALYs was highest in the 65-69 age group and there was a positive association between SDI and the age-standardized DALY rate.

Conclusions: The results of this study clearly illustrate that renewed efforts are required to increase utilization of evidence-based smoking cessation support in order to reduce the burden of smoking-related diseases.
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http://dx.doi.org/10.1002/cam4.4647DOI Listing
May 2022

Association between long-term exposure to ambient air pollution and COVID-19 severity: a prospective cohort study.

CMAJ 2022 May;194(20):E693-E700

Scripps Institution of Oceanography (C. Chen, Benmarhnia), University of California San Diego, La Jolla, Calif.; Public Health Ontario (Wang, Kwong, Kim, H. Chen); ICES Central (Kwong, H. Chen); Dalla Lana School of Public Health (Kwong, Kim, H. Chen), and Department of Family and Community Medicine (Kwong), University of Toronto, Toronto, Ont.; Department of Energy, Environmental, and Chemical Engineering (van Donkelaar, Martin), Washington University in St. Louis, St. Louis, Mo.; College of Public Health and Human Studies (Hystad), Oregon State University, Corvallis, Ore.; Ontario Ministry of the Environment (Su), Conservation and Parks, Toronto, Ont.; Environmental Health Science and Research Bureau (Lavigne, H. Chen), Health Canada, Ottawa, Ont.; Department of Epidemiology and Biostatistics and Occupational Health (Kirby-McGregor, Kaufman), McGill University, Montréal, Que.

Background: The tremendous global health burden related to COVID-19 means that identifying determinants of COVID-19 severity is important for prevention and intervention. We aimed to explore long-term exposure to ambient air pollution as a potential contributor to COVID-19 severity, given its known impact on the respiratory system.

Methods: We used a cohort of all people with confirmed SARS-CoV-2 infection, aged 20 years and older and not residing in a long-term care facility in Ontario, Canada, during 2020. We evaluated the association between long-term exposure to fine particulate matter (PM), nitrogen dioxide (NO) and ground-level ozone (O), and risk of COVID-19-related hospital admission, intensive care unit (ICU) admission and death. We ascertained individuals' long-term exposures to each air pollutant based on their residence from 2015 to 2019. We used logistic regression and adjusted for confounders and selection bias using various individual and contextual covariates obtained through data linkage.

Results: Among the 151 105 people with confirmed SARS-CoV-2 infection in Ontario in 2020, we observed 8630 hospital admissions, 1912 ICU admissions and 2137 deaths related to COVID-19. For each interquartile range increase in exposure to PM (1.70 μg/m), we estimated odds ratios of 1.06 (95% confidence interval [CI] 1.01-1.12), 1.09 (95% CI 0.98-1.21) and 1.00 (95% CI 0.90-1.11) for hospital admission, ICU admission and death, respectively. Estimates were smaller for NO. We also estimated odds ratios of 1.15 (95% CI 1.06-1.23), 1.30 (95% CI 1.12-1.50) and 1.18 (95% CI 1.02-1.36) per interquartile range increase of 5.14 ppb in O for hospital admission, ICU admission and death, respectively.

Interpretation: Chronic exposure to air pollution may contribute to severe outcomes after SARS-CoV-2 infection, particularly exposure to O.
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http://dx.doi.org/10.1503/cmaj.220068DOI Listing
May 2022

Association between long-term exposure to ambient air pollution and COVID-19 severity: a prospective cohort study.

CMAJ 2022 May;194(20):E693-E700

Scripps Institution of Oceanography (C. Chen, Benmarhnia), University of California San Diego, La Jolla, Calif.; Public Health Ontario (Wang, Kwong, Kim, H. Chen); ICES Central (Kwong, H. Chen); Dalla Lana School of Public Health (Kwong, Kim, H. Chen), and Department of Family and Community Medicine (Kwong), University of Toronto, Toronto, Ont.; Department of Energy, Environmental, and Chemical Engineering (van Donkelaar, Martin), Washington University in St. Louis, St. Louis, Mo.; College of Public Health and Human Studies (Hystad), Oregon State University, Corvallis, Ore.; Ontario Ministry of the Environment (Su), Conservation and Parks, Toronto, Ont.; Environmental Health Science and Research Bureau (Lavigne, H. Chen), Health Canada, Ottawa, Ont.; Department of Epidemiology and Biostatistics and Occupational Health (Kirby-McGregor, Kaufman), McGill University, Montréal, Que.

Background: The tremendous global health burden related to COVID-19 means that identifying determinants of COVID-19 severity is important for prevention and intervention. We aimed to explore long-term exposure to ambient air pollution as a potential contributor to COVID-19 severity, given its known impact on the respiratory system.

Methods: We used a cohort of all people with confirmed SARS-CoV-2 infection, aged 20 years and older and not residing in a long-term care facility in Ontario, Canada, during 2020. We evaluated the association between long-term exposure to fine particulate matter (PM), nitrogen dioxide (NO) and ground-level ozone (O), and risk of COVID-19-related hospital admission, intensive care unit (ICU) admission and death. We ascertained individuals' long-term exposures to each air pollutant based on their residence from 2015 to 2019. We used logistic regression and adjusted for confounders and selection bias using various individual and contextual covariates obtained through data linkage.

Results: Among the 151 105 people with confirmed SARS-CoV-2 infection in Ontario in 2020, we observed 8630 hospital admissions, 1912 ICU admissions and 2137 deaths related to COVID-19. For each interquartile range increase in exposure to PM (1.70 μg/m), we estimated odds ratios of 1.06 (95% confidence interval [CI] 1.01-1.12), 1.09 (95% CI 0.98-1.21) and 1.00 (95% CI 0.90-1.11) for hospital admission, ICU admission and death, respectively. Estimates were smaller for NO. We also estimated odds ratios of 1.15 (95% CI 1.06-1.23), 1.30 (95% CI 1.12-1.50) and 1.18 (95% CI 1.02-1.36) per interquartile range increase of 5.14 ppb in O for hospital admission, ICU admission and death, respectively.

