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American Journal of Epidemiology
Journal Prestige (SJR): 2.713
Citation Impact (citeScore): 3
Number of Followers: 166  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9262 - ISSN (Online) 1476-6256
Published by Oxford University Press Homepage  [396 journals]
  • The Brazilian Longitudinal Study of Aging (ELSI-Brazil): Objectives and
           Design
    • Authors: Lima-Costa M; de Andrade F, Souza P, et al.
      Pages: 1345 - 1353
      Abstract: Brazil is experiencing among the world’s fastest demographic aging worldwide. This demographic transition is occurring in a context of few resources and great social inequalities. The Brazilian Longitudinal Study of Aging (ELSI-Brazil) is a nationally representative study of 9,412 people aged 50 years or older, residing in 70 municipalities across the 5 Brazilian regions. ELSI-Brazil allows investigations of the aging process, its health, psychosocial and economic determinants, and societal consequences. The baseline examination (2015–2016) included detailed household and individual interviews and physical measurements (blood pressure, anthropometry, grip strength, and timed walk and balance tests). Blood tests and sample storage were performed in a subsample of study participants. Subsequent waves are planned for every 3 years. The study adopts a conceptual framework common to other large-scale longitudinal studies of aging in the world, such as the Health and Retirement Study, allowing cross-national comparisons. The goal of ELSI-Brazil is not only to build an understanding of aging in a large, Western, middle-income country in a rapid demographic transition but also to provide scientific data to support and study policy changes that may affect older adults. We describe the methodology of the study and some descriptive results of the baseline survey.
      PubDate: Wed, 31 Jan 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwx387
      Issue No: Vol. 187, No. 7 (2018)
       
  • Placental Weight and Risk of Cryptorchidism and Hypospadias in the
           Collaborative Perinatal Project
    • Authors: Ghazarian A; Trabert B, Graubard B, et al.
      Pages: 1354 - 1361
      Abstract: Cryptorchidism and hypospadias are the most common congenital anomalies of the genitourinary tract in males, but their etiology remains unclear. Placental insufficiency has been suggested to be linked to both conditions. Placental weight is a commonly used proxy measure for placental insufficiency; thus, we examined placental weight and other placental characteristics in relation to cryptorchidism and hypospadias in the Collaborative Perinatal Project, a US mother-child cohort study. Pregnant women were recruited between 1959 and 1965. The analysis contrasted boys with cryptorchidism (n = 413) and boys with hypospadias (n = 145) with boys without cryptorchidism (n = 23,799) and boys without hypospadias (n = 22,326). Odds ratios and 95% confidence intervals were calculated using unconditional logistic regression. In categorical analyses in which the middle tertile was the referent, cryptorchidism was inversely associated with placental weight (odds ratio = 0.66, 95% confidence interval: 0.46, 0.95) among white boys and positively associated with the lowest tertile of placental weight among black boys (odds ratio = 1.70, 95% confidence interval: 1.11, 2.59). We conclude that lower placental weight may be related to risk of cryptorchidism. Further investigation of placental functioning may offer insights into the etiology of cryptorchidism.
      PubDate: Tue, 16 Jan 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy005
      Issue No: Vol. 187, No. 7 (2018)
       
  • Associations Between Maternal Obesity and Pregnancy Hyperglycemia and
           Timing of Puberty Onset in Adolescent Girls: A Population-Based Study
    • Authors: Kubo A; Deardorff J, Laurent C, et al.
      Pages: 1362 - 1369
      Abstract: Early puberty is associated with adverse health outcomes. We investigated whether in utero exposure to maternal obesity is associated with daughters’ pubertal timing using 15,267 racially/ethnically diverse Kaiser Permanente Northern California members aged 6–11 years with pediatrician-assessed Tanner staging (2003–2017). We calculated maternal body mass index (BMI; weight (kg)/height (m)2) during pregnancy from the electronic health record data. Using a proportional hazards model with interval censoring, we examined the associations between maternal obesity and girls’ pubertal timing, as well as effect modification by race/ethnicity and mediation by prepubertal BMI. Maternal obesity (BMI ≥30) and overweight (BMI 25–29.9) were associated with earlier onset of breast development in girls (hazard ratio (HR) = 1.39 (95% confidence interval (CI): 1.30, 1.49) and HR = 1.21 (95% CI: 1.13, 1.29), respectively), after adjustment for girl’s race/ethnicity, maternal age, education, parity, and smoking during pregnancy. There was interaction by race/ethnicity for associations between maternal obesity and girls’ pubic hair onset: Associations were strongest among Asian and non-Hispanic white girls (HR = 1.53 (95% CI: 1.24, 1.90) and HR = 1.34 (95% CI: 1.18, 1.52), respectively) and absent for African-American girls. Adjustment for girl’s prepubertal BMI only slightly attenuated associations. Our results suggest the importance of maternal metabolic factors during pregnancy in the timing of girls’ puberty and potential differences in the associations by race/ethnicity.
      PubDate: Thu, 15 Mar 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy040
      Issue No: Vol. 187, No. 7 (2018)
       
  • Type of Menopause, Age at Menopause, and Risk of Developing Obstructive
           Sleep Apnea in Postmenopausal Women
    • Authors: Huang T; Lin B, Redline S, et al.
      Pages: 1370 - 1379
      Abstract: Despite established sex differences and longstanding hypotheses of sex hormone influence in the etiology of obstructive sleep apnea (OSA), we have found no studies that evaluated type of menopause and age at menopause, which affect postmenopausal hormonal milieu, in relation to OSA risk in women. We followed 50,473 postmenopausal women from the Nurses’ Health Study during 2002–2012 and 53,827 postmenopausal women from the Nurses’ Health Study II during 1995–2013, with 1,712 and 2,560 incident OSA diagnoses, respectively. Compared with natural menopause, the pooled hazard ratio for OSA was 1.27 (95% confidence interval (CI): 1.17, 1.38) for surgical menopause by hysterectomy/oophorectomy. The association remained the same after further accounting for age at menopause (hazard ratio = 1.26, 95% CI: 1.15, 1.38). The risk associated with surgical menopause was higher among women who were not obese as well as among women who never used hormone therapy (P for interaction < 0.05). Earlier menopause was associated with higher OSA risk prior to adjustment for type of menopause (comparing those aged <40 years versus those aged 50–54 years, hazard ratio = 1.21, 95% CI: 1.08, 1.35; P for trend = 0.008), although no association was observed after the adjustment. Surgical as compared with natural menopause was independently associated with higher OSA risk in postmenopausal women. Our results provide additional evidence for a role for sex hormones, particularly abrupt hormonal changes, in modulating OSA risk.
      PubDate: Mon, 22 Jan 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy011
      Issue No: Vol. 187, No. 7 (2018)
       
  • Type 2 Diabetes and Risk of Incident Cancer in China: A Prospective Study