Publications by authors named "Jay S Kaufman"

339 Publications

Comparison of Methods for Interpolating Gestational Weight Gain Between Clinical Visits in Twin and Singleton Pregnancies.

Ann Epidemiol 2021 Apr 21. Epub 2021 Apr 21.

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 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 weight gain among remaining weights. We evaluated 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 between measurements differed by method, and was best among individually-tailored and flexible models.
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http://dx.doi.org/10.1016/j.annepidem.2021.04.010DOI Listing
April 2021

Commentary on: A Data-Based Approach to Evaluate Representation by Gender and Affiliation in Key Presentation Formats at the SER Annual Meeting.

Am J Epidemiol 2021 Apr 8. Epub 2021 Apr 8.

Department of Epidemiology, Boston University School of Public Health, Boston Massachusetts, United States.

In the article by Nobles et al (Am J Epidemiol. XXXX;XXX(XX):XXXX-XXXX), 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 were compared, including 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 a priority and is committed to positive change. New programs and processes have been employed to broaden participation and improve diversity since 2018, but SER must continue its efforts to change processes and to 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
April 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 Mar 24. Epub 2021 Mar 24.

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

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 (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 paradoxical 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
March 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 Jan 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

Selection bias can creep into unselected cohorts and produce counterintuitive findings.

Int J Obes (Lond) 2021 Jan 25;45(1):276-277. Epub 2020 Nov 25.

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

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http://dx.doi.org/10.1038/s41366-020-00720-2DOI Listing
January 2021

Selection bias can creep into unselected cohorts and produce counterintuitive findings.

Int J Obes (Lond) 2021 Jan 25;45(1):276-277. Epub 2020 Nov 25.

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

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http://dx.doi.org/10.1038/s41366-020-00720-2DOI Listing
January 2021

Spatiotemporal distribution and socioeconomic disparities of dengue, chikungunya and Zika in two Latin American cities from 2007 to 2017.

Trop Med Int Health 2021 Mar 13;26(3):301-315. Epub 2020 Dec 13.

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

Objective: To assess the presence, pattern and magnitude of socioeconomic inequalities on dengue, chikungunya and Zika in Latin America, accounting for their spatiotemporal distribution.

Methods: Using longitudinal surveillance data (reported arboviruses) from Fortaleza, Brazil and Medellin, Colombia (2007-2017), we fit Bayesian hierarchical models with structured random effects to estimate: (i) spatiotemporally adjusted incidence rates; (ii) Relative Concentration Index and Absolute Concentration Index of inequality; (iii) temporal trends in RCIs; and (iv) socioeconomic-specific estimates of disease distribution. The spatial analysis was conducted at the neighbourhood level (urban settings). The socioeconomic measures were the median monthly household income (MMHI) for Brazil and the Socio-Economic Strata index (SES) in Colombia.

Results: There were 281 426 notified arboviral cases in Fortaleza and 40 887 in Medellin. We observed greater concentration of dengue among residents of low socioeconomic neighbourhoods in both cities: Relative Concentration Index = -0.12 (95% CI = -0.13, -0.10) in Fortaleza and Relative Concentration Index = -0.04 (95% CI = -0.05, -0.03) in Medellin. The magnitude of inequalities varied over time across sites and was larger during outbreaks. We identified a non-monotonic association between disease rates and socioeconomic measures, especially for chikungunya, that changed over time. The Relative Concentration Index and Absolute Concentration Index showed few if any inequalities for Zika. The socioeconomic-specific model showed increased disease rates at MMHI below US$400 in Brazil and at SES-index below level four, in Colombia.

Conclusions: We provide robust quantitative estimates of socioeconomic inequalities in arboviruses for two Latin American cities. Our findings could inform policymaking by identifying spatial hotspots for arboviruses and targeting strategies to decrease disparities at the local level.
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http://dx.doi.org/10.1111/tmi.13530DOI Listing
March 2021

Migrant status, ethnicity and COVID-19: more accurate European data are greatly needed.

Clin Microbiol Infect 2021 Feb 23;27(2):160-162. Epub 2020 Oct 23.