Interpretation: Chronic exposure to air pollution may contribute to severe outcomes after SARS-CoV-2 infection, particularly exposure to O.
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http://dx.doi.org/10.1503/cmaj.220068DOI Listing
May 2022

Prevalence, Deaths and Disability-Adjusted-Life-Years (DALYs) Due to Type 2 Diabetes and Its Attributable Risk Factors in 204 Countries and Territories, 1990-2019: Results From the Global Burden of Disease Study 2019.

Front Endocrinol (Lausanne) 2022 25;13:838027. Epub 2022 Feb 25.

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Aim: To report the point prevalence, deaths and disability-adjusted-life-years (DALYs) due to type 2 diabetes and its attributable risk factors in 204 countries and territories during the period 1990-2019.

Methods: We used the data of the Global Burden of Disease (GBD) Study 2019 to report number and age-standardised rates per 100 000 population of type 2 diabetes. Estimates were reported with 95% uncertainty intervals (UIs).

Results: In 2019, the global age-standardised point prevalence and death rates for type 2 diabetes were 5282.9 and 18.5 per 100 000, an increase of 49% and 10.8%, respectively, since 1990. Moreover, the global age-standardised DALY rate in 2019 was 801.5 per 100 000, an increase of 27.6% since 1990. In 2019, the global point prevalence of type 2 diabetes was slightly higher in males and increased with age up to the 75-79 age group, decreasing across the remaining age groups. American Samoa [19876.8] had the highest age-standardised point prevalence rates of type 2 diabetes in 2019. Generally, the burden of type 2 diabetes decreased with increasing SDI (Socio-demographic Index). Globally, high body mass index [51.9%], ambient particulate matter pollution [13.6%] and smoking [9.9%] had the three highest proportions of attributable DALYs.

Conclusion: Low and middle-income countries have the highest burden and greater investment in type 2 diabetes prevention is needed. In addition, accurate data on type 2 diabetes needs to be collected by the health systems of all countries to allow better monitoring and evaluation of population-level interventions.
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http://dx.doi.org/10.3389/fendo.2022.838027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8915203PMC
April 2022

Global, regional, and national cancer deaths and disability-adjusted life-years (DALYs) attributable to alcohol consumption in 204 countries and territories, 1990-2019.

Cancer 2022 May 3;128(9):1840-1852. Epub 2022 Mar 3.

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Background: Alcohol consumption is a risk factor for a number of communicable and non-communicable diseases, including several types of cancer. This article reports the burden of cancers attributable to alcohol consumption by age, sex, location, sociodemographic index (SDI), and cancer type from 1990 to 2019.

Methods: The Comparative Risk Assessment approach was used in the 2019 Global Burden of Disease study to report the burden of cancers attributable to alcohol consumption between 1990 and 2019.

Results: In 2019, there were globally an estimated 494.7 thousand cancer deaths (95% uncertainty interval [UI], 439.7 to 554.1) and 13.0 million cancer disability-adjusted life-years (DALYs; 95% UI, 11.6 to 14.5) that were attributable to alcohol consumption. The alcohol-attributable DALYs were much higher in men (10.5 million; 95% UI, 9.2 to 11.8) than women (2.5 million; 95% UI, 2.2 to 2.9). The global age-standardized death and DALY rates of cancers attributable to alcohol decreased by 14.7% (95% UI, 6.4% to 23%) and 18.1% (95% UI, 9.2% to 26.5%), respectively, over the study period. Central Europe had the highest age-standardized death rates that were attributable to alcohol consumption(10.3; 95% UI, 8.7 to12.0). Moreover, there was an overall positive association between SDI and the regional age-standardized DALY rate for alcohol-attributable cancers.

Conclusions: Despite decreases in age-standardized deaths and DALYs, substantial numbers of cancer deaths and DALYs are still attributable to alcohol consumption. Because there is a higher burden in males, the elderly, and developed regions (based on SDI), these groups and regions should be prioritized in any prevention programs.
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http://dx.doi.org/10.1002/cncr.34111DOI Listing
May 2022

Selection bias: "The unseen enemy is always the most fearsome".

Int J Obes (Lond) 2022 Jun 9;46(6):1247. Epub 2022 Feb 9.

Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.

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http://dx.doi.org/10.1038/s41366-021-00981-5DOI Listing
June 2022

Limitations of Canadian COVID-19 data reporting to the general public.

J Public Health Policy 2022 Jun 31;43(2):203-221. Epub 2022 Jan 31.

Department of Family Medicine, McGill University, Montreal, QC, Canada.

Canadian coronavirus (COVID-19) case statistics reported by governmental bodies and news outlets are central to inform the public and to guide health policy. We searched Canadian governmental and news outlets websites to determine how COVID-19 case statistics were reported to the general public, whether they were reported with appropriate denominators, data sources, and accounted for age, sex, and race or ethnicity. Canadian COVID-19 data reporting practices were found to have limited utility due to varying case definitions, heterogeneous and dynamic testing criteria, lack of appropriate standardization accounting for dynamics, sizes, and characteristics of the populations being tested. Population-wide representative COVID-19 testing should be implemented to enable accurate estimation of the scale and dynamics of the epidemiological situation. Comprehensive COVID-19 data on underrepresented and marginalized populations should be collected and reported in an effort to develop equitable health policies.
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http://dx.doi.org/10.1057/s41271-022-00337-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8802988PMC
June 2022

Decomposition of socioeconomic inequalities in arboviral diseases in Brazil and Colombia (2007-2017).

Trans R Soc Trop Med Hyg 2022 Jan 27. Epub 2022 Jan 27.

Department of Epidemiology, Biostatistics and Occupational Health, McGill University 2001 McGill College, Suite 1200, Montreal, QC, Canada H3A 1G1.

Background: We used surveillance data from Brazil and Colombia during 2007-2017 to assess the presence of socioeconomic inequalities on dengue, chikungunya and Zika at the neighborhood level in two Latin American cities.

Methods: To quantify the inequality, we estimated and decomposed the relative concentration index of inequality (RCI) accounting for the spatiotemporal distribution of the diseases.

Results: There were 281 426 arboviral cases notified in Fortaleza, Brazil, and 40 889 in Medellin, Colombia. The RCI indicated greater concentration of dengue cases among people living in low socioeconomic settings in both sites. The RCIs for chikungunya in Fortaleza covered the line of equality during their introduction in 2014, while the RCIs for Zika and chikungunya in Medellin indicated the presence of a small inequality. The RCI decomposition showed that year of notification and age were the main contributors to this inequality. In Medellin, the RCI decomposition showed that age and access to waste management accounted for 75.5%, 72.2% and 54.5% of the overall inequality towards the poor for dengue, chikungunya and Zika, respectively.

Conclusions: Our study presents estimates of the socioeconomic inequality of arboviruses and its decomposition in two Latin American cities. We corroborate the concentration of arboviral diseases in low socioeconomic neighborhoods and identify that year of occurrence, age, presence of healthcare facilities and waste management are key determinants of the heterogenous distribution of endemic arboviruses across the socioeconomic spectrum.
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http://dx.doi.org/10.1093/trstmh/trac004DOI Listing
January 2022

Global, regional, and national burden of cancers attributable to excess body weight in 204 countries and territories, 1990 to 2019.

Obesity (Silver Spring) 2022 02 18;30(2):535-545. Epub 2022 Jan 18.

Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia, USA.

Objective: The aim of this study was to report the level and trends of 13 cancers that are attributable to excess body weight (EBW) for 204 countries and territories from 1990 to 2019.

Methods: Using publicly available data, the burden of cancers attributable to EBW was reported from 1990 to 2019 based on the comparative risk assessment approach used in the Global Burden of Disease study 2019. [Correction added on 27 January 2022, after first online publication: 'Using publicly available data,' has been added before the first sentence and 'estimated' was corrected to 'reported'.] RESULTS: In 2019, EBW caused 11.2 million disability-adjusted life-years (DALYs), or 4.4% of all cancer-related DALYs. Between 1990 and 2019, the global EBW-attributable age-standardized cancer DALY rates (per 100,000) increased from 109.9 to 133.9, a relative increase of 21.9%. The age-standardized DALY rates (per 100,000) of cancers attributable to EBW in 2019 were highest and lowest in Mongolia (611.8) and Bangladesh (30.2), respectively. The 60- to 64-year age group had the highest number of DALYs attributable to EBW, whereas there were no large sex differences in the cancer-related burden attributable to EBW. Furthermore, the association between the age-standardized DALY rates and the sociodemographic index was generally positive.

Conclusions: Overall, the EBW-attributable burden of cancers has increased in the past three decades. Public health efforts should focus on identifying appropriate preventive interventions at the population and individual levels, especially in the regions and countries with the highest burden.
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http://dx.doi.org/10.1002/oby.23355DOI Listing
February 2022

Does weight mediate the effect of smoking on coronary heart disease? Parametric mediational g-formula analysis.

PLoS One 2022 13;17(1):e0262403. Epub 2022 Jan 13.

Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.

Background: In settings in which there are time-varying confounders affected by previous exposure and a time-varying mediator, natural direct and indirect effects cannot generally be estimated unbiasedly. In the present study, we estimate interventional direct effect and interventional indirect effect of cigarette smoking as a time-varying exposure on coronary heart disease while considering body weight as a time-varying mediator.

Methods: To address this problem, the parametric mediational g-formula was proposed to estimate interventional direct effect and interventional indirect effect. We used data from the Multi-Ethnic Study of Atherosclerosis to estimate effect of cigarette smoking on coronary heart disease, considering body weight as time-varying mediator.

Results: Over a 11-years period, smoking 20 cigarettes per day compared to no smoking directly (not through weight) increased risk of coronary heart disease by an absolute difference of 1.91% (95% CI: 0.49%, 4.14%), and indirectly decreased coronary heart disease risk by -0.02% (95% CI: -0.05%, 0.04%) via change in weight. The total effect was estimated as an absolute 1.89% increase (95% CI: 0.49%, 4.13%).

Conclusion: The overall absolute impact of smoking to incident coronary heart disease is modest, and we did not discern any important contribution to this effect relayed through changes to bodyweight. In fact, changes in weight because of smoking have no meaningful mediating effect on CHD risk.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0262403PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8757910PMC
February 2022

Gender Influences on Editorial Decisions at Epidemiology.

Epidemiology 2022 03;33(2):153-156

From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.

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http://dx.doi.org/10.1097/EDE.0000000000001457DOI Listing
March 2022

Nutrition-related health taxes: setting expectations.

Lancet Diabetes Endocrinol 2022 02 20;10(2):93-94. Epub 2021 Dec 20.

Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.

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http://dx.doi.org/10.1016/S2213-8587(21)00325-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8687666PMC
February 2022

Burden of ischemic heart disease and its attributable risk factors in 204 countries and territories, 1990-2019.

Eur J Prev Cardiol 2022 03;29(2):420-431

Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Aims: To report the prevalence, deaths, and disability-adjusted life years (DALYs) associated with ischemic heart disease (IHD) and its attributable risk factors in 204 countries and territories from 1990 to 2019, by age, sex, and socio-demographic index (SDI).