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

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http://dx.doi.org/10.1016/j.cmi.2020.10.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7582038PMC
February 2021

A pragmatic stepped-wedge cluster randomized trial to evaluate the effectiveness and cost-effectiveness of active case finding for household contacts within a routine tuberculosis program, San Juan de Lurigancho, Lima, Peru.

Int J Infect Dis 2020 Nov 18;100:95-103. Epub 2020 Sep 18.

Departments of Medicine and Epidemiology, David Geffen School of Medicine, Jonathan & Karin Fielding School of Public Health, University of California, Los Angeles, CA, United States. Electronic address:

Background: Active case finding (ACF) in household contacts of tuberculosis (TB) patients is now recommended for National TB Programs (NTP) in low- and middle-income countries. However, evidence supporting these recommendations remains limited. This study evaluates the effectiveness and cost-effectiveness of ACF for household contacts of TB cases in a large TB endemic district of Lima, Peru.

Methods: A pragmatic stepped-wedge cluster randomized controlled trial was conducted in 34 health centers of San Juan de Lurigancho district. Centers were stratified by TB rate and randomly allocated to initiate ACF in groups of eight or nine centers at four-month intervals. In the intervention arm, NTP providers visited households of index patients to screen contacts for active TB. The control arm was routine passive case finding (PCF) of symptomatic TB cases. The primary outcomes were the crude and adjusted active TB case rates among household contacts. Program costs were directly measured, and the cost-effectiveness of the ACF intervention was determined.

Findings: 3222 index TB cases and 12,566 household contacts were included in the study. ACF identified more household contact TB cases than PCF, 199.29/10,000 contacts/year vs. 132.13 (incidence rate ratio of 1.51 (95% CI 1.21-1.88)). ACF was associated with an incremental cost-effectiveness ratio of US $16,400 per disability-adjusted life year averted and not cost-effective assuming a willingness-to-pay threshold for Peru of US $6360.

Conclusion: ACF of TB case household contacts detected significantly more secondary TB cases than PCF alone, but was not cost-effective in this setting. In threshold analyses, ACF becomes cost-effective if associated with case detection rates 2.5 times higher than existing PCF programs.
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http://dx.doi.org/10.1016/j.ijid.2020.09.034DOI Listing
November 2020

Evaluation of propensity score used in cardiovascular research: a cross-sectional survey and guidance document.

BMJ Open 2020 08 26;10(8):e036961. Epub 2020 Aug 26.

Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada

Background: Propensity score (PS) methods are frequently used in cardiovascular clinical research. Previous evaluations revealed poor reporting of PS methods, however a comprehensive and current evaluation of PS use and reporting is lacking. The objectives of the present survey were to (1) evaluate the quality of PS methods in cardiovascular publications, (2) summarise PS methods and (3) propose key reporting elements for PS publications.

Methods: A PubMed search for cardiovascular PS articles published between 2010 and 2017 in high-impact general medical (top five by impact factor) and cardiovascular (top three by impact factor) journals was performed. Articles were evaluated for the reporting of PS techniques and methods. Data extraction elements were identified from the PS literature and extraction forms were pilot tested.

Results: Of the 306 PS articles identified, most were published in (29%; n=88), and (27%, n=81), followed by (15%; n=47). PS matching was performed most often, followed by direct adjustment, inverse probability of treatment weighting and stratification. Most studies (77%; n=193) selected variables to include in the PS model a priori. A total of 38% (n=116) of studies did not report standardised mean differences, but instead relied on hypothesis testing. For matching, 92% (n=193) of articles presented the balance of covariates. Overall, interpretations of the effect estimates corresponded to the PS method conducted or described in 49% (n=150) of the reviewed articles.

Discussion: Although PS methods are frequently used in high-impact medical journals, reporting of methodological details has been inconsistent. Improved reporting of PS results is warranted and these proposals should aid both researchers and consumers in the presentation and interpretation of PS methods.
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http://dx.doi.org/10.1136/bmjopen-2020-036961DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451534PMC
August 2020

Towards a better integration of social sciences in arbovirus research and decision-making: an experience from scientific collaboration between Cuban and Quebec institutions.

Glob Health Promot 2020 Dec 14;27(4):157-163. Epub 2020 Aug 14.

University of Montreal Public Health Research Institute (IRSPUM), Montreal, Canada.