Methods And Results: Ischemic heart disease was defined as acute myocardial infarction (MI) and chronic IHD (angina; asymptomatic IHD following MI). Cause of death ensemble modelling was used to produce fatality estimates. The prevalence of the non-fatal sequalae of IHD was estimated using DisMod MR 2.1. All estimates were presented as counts and age-standardized rates per 100 000 population. In 2019, IHD accounted for 197.2 million (177.7-219.5) prevalent cases, 9.1 million (8.4-9.7) deaths, and 182.0 million (170.2-193.5) DALYs worldwide. There were decreases in the global age-standardized prevalence rates of IHD [-4.6% (-5.7, -3.6)], deaths [-30.8% (-34.8, -27.2)], and DALYs [-28.6% (-33.3, -24.2)] from 1990 to 2019. In 2019, the global prevalence and death rates of IHD were higher among males across all age groups, while the death rate peaked in the oldest group for both sexes. A negative association was found between the age-standardized DALY rates and SDI. Globally, high systolic blood pressure (54.6%), high low-density lipoprotein cholesterol (46.6%), and smoking (23.9%) were the three largest contributors to the DALYs attributable to IHD.

Conclusion: Although the global age-standardized prevalence, death, and DALY rates all decreased. Prevention and control programmes should be implemented to reduce population exposure to risk factors, reduce the risk of IHD in high-risk populations, and provide appropriate care for communities.
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http://dx.doi.org/10.1093/eurjpc/zwab213DOI Listing
March 2022

Gestational Diabetes in Twin Versus Singleton Pregnancies With Normal Weight or Overweight Pre-Pregnancy Body Mass Index: The Mediating Role of Mid-Pregnancy Weight Gain.

Epidemiology 2022 03;33(2):278-286

Department of Obstetrics & Gynaecology, University of British Columbia.

Background: Gestational diabetes might be more common in twin versus singleton pregnancies, yet the reasons for this are unclear. We evaluated the extent to which this relationship is explained by higher mid-pregnancy weight gain within normal weight and overweight pre-pregnancy body mass index (BMI) strata.

Methods: We analyzed serial weights and glucose screening and diagnostic data abstracted from medical charts for twin (n = 1397) and singleton (n = 3117) pregnancies with normal or overweight pre-pregnancy BMI delivered from 1998 to 2013 at Magee-Womens Hospital in Pennsylvania. We used causal mediation analyses to estimate the total effect of twin versus singleton pregnancy on gestational diabetes, as well as those mediated (natural indirect effect) and not mediated (natural and controlled direct effects) by pathways involving mid-pregnancy weight gain.

Results: Odds of gestational diabetes were higher among twin pregnancies [odds ratios (ORs) for total effect = 2.83 (95% CI = 1.54, 5.19) for normal weight and 2.09 (95% CI = 1.16, 3.75) for overweight pre pregnancy BMI], yet there was limited evidence that this relationship was mediated by mid-pregnancy weight gain [ORs for natural indirect effect = 1.21 (95% CI = 0.90, 1.24) for normal weight and 1.06 (95% CI = 0.92, 1.21) for overweight pre-pregnancy BMI] and more evidence of mediation via other pathways [ORs for natural direct effect = 2.34 (95% CI = 1.24, 4.40) for normal weight and 1.97 (95% CI = 1.08, 3.60) for overweight pre-pregnancy BMI].

Conclusions: While twin pregnancies with normal weight or overweight pre-pregnancy BMI experienced higher odds of gestational diabetes versus singletons, most of this effect was explained by pathways not involving mid-pregnancy weight gain.
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http://dx.doi.org/10.1097/EDE.0000000000001454DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8810679PMC
March 2022

Evaluating the Impact and Rationale of Race-Specific Estimations of Kidney Function: Estimations from U.S. NHANES, 2015-2018.

EClinicalMedicine 2021 Dec 19;42:101197. Epub 2021 Nov 19.

Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada.

Background: Standard equations for estimating glomerular filtration rate (eGFR) employ race multipliers, systematically inflating eGFR for Black patients. Such inflation is clinically significant because eGFR thresholds of 60, 30, and 20 ml/min/1.73m guide kidney disease management. Racialized adjustment of eGFR in Black Americans may thereby affect their clinical care. In this study, we analyze and extrapolate national data to assess potential impacts of the eGFR race adjustment on qualification for kidney disease diagnosis, nephrologist referral, and transplantation listing.

Methods: Using population-representative cross-sectional data from the United States National Health and Nutrition Examination Survey (NHANES) from 2015-2018, eGFR values for Black Americans were calculated using the Modification of Diet in Renal Disease (MDRD) equation with and without the 1.21 race-specific coefficient using cohort data on age, sex, race, and serum creatinine.

Findings: Without the MDRD eGFR race adjustment, 3.3 million (10.4%) more Black Americans would reach a diagnostic threshold for Stage 3 Chronic Kidney Disease, 300,000 (0.7%) more would qualify for beneficial nephrologist referral, and 31,000 (0.1%) more would become eligible for transplant evaluation and waitlist inclusion.

Interpretation: These findings suggest eGFR race coefficients may contribute to racial differences in the management of kidney. We provide recommendations for addressing this issue at institutional and individual levels.

Funding: No external funding was received for this study.
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http://dx.doi.org/10.1016/j.eclinm.2021.101197DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8608882PMC
December 2021

Differences in birthweight by maternal and paternal nativity status in Canada.

Paediatr Perinat Epidemiol 2022 Jan 22;36(1):113-122. Epub 2021 Nov 22.

Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada.

Background: Parental nativity, as well as duration of residence of foreign-born parents in the host country, has been shown to be associated with size at birth. However, most studies have focused on maternal nativity status only and have not accounted for important characteristics of both parents.

Objective: To explore whether maternal and paternal nativity and length of residence (LOR) are independently associated with birthweight for gestational age in a representative sample of infants in Canada.

Methods: We compared mean differences in sex- and gestational age-standardised birthweight z-score by nativity status of both parents in a nationally representative sample of 130,532 singleton infants born between May 2004 and May 2006 to mothers residing in Canada. We categorised parental nativity status into four groups (both parents Canada-born, mother only foreign-born, father only foreign-born and both parents foreign-born) and parents' LOR into three (both ≤10 years, only one parent ≤10 years and both >10 years). We estimated mean differences in birthweight z-score and their 95% confidence intervals in linear regression models adjusted for parity, parents' ages, education, ethnicity and marital status of the mother.

Results: Compared with babies of Canada-born couples, those of two foreign-born parents had on average smaller birthweight z-score, -0.23 (95% CI -0.28, -0.25). However, after adjustment, the mean difference in z-score was -0.02 (95% CI -0.05, 0.00). Infants born to parents who had both resided in Canada for ≤10 years had a unadjusted mean difference in z-score of -0.27 (95% CI -0.29, -0.26), compared infants whose parents were both Canada-born, but the difference became negligible (-0.02, 95% CI -0.04, 0.01) after adjustment.

Conclusion: The birthweight differences by parental nativity or length of residence observed in our study population could be attributed to differences in the distribution of other parental characteristics that affect birthweight.
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http://dx.doi.org/10.1111/ppe.12817DOI Listing
January 2022

Burden of anemia and its underlying causes in 204 countries and territories, 1990-2019: results from the Global Burden of Disease Study 2019.

J Hematol Oncol 2021 11 4;14(1):185. Epub 2021 Nov 4.

Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.

Background: Anemia is a common disease which affects around 40% of children and 30% of reproductive age women and can have major health consequences. The present study reports the global, regional and national burden of anemia and its underlying causes between 1990 and 2019, by age, sex and socio-demographic index (SDI).

Methods: Publicly available data on the point prevalence and years lived with disability (YLDs) were retrieved from the global burden of disease (GBD) 2019 study for 204 countries and territories between 1990 and 2019. The point prevalence, YLD counts and rates per 100,000 population were presented, along with their corresponding 95% uncertainty intervals.

Results: In 2019, the global age-standardized point prevalence and YLD rates for anemia were 23,176.2 (22,943.5-23,418.6) and 672.4 (447.2-981.5) per 100,000 population, respectively. Moreover, the global age-standardized point prevalence and YLD rate decreased by 13.4% (12.1-14.5%) and 18.8% (16.9-20.8%), respectively, over the period 1990-2019. The highest national point prevalences of anemia were found in Zambia [49327.1 (95% UI: 46,838.5-51,700.1)], Mali [46890.1 (95% UI: 44,301.1-49,389.8)], and Burkina Faso [46117.2 (95% UI: 43,640.7-48,319.2)]. In 2019, the global point prevalence of anemia was highest in the 15-19 and 95+ age groups in females and males, respectively. Also, the burden of anemia was lower in regions with higher socio-economic development. Globally, most of the prevalent cases were attributable to dietary iron deficiency, as well as hemoglobinopathies and hemolytic anemias.

Conclusions: Anemia remains a major health problem, especially among females in less developed countries. The implementation of preventive programs with a focus on improving access to iron supplements, early diagnosis and the treatment of hemoglobinopathies should be taken into consideration.
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http://dx.doi.org/10.1186/s13045-021-01202-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8567696PMC
November 2021

Prevalence, Deaths, and Disability-Adjusted Life-Years Due to Asthma and Its Attributable Risk Factors in 204 Countries and Territories, 1990-2019.

Chest 2022 02 23;161(2):318-329. Epub 2021 Oct 23.

Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada.

Background: Understanding global trends in the point prevalence, deaths, and disability-adjusted life-years (DALYs) for asthma will facilitate evidence-based decision-making.

Research Question: What are the global, regional, and national burdens of asthma in 204 countries and territories between 1990 and 2019 by age, sex, and sociodemographic index (SDI)?

Study Design And Methods: Publicly available data from the Global Burden of Disease study from 1990 through 2019 were used. All estimates were presented as counts and age-standardized rates per 100,000, along with their associated uncertainty intervals.

Results: In 2019, the global age-standardized point prevalence and death rates for asthma were 3,415.5 and 5.8 per 100,000, which represent a 24% and 51.3% decrease since 1990, respectively. Moreover, in 2019, the global age-standardized DALY rate was 273.6 and the global point prevalence of asthma was highest in the group 5 to 9 years of age. Also in 2019, the United States (10,399.3) showed the highest age-standardized point prevalence rate of asthma. Generally, the burden of asthma decreased with increasing SDI. Globally, high BMI (16.9%), smoking (9.9%), and occupational asthmagens (8.8%) contributed to the 2019 asthma DALYs.

Interpretation: Asthma remains an important public health issue, particularly in regions with low socioeconomic development. Future research is needed to examine thoroughly the associations asthma has with its risk factors and the factors impeding optimal self-management. Further research also is needed to understand and implement better the interventions that have reduced the burden of asthma.
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http://dx.doi.org/10.1016/j.chest.2021.09.042DOI Listing
February 2022

Changes in exposure to ambient fine particulate matter after relocating and long term survival in Canada: quasi-experimental study.

BMJ 2021 10 8;375:n2368. Epub 2021 Oct 8.

Scripps Institution of Oceanography, University of California, San Diego, La Jolla, CA, USA.

Objective: To investigate the association between changes in long term residential exposure to ambient fine particulate matter (PM) and premature mortality in Canada.

Design: Population based quasi-experimental study.

Setting: Canada.