In 2017, the Institute of Tropical Medicine Pedro Kourí, University of Montreal Public Health Research Institute, and McGill University joined efforts to provide scenarios for scientific exchange and knowledge dissemination about the social science contribution on arboviral research. This commentary describes the scientific collaboration between Cuban and Canadian (Quebec) institutions, illustrating the need and opportunities to facilitate research and effective decision-making processes for arboviral prevention and control, going beyond traditional biomedical aspects. We organized a set of scientific activities within three international events conducted in Cuba between 2017 and 2018. Given the collaborating institutions' expertise and the knowledge gaps in arboviral research, we selected three main thematic areas: social determinants and equity, community-based interventions and use of evidence for decision-making. The partnership shows that interdisciplinary collaboration and the use and integration of quantitative and qualitative methods from the social sciences is essential to face the current challenges in arbovirus research.
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http://dx.doi.org/10.1177/1757975920943859DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7750670PMC
December 2020

Regional variation in Black infant mortality: The contribution of contextual factors.

PLoS One 2020 11;15(8):e0237314. Epub 2020 Aug 11.

Department of Pediatrics, Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts, United States of America.

Background: Compared to other racial/ethnic groups, infant mortality rates (IMR) are persistently highestamong Black infants in the United States, yet there is considerable regional variation. We examined state and county-level contextual factors that may explain regional differences in Black IMR and identified potential strategies for improvement.

Methods And Findings: Black infant mortality data are from the Linked Birth/Infant Death files for 2009-2011. State and county contextual factors within social, economic, environmental, and health domains were compiled from various Census databases, the Food Environment Atlas, and the Area Health Resource File. Region was defined by the nine Census Divisions. We examined contextual associations with Black IMR using aggregated county-level Poisson regression with standard errors adjusted for clustering by state. Overall, Black IMR varied 1.5-fold across regions, ranging from 8.78 per 1,000 in New England to 13.77 per 1,000 in the Midwest. In adjusted models, the following factors were protective for Black IMR: higher state-level Black-White marriage rate (rate ratio (RR) per standard deviation (SD) increase = 0.81, 95% confidence interval (CI):0.70-0.95), higher state maternal and child health budget per capita (RR per SD = 0.96, 95% CI:0.92-0.99), and higher county-level Black index of concentration at the extremes (RR per SD = 0.85, 95% CI:0.81-0.90). Modeled variables accounted for 35% of the regional variation in Black IMR.

Conclusions: These findings are broadly supportive of ongoing public policy efforts to enhance social integration across races, support health and social welfare program spending, and improve economic prosperity. Although contextual factors accounted for about a third of regional variation, further research is needed to more fully understand regional variation in Black IMR disparities.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237314PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7418975PMC
October 2020

Prevalence, Incidence, and Years Lived With Disability Due to Gout and Its Attributable Risk Factors for 195 Countries and Territories 1990-2017: A Systematic Analysis of the Global Burden of Disease Study 2017.

Arthritis Rheumatol 2020 11 10;72(11):1916-1927. Epub 2020 Sep 10.

Institute of Bone and Joint Research, The University of Sydney, Sydney, New South Wales, Australia.

Objective: To describe the levels and trends of point prevalence, annual incidence, and years lived with disability (YLD) for gout and its attributable risk factors in 195 countries and territories from 1990 to 2017 according to age, sex, and Sociodemographic Index (SDI; a composite of sociodemographic factors).

Methods: Data were extracted from the Global Burden of Disease (GBD) 2017 study. A comprehensive systematic review of databases and the disease-modeled analysis were performed by the GBD team at the Institute for Health Metrics and Evaluation, in collaboration with researchers and experts worldwide, to provide estimates at global, regional, and national levels during 1990 and 2017. Counts and age-standardized rates per 100,000 population, along with 95% uncertainty intervals (95% UIs), were reported for point prevalence, annual incidence, and YLD.