Participants: 663 100 respondents to the 1996, 2001, and 2006 Canadian censuses aged 25-89 years who had consistently lived in areas with either high or low PM levels over five years preceding census day and moved during the ensuing five years.

Interventions: Changes in long term exposure to PM arising from residential mobility.

Main Outcome Measures: The primary outcome was deaths from natural causes. Secondary outcomes were deaths from any cardiometabolic cause, any respiratory cause, and any cancer cause. All outcomes were obtained from the national vital statistics database.

Results: Using a propensity score matching technique with numerous personal, socioeconomic, health, and environment related covariates, each participant who moved to a different PM area was matched with up to three participants who moved within the same PM area. In the matched groups that moved from high to intermediate or low PM areas, residential mobility was associated with a decline in annual PM exposure from 10.6 μg/m to 7.4 and 5.0 μg/m, respectively. Conversely, in the matched groups that moved from low to intermediate or high PM areas, annual PM increased from 4.6 μg/m to 6.7 and 9.2 μg/m. Five years after moving, individuals who experienced a reduction in exposure to PM from high to intermediate levels showed a 6.8% (95% confidence interval 1.7% to 11.7%) reduction in mortality (2510 deaths in 56 025 4925 deaths in 101 960). A greater decline in mortality occurred among those exposed to a larger reduction in PM. Increased mortality was found with exposure to PM from low to high levels, and to a lesser degree from low to intermediate levels. Furthermore, the decreases in PM exposure were most strongly associated with reductions in cardiometabolic deaths, whereas the increases in PM exposure were mostly related to respiratory deaths. No strong evidence was found for the changes in PM exposure with cancer related deaths.

Conclusions: In Canada, decreases in PM were associated with lower mortality, whereas increases in PM were associated with higher mortality. These results were observed at PM levels considerably lower than many other countries, providing support for continuously improving air quality.
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http://dx.doi.org/10.1136/bmj.n2368DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8498990PMC
October 2021

Use of Racial and Ethnic Categories in Medical Testing and Diagnosis: Primum Non Nocere.

Clin Chem 2021 11;67(11):1456-1465

Loyola University Medical School, Maywood, IL.

Background: Use of race and ethnicity is common in medical tests and procedures, even though these categories are defined by sociological, historical, and political processes, and vary considerably in their definitions over time and place. Because all societies organize themselves around these constructs in some way, they are undeniable facets of the human experience, with myriad health consequences. In the biomedical literature, they are also commonly interpreted as representing biological heterogeneity that is relevant for health and disease.

Content: We review the use of race and ethnicity in medical practice, especially in the USA, and provide 2 specific examples to represent a large number of similar instances. We then critique these uses along a number of different dimensions, including limitations in measurement, within- versus between-group variance, and implications for informativeness of risk markers for individuals, generalization from arbitrary or nonrepresentative samples, perpetuation of myths and stereotypes, instability in time and place, crowding out of more relevant risk markers, stigmatization, and the tainting of medicine with the history of oppression. We conclude with recommendations to improve practice that are technical, ethical, and pragmatic.

Summary: Medicine has evolved from a mystical healing art to a mature science of human health through a rigorous process of quantification, experimentation, and evaluation. Folkloric traditions, such as race- and ethnic-specific medicine will fade from use as we become increasingly critical of outdated and irrational clinical practices and replace these with personalized, evidenced-based tests, algorithms, and procedures that privilege patients' individual humanity over obsolete and misleading labels.
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http://dx.doi.org/10.1093/clinchem/hvab164DOI Listing
November 2021

Invited Commentary: The Society for Epidemiologic Research's Commitment to Diversity and Equity-Pathways to Filling the Glass.

Am J Epidemiol 2021 09;190(9):1727-1729

In the article by Nobles et al. (Am J Epidemiol. 2021;190(9):1710-1720), characteristics of those epidemiologists selected for various chair and presentation roles at the annual meetings of the Society for Epidemiologic Research (SER) from 2015 through 2017 were examined. Characteristics that were compared included inferred gender, institutional affiliation, subject area, and h-index. Important disparities were observed between session chairs, speakers, and poster presenters. SER leadership considers diversity and equity to be priorities and is committed to positive change. New programs and processes have been used to broaden participation and improve diversity since 2018, but the SER must continue its efforts to change processes and monitor of the experiences of SER members. A diversity of perspectives within the SER membership and at its meetings will improve all aspects of our practice of epidemiology.
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http://dx.doi.org/10.1093/aje/kwab083DOI Listing
September 2021

Effect of preschool childcare on school-aged children's adiposity in Quebec, Canada.

Paediatr Perinat Epidemiol 2021 11 24;35(6):736-747. Epub 2021 Jun 24.

Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.

Background: Regulated public childcare must follow nutrition and physical activity guidelines, but the impact of public childcare on childhood adiposity is unclear.

Objectives: To estimate the effects of universal preschool childcare on children's BMI in elementary school in Quebec, Canada, and whether the effects differed in children from more or less advantaged families.

Methods: For 1657 children enrolled in the Quebec Longitudinal Study of Child Development (1998-2010), BMI z-scores (BMIz) from 6 to 13 years were regressed on the childcare used from 2 to 5 years, adjusted for pre-childcare variables. Average treatment effects were estimated using the Bayesian multilevel linear regression and g-computation for four childcare profiles: 1) parental care or full-time care (35 hours/week) in a 2) centre-based, 3) regulated home-based or 4) unregulated home-based arrangement.

Results: Had all participants attended centre-based care, mean BMIz in kindergarten would have been 0.38 (95% credible interval [CrI] 0.23, 0.52), which was 0.40 (95% CrI 0.14, 0.65) SD higher than regulated home-based, 0.20 (95% CrI -0.04, 0.43) SD higher than unregulated home-based and 0.36 (95% CrI 0.11, 0.60) SD higher than parental care. By 12 years, mean BMIz had increased for all childcare profiles, but differences between childcare profiles had diminished.

Conclusions: Although centre-based childcare was associated with an earlier rise in BMI, compared with informal care, it had no large, enduring effect, overall, or for less advantaged children, in particular.
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http://dx.doi.org/10.1111/ppe.12790DOI Listing
November 2021

Emulating a Randomised Controlled Trial With Observational Data: An Introduction to the Target Trial Framework.

Can J Cardiol 2021 09 6;37(9):1365-1377. Epub 2021 Jun 6.

Department of Medicine, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada. Electronic address:

Randomised controlled trials (RCTs) are often considered to be the highest quality of evidence owing to the absence of baseline confounding, the simplicity of analyses, and direct estimation of causal effects. However, observational studies can be designed to mimic RCTs and estimate causal treatment effects. In this review, we describe the target trial framework to illustrate how observational studies can successfully emulate RCTs. We focus on key design elements of RCTs and how to emulate them with observational data. These elements include 1) eligibility criteria, 2) treatment assignment and randomisation, 3) specification of "time zero", 4) outcomes, 5) follow-up, 6) causal contrasts (intention-to-treat vs per-protocol), and 7) statistical analyses. In addition, we describe the design of an example target trial created to emulate the Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition With Prasugrel Thrombolysis in Myocardial Infarction (TRITON-TIMI) 38 trial and compare effect estimates. Overall, careful design of a target trial using observational data can produce causal effect estimates that are often comparable to RCTs.
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http://dx.doi.org/10.1016/j.cjca.2021.05.012DOI Listing
September 2021

Housing conditions and adverse birth outcomes among Indigenous people in Canada.

Can J Public Health 2021 10 26;112(5):903-911. Epub 2021 May 26.

Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pine Ave West, Montreal, Quebec, H3A 1A2, Canada.

Objectives: Poor housing conditions and household crowding have been identified as important health concerns for Indigenous populations in many countries but have not been explored in relation to adverse birth outcomes in these populations. We investigated housing conditions and adverse birth outcomes in a nationally representative sample of Indigenous people in Canada.

Methods: Data were from a cohort of births between May 2004 and May 2006 created by linking birth and infant death registration data with the 2006 Canadian census. Log-binomial regression was used to examine associations between housing variables (persons per room and needed household repairs) and three adverse birth outcomes: preterm birth (PTB), small-for-gestational-age (SGA) birth, and infant mortality. Separate regression models were run for First Nations, Métis and Inuit mothers, with adjustment for parity and parental socio-economic variables.

Results: Need for major household repairs was associated with a slightly increased risk of PTB among First Nations and Métis mothers (adjusted RRs 1.12 and 1.13, respectively; 95% CI 0.94-1.34 and 0.89-1.44, respectively) and a moderately increased risk of infant death in all three groups (aRR = 1.69, 95% CI 1.00-2.85). Household crowding was also associated with a slightly elevated risk of PTB in all three groups (aRR = 1.10, 95% CI 0.95-1.29) and with an increased risk of infant mortality among First Nations (aRR = 1.57, 95% CI 0.97-2.53).

Conclusion: This study highlights the need to improve understanding of links between housing conditions and perinatal health outcomes in Indigenous populations, including examining cause-specific infant mortality in relation to housing characteristics.
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http://dx.doi.org/10.17269/s41997-021-00527-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8152187PMC
October 2021

Comparison of methods for interpolating gestational weight gain between clinical visits in twin and singleton pregnancies.

Ann Epidemiol 2021 08 22;60:45-52. Epub 2021 Apr 22.

Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.

Purpose: Researchers are interested in studying longitudinal patterns of gestational weight gain, yet this requires daily/weekly weights, and maternal weight is measured only during prenatal visits. We evaluated the relative accuracy and precision of methods for estimating maternal weight gain between prenatal visits among twin and singleton pregnancies.

Methods: We analyzed cohorts of dichorionic twin and singleton pregnancies delivered from 1998-2013 in Pittsburgh, Pennsylvania. We mimicked a typical study by retaining pre-pregnancy, first prenatal visit, glucose screening visit, and delivery weights, using these to fit interpolation models, estimating weight throughout pregnancy using 16 different methods, and calculating the difference in kilograms between predicted and measured values among remaining weights. We evaluated the performance of each model by calculating root mean squared error (RMSE).

Results: RMSE ranged from 1.55 to 6.09 kg in twins (n = 2067) and 1.45 to 4.87 kg in singletons (n = 7331). The most accurate and precise methods incorporated restricted cubic splines, random intercepts and slopes for pregnancy, and internal knots demarcating trimesters/quantiles (RMSE = 1.55/1.56 kg in twins, 1.45/1.45 kg in singletons), while individual-level linear interpolation between proximal measurements also performed well.

Conclusions: Accuracy and precision of methods for estimating maternal weight gain between measurements differed by model, and were best among individually-tailored and flexible models.
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http://dx.doi.org/10.1016/j.annepidem.2021.04.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8355187PMC
August 2021

Variation in Non-external and External Causes of Death in Peru in Relation to the COVID-19 Lockdown.

Yale J Biol Med 2021 03 31;94(1):23-40. Epub 2021 Mar 31.

Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.