Results: Globally, there were ~41.2 million (95% UI 36.7 million, 46.1 million) prevalent cases of gout, with 7.4 million incident cases per year (95% UI 6.6 million, 8.5 million) and almost 1.3 million YLD (95% UI 0.87 million, 1.8 million) in 2017. The global age-standardized point prevalence estimates and annual incidence rates in 2017 were 510.6 (95% UI 455.6, 570.3) and 91.8 (95% UI 81.3, 104.1) cases per 100,000 population, respectively, an increase of 7.2% (95% UI 6.4%, 8.1%) and 5.5% (95% UI 4.8%, 6.3%) from 1990. The corresponding age-standardized YLD rate was 15.9 (95% UI 10.7, 21.8) cases per 100,000 persons, a 7.2% increase (95% UI 5.9%, 8.6%) from 1990. In 2017, the global point prevalence estimates for gout were higher in males, and higher prevalence was seen in older age groups and increased with age for both males and females. The burden of gout was generally highest in developed regions and countries. The 3 countries with the highest age-standardized point prevalence estimates of gout in 2017 were New Zealand (1,394.0 cases [95% UI 1,290.1, 1,500.9]), Australia (1,171.4 cases [95% UI 1,038.1, 1,322.9]), and the US (996.0 cases [95% UI 923.1, 1,076.8]). The countries with the highest increases in age-standardized point prevalence estimates of gout from 1990 to 2017 were the US (34.7% [95% UI 27.7%, 43.1%]), Canada (28.5% [95% UI 21.9%, 35.4%]), and Oman (28.0% [95% UI 21.5%, 34.8%]). Globally, high body mass index and impaired kidney function accounted for 32.4% (95% UI 18.7%, 49.2%) and 15.3% (95% UI 13.5%, 17.1%), respectively, of YLD due to gout in the 2017 estimates. The YLD attributable to these risk factors were higher in males.

Conclusion: The burden of gout increased across the world from 1990 to 2017, with variations in point prevalence, annual incidence, and YLD between countries and territories. Besides improving the clinical management of disease, prevention and health promotion in communities to provide basic knowledge of the disease, risk factors, consequences, and effective treatment options (tailoring to high-risk groups such as the middle-aged male population) are crucial to avoid disease onset and hence to decrease the global disease burden.
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http://dx.doi.org/10.1002/art.41404DOI Listing
November 2020

Transmission of SARS-CoV-2 by Children.

Dtsch Arztebl Int 2020 08;117(33-34):553-560

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

Background: Six months into the COVID-19 pandemic, children appear largely spared from the direct effects of disease, suggesting age as an important predictor of infection and severity. They remain, however, impacted by far-reaching public health interventions. One crucial question often posed is whether children generally transmit SARS-CoV-2 effectively.

Methods: We assessed the components of transmission and the different study designs and considerations necessary for valid assessment of transmission dynamics. We searched for published evidence about transmission of SARS-CoV-2 by children employing a narrative review methodology through 25 June, 2020.

Results: Transmission dynamics must be studied in repre - sentative pediatric populations with a combination of study designs including rigorous epidemiological studies (e.g. in households, schools, daycares, clinical settings) and laboratory studies while taking into account the social and socio-economic contexts. Viral load (VL) estimates from representative pediatric samples of infected children are missing so far. Currently available evidence suggests that the secondary attack rate stratified by age of the infector is lower for children, however this age pattern needs to be better quantified and understood.

Conclusion: A generalizable pediatric evidence base is urgently needed to inform policy making now, later when facing potential subsequent waves, and extending through a future in which endemicity alongside vaccination may become the enduring reality.
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http://dx.doi.org/10.3238/arztebl.2020.0553DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7376445PMC
August 2020

Commentary: Cynical epidemiology.

Authors:
Jay S Kaufman

Int J Epidemiol 2020 10;49(5):1507-1508

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http://dx.doi.org/10.1093/ije/dyaa096DOI Listing
October 2020

What Was the Goal of the Analysis?

Am J Med 2020 05;133(5):e213-e214

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

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http://dx.doi.org/10.1016/j.amjmed.2020.01.010DOI Listing
May 2020

Unjustified assertions regarding race and ethnicity in clinical decision-making (Re: The effect of ethnicity on semen analysis and hormones in the infertile patient, CUAJ, Feb 2020).

Can Urol Assoc J 2020 Apr 1;14(4):143. Epub 2020 Apr 1.

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

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http://dx.doi.org/10.5489/cuaj.6265DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7124166PMC
April 2020

The impact of anti-tobacco legislation on birth weight in Peru.

Glob Health Res Policy 2020 28;5. Epub 2020 Feb 28.

2Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.

Background: Tobacco exposure remains a significant issue for public health, especially for pregnant women. It increases the risk for premature labor, low birth weight and small for gestational age (SGA), among other effects. To reduce these risks, many countries have enacted public policies to curb tobacco exposure. Peru enacted anti-tobacco laws that forbid smoking in public places, require prevention text and images in products and publicity, along with restriction of sales to adults. We evaluated the effect of the implementation of this law on newborn outcomes: birth weight, prematurity and SGA.

Methods: This was a quasi-experimental study that utilized data from the Peruvian Live Birth Registry. Children born to mothers from urban areas were the intervention group, while children born to mothers from rural areas were considered the control group. Only singletons with information on birth weight and gestational age, born to mothers aged 12 to 49 years were included in the study. In addition, newborns with birth weights greater than + 4 standard deviations (SD) or less than - 4 SD from the gestational age-specific mean were excluded. To measure the effect of legislation on birth weight we performed a difference in differences analysis.

Results: A total of 2,029,975 births were included in the analysis. After adjusting for characteristics of the mother and the child, and contextual variables, the anti-tobacco law in Peru reduced the incidence of prematurity by 30 cases per 10,000 live births (95% CI: 19 to 42).

Conclusions: The reform had negligible effects on overall birth weights and on the incidence of SGA. This modest result suggests the need for a more aggressive fight against tobacco, prohibiting all types of advertising and promotion of tobacco products, among others measures.
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http://dx.doi.org/10.1186/s41256-020-00136-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7048150PMC
February 2020

Step-Up Therapy in Black Patients with Asthma.

N Engl J Med 2020 01;382(4):390-391

Loyola University Medical School, Maywood, IL.

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http://dx.doi.org/10.1056/NEJMc1915819DOI Listing
January 2020

Genetic instruments with too many strings: acknowledging pleiotropy and population structure in Mendelian randomization studies.

Eur Heart J 2020 02;41(7):892-893

Department of Biostatistics, Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), 117609, Singapore.

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http://dx.doi.org/10.1093/eurheartj/ehz943DOI Listing
February 2020

Impact of State-Level Changes on Maternal Mortality: A Population-Based, Quasi-Experimental Study.

Am J Prev Med 2020 02 16;58(2):165-174. Epub 2019 Dec 16.

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

Introduction: Recent increases in maternal mortality and persistent disparities have led to speculation about why the U.S. has higher rates than most high-income countries. The aim was to examine the impact of changes in state-level factors plausibly linked to maternal mortality on overall rates and by race/ethnicity.

Methods: This quasi-experimental, population-based, difference-in-differences study used 2007-2015 National Vital Statistics System microdata mortality files from 38 states and DC. The primary exposures were 5 state-level sexual and reproductive health indicators and 6 health and economic conditions. Maternal mortality rate was defined as number of deaths of women while pregnant or within 42 days of termination of pregnancy per 100,000 live births. A difference-in-differences zero-inflated negative binomial regression model was estimated using the race/ethnicity-age-state-year population as the denominator and adjusting for race/ethnicity, age, state, and year. Data were analyzed in 2017-2018.

Results: There were 4,767 deaths among women up to age 44 years, resulting in a maternal mortality rate of 17.9. Reducing the proportion of Planned Parenthood clinics by 20% from the state-year mean increased the maternal mortality rate by 8% (incidence rate ratio, 1.08; 95% CI=1.04, 1.12). States that enacted legislation to restrict abortions based on gestational age increased the maternal mortality rate by 38% (incidence rate ratio, 1.38; 95% CI=1.03, 1.84). Planned Parenthood clinic closures negatively impacted all women, increasing mortality by 6%-15% across racial/ethnic groups, whereas gestational limits primarily increased mortality among white women.

Conclusions: Recent fiscal and legislative changes reducing women's access to family planning and reproductive health services have contributed to rising maternal mortality rates.
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http://dx.doi.org/10.1016/j.amepre.2019.09.012DOI Listing
February 2020

Using change in a seat belt law to study racially-biased policing in South Carolina.