: Lockdowns are designed to slow COVID-19 transmission, but they may have unanticipated relationships with other aspects of public health. Assessing the overall pattern in population health as a country implements and relaxes a lockdown is relevant, as these patterns may not necessarily be symmetric. We aimed to estimate the changing trends in cause-specific mortality in relation to the 2020 COVID-19 related lockdowns in Peru. : Based on data from the Peruvian National Death Information System (SINADEF), we calculated death rates per 10 million population to assess the trends in mortality rates for non-external and external causes of death (suicides, traffic accidents, and homicides). We compared these trends to 2018-2019, before, during, and after the lockdown, stratified by sex, and adjusted by Peruvian macro-region (Lima & Callao (capital region), Coast, Highland, and Jungle). : Non-external deaths presented a distinctive pattern among macro-regions, with an early surge in the Jungle and a later increase in the Highland. External deaths dropped during the lockdown, however, suicides and homicides returned to previous levels in the post-lockdown period. Deaths due to traffic accidents dropped during the lockdown and returned to pre-pandemic levels by December 2020. : We found a sudden drop in external causes of death, with suicides and homicides returning to previous levels after the lifting of the lockdown. Non-external deaths showed a differential pattern by macro-region. A close monitoring of these trends could help identify early spikes among these causes of death and take action to prevent a further increase in mortality indirectly affected by the pandemic.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7995934PMC
March 2021

Dengue, Severity Paradox, and Socioeconomic Distribution Among Afro-Colombians.

Epidemiology 2021 07;32(4):541-550

From the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.

Background: The clinical presentation of dengue ranges from self-limited mild illness to severe forms, including death. African ancestry is often described as protective against dengue severity. However, in the Latin American context, African ancestry has been associated with increased mortality. This "severity paradox" has been hypothesized as resulting from confounding or heterogeneity by socioeconomic status (SES). However, few systematic analyses have been conducted to investigate the presence and nature of the disparity paradox.

Methods: We fit Bayesian hierarchical spatiotemporal models using individual-level surveillance data from Cali, Colombia (2012-2017), to assess the overall morbidity and severity burden of notified dengue. We fitted overall and ethnic-specific models to assess the presence of heterogeneity by SES across and within ethnic groups (Afro-Colombian vs. non-Afro-Colombians), conducting sensitivity analyses to account for potential underreporting.

Results: Our study included 65,402 dengue cases and 13,732 (21%) hospitalizations. Overall notified dengue incidence rates did not vary across ethnic groups. Severity risk was higher among Afro-Colombians (risk ratio [RR] = 1.16; 95% Credible Interval [95% CrI] = 1.08, 1.24) but after accounting for underreporting by ethnicity this association was nearly null (RR = 1.02; 95% CrI = 0.97, 1.07). Subsidized health insurance and low-SES were associated with increased overall dengue rates and severity.

Conclusion: The paradoxically increased severity among Afro-Colombians can be attributed to differential health-seeking behaviors and reporting among Afro-Colombians. Such differential reporting can be understood as a type of intersectionality between SES, insurance scheme, and ethnicity that requires a quantitative assessment in future studies.
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http://dx.doi.org/10.1097/EDE.0000000000001353DOI Listing
July 2021

Police harassment and psychosocial vulnerability, distress, and depressive symptoms among black men who have sex with men in the U.S.: Longitudinal analysis of HPTN 061.

SSM Popul Health 2021 Mar 7;13:100753. Epub 2021 Feb 7.

Department of Population Health, New York University School of Medicine, New York, NY, USA.

The mental health impact of exposure to police harassment is understudied, particularly among Black men who have sex with men (BMSM), a group at elevated risk of exposure to such discrimination. This study aimed to identify the associations among BMSM between recent police harassment and psychosocial vulnerability, psychological distress, and depression measured six months later. Data come from the HIV Prevention Trials Network (HPTN) 061 Study, a cohort study of BMSM recruited in 6 U.S. cities (Atlanta, GA, Boston, MA, Los Angeles, CA, New York, NY, San Francisco, CA, and Washington DC). Participants completed baseline, 6-month follow-up, and 12-month follow-up interviews. A convenience sample of 1553 BMSM was recruited between July 2009 and October 2010 of whom 1155 returned for a follow-up interview 12 months later. Accounting for previous police interaction, poverty, psychopathology, drug use, and alcohol use, we estimated associations between recent police harassment reported at the 6 month follow-up interview and 12 month outcomes including psychosocial vulnerability (elevated racial/sexual identity incongruence), psychological distress (being distressed by experiences of racism and/or homophobia), and depression. About 60% of men reported experiencing police harassment between the baseline and 6-month interview due to their race and/or sexuality. Adjusted analyses suggested police harassment was independently associated with a 10.81 (95% CI: 7.97, 13.66) point increase and 8.68 (95% CI: 6.06, 11.30) point increase in distress due to experienced racism and distress due to experienced homophobia scores, respectively. Police harassment perceived to be dually motivated predicted disproportionate levels of distress. Police harassment is prevalent and associated with negative influences on psychosocial vulnerability and psychological distress among BMSM. Reducing exposure to police harassment may improve the psychosocial health of BMSM.
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http://dx.doi.org/10.1016/j.ssmph.2021.100753DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902537PMC
March 2021

Inferential challenges when assessing racial/ethnic health disparities in environmental research.

Environ Health 2021 01 12;20(1). Epub 2021 Jan 12.

Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada.

Numerous epidemiologic studies have documented environmental health disparities according to race/ethnicity (R/E) to inform targeted interventions aimed at reducing these disparities. Yet, the use of R/E under the potential outcomes framework implies numerous underlying assumptions for epidemiologic studies that are often not carefully considered in environmental health research. In this commentary, we describe the current state of thinking about the interpretation of R/E variables in etiologic studies. We then discuss how such variables are commonly used in environmental epidemiology. We observed three main uses for R/E: i) as a confounder, ii) as an effect measure modifier and iii) as the main exposure of interest either through descriptive analysis or under a causal framework. We identified some common methodological concerns in each case and provided some practical solutions. The use of R/E in observational studies requires particular cautions in terms of formal interpretation and this commentary aims at providing a practical resource for future studies assessing racial/ethnic health disparities in environmental research.
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http://dx.doi.org/10.1186/s12940-020-00689-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802337PMC
January 2021
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