Prev Med 2020 01 6;130:105884. Epub 2019 Nov 6.

Department of Epidemiology, Biostatistics & Occupational Health, McGill University, 1020 Pine Avenue West, Room 27, Montreal, QC H3A 1A2, Canada.

Seat belt laws have increased seat belt use in the US and contributed to reduced fatalities and injuries. However, these policies provide the potential for increased discrimination. The objective of this study is to determine whether a change in seat belt use enforcement led to a differential change in the number of stops, arrests, and searches to White, Black and Hispanic drivers in one US state. We used data on 1,091,424 traffic stops conducted by state troopers in South Carolina in 2005 and 2006 to examine how the change from secondary to primary enforcement of seat belt use in December 2005 affected the number of stops, arrests, and searches to White, Black, and Hispanic drivers using quasi-Poisson and logistic regressions. We found that the policy led to a 50% increase in the number of non-speeding stops for White drivers, and that this increase was 5% larger among Black drivers [RR (95% CI) = 1.05 (1.00, 1.10)], but not larger among Hispanic drivers [1.00 (0.93, 1.08)]. The policy decreased arrests and searches among non-speeding stops, with larger decreases for Black vs. White drivers [RR searches = 0.86 (0.81, 0.91) and RR arrests = 0.90 (0.85, 0.96)]. For Hispanic drivers, effects of the policy change were also found among stops for speeding, which failed the falsification test and suggested that other changes likely affected this group. These findings may support the hypothesis of differential enforcement of seat belt policy in South Carolina for Black and White drivers.
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http://dx.doi.org/10.1016/j.ypmed.2019.105884DOI Listing
January 2020

RE: "INVESTIGATION OF THE OBESITY PARADOX IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE, ACCORDING TO SMOKING STATUS, IN THE UNITED STATES".

Am J Epidemiol 2020 05;189(5):481-482

Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN.

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http://dx.doi.org/10.1093/aje/kwz244DOI Listing
May 2020

Black and White Differences in Life Expectancy in 4 US States, 1969-2013.

Public Health Rep 2019 Nov/Dec;134(6):634-642. Epub 2019 Oct 10.

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

Objectives: Racial differences in mortality in the United States have narrowed and vary by time and place. The objectives of our study were to (1) examine the gap in life expectancy between white and black persons (hereinafter, racial gap in life expectancy) in 4 states (California, Georgia, Illinois, and New York) and (2) estimate trends in the contribution of major causes of death (CODs) to the racial gap in life expectancy by age group.

Methods: We extracted data on the number of deaths and population sizes for 1969-2013 by state, sex, race, age group, and 6 major CODs. We used a Bayesian time-series model to smooth and impute mortality rates and decomposition methods to estimate trends in sex- and age-specific contributions of CODs to the racial gap in life expectancy.

Results: The racial gap in life expectancy at birth decreased in all 4 states, especially among men in New York (from 8.8 to 1.1 years) and women in Georgia (from 8.0 to 1.7 years). Although few deaths occurred among persons aged 1-39, racial differences in mortality at these ages (mostly from injuries and infant mortality) contributed to the racial gap in life expectancy, especially among men in California (1.0 year of the 4.3-year difference in 2013) and Illinois (1.9 years of the 6.7-year difference in 2013). Cardiovascular deaths contributed most to the racial gap in life expectancy for adults aged 40-64, but contributions decreased among women aged 40-64, especially in Georgia (from 2.8 to 0.5 years). The contribution of cancer deaths to inequality increased in California and Illinois, whereas New York had the greatest reductions in inequality attributable to cancer deaths (from 0.6 to 0.2 years among men and from 0.2 to 0 years among women).

Conclusions: Future research should identify policy innovations and economic changes at the state level to better understand New York's success, which may help other states emulate its performance.
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http://dx.doi.org/10.1177/0033354919878158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832087PMC
February 2020

Effects of Hypothetical Interventions on Ischemic Stroke Using Parametric G-Formula.

Stroke 2019 11 4;50(11):3286-3288. Epub 2019 Sep 4.

Department of Epidemiology, University of Pittsburgh PA (A.I.N.).

Background and Purpose- Standard analytic approaches (eg, logistic regression) fail to adequately control for time-dependent confounding and, therefore, may yield biased estimates of the total effect of the exposure on the outcome. In the present study, we estimate the effect of body mass index, intentional physical activity, HDL (high-density lipoprotein) cholesterol, LDL (low-density lipoprotein) cholesterol, hypertension, and cigarette smoking on the 11-year risk of ischemic stroke by sex using the parametric g-formula to control time-dependent confounders. Methods- Using data from the MESA (Multi-Ethnic Study of Atherosclerosis), we followed 6809 men and women aged 45 to 84 years. We estimated the risk of stroke under 6 hypothetical interventions: maintaining body mass index <25 kg/m, maintaining normotension (systolic blood pressure <140 and diastolic <90 mm Hg), quitting smoking, maintaining HDL >1.55 mmol/L, maintaining LDL <3.11 mmol/L, and exercising at least 210 minutes per week. The effects of joint hypothetical interventions were also simulated. Results- In men, the 11-year risk of ischemic stroke would be reduced by 85% (95% CI, 66-96) for all 6 hypothetical interventions. In women, this same effect was estimated as 55% (95% CI, 6-82). Conclusions- The hypothetical interventions explored in our study resulted in risk reduction in both men and women.
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http://dx.doi.org/10.1161/STROKEAHA.119.025749DOI Listing
November 2019

Heterogeneous Treatment Response by Race Cannot Be Claimed in the Absence of Evidence.

Am J Hypertens 2020 02;33(2):e1

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

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http://dx.doi.org/10.1093/ajh/hpz127DOI Listing
February 2020

Health profile differences between recipients and non-recipients of the Brazilian Income Transfer Program in a low-income population.

Cad Saude Publica 2019 07 4;35(6):e00141218. Epub 2019 Jul 4.

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

We investigated the relationship between living in a household that receives the Brazilian Income Transfer Program (Bolsa Família, in Portuguese - BF), a Brazilian conditional cash transfer program, and aspects of health and whether these relationships are heterogeneous across the 27 Brazilian states. According to data from the 2013 Brazilian National Health Survey, 18% of households participated in BF. Among households with household per capita income below BRL 500, many aspects of health differed between people living in BF and non-BF houses. For example, BF households were less likely to have medical coverage but more likely to have visited the doctor in the last 12 months as well as being more likely to smoke and less likely to do exercise. They ate nearly one less serving of fruits and vegetables a week but were less likely to substitute junk food for a meal. They reported worse self-rated health but did not differ importantly on reporting illnesses. Moderate amounts of heterogeneity in the difference in health characteristics were found for some variables. For instance, medical coverage had an I2 value of 40.7% and the difference in coverage between BF and non-BF households ranged from -0.09 to -0.03. Some illnesses differed qualitatively across states such as high cholesterol, asthma and arthritis. This paper is the first to outline the health profile of people living in households receiving payments from a cash transfer program. It is also the first to find geographic heterogeneity in the relationship between a cash transfer program and health variables. These results suggest the possibility that the effect of cash transfer programs may differ based on the population on which it is implemented.
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http://dx.doi.org/10.1590/0102-311X00141218DOI Listing
July 2019

The impact of increasing the minimum legal age for work on school attendance in low- and middle-income countries.

SSM Popul Health 2019 Aug 6;8:100426. Epub 2019 Jun 6.

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

Several countries have increased their legal minimum age for work in line with international conventions on child labor. We evaluated the effect of increasing the legal minimum age for work on school attendance in 3 low- and middle-income countries using difference-in-differences analyses. Increasing the legal minimum age for work increased school attendance by 3.0 (0.2, 5.8) percentage-points in Malawi, and 2.0 (0.2, 3.6) percentage-points in Colombia. In Malawi, we found a greater policy effect among girls compared to boys. In Colombia, the poorest tercile experienced the greatest improvement in educational outcomes. We found no evidence of an impact of increasing the legal minimum age for work on school attendance in Burkina Faso. Our findings suggest that increasing the legal minimum age for work has had a positive effect on educational outcomes in some low and middle income countries.
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http://dx.doi.org/10.1016/j.ssmph.2019.100426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6593206PMC
August 2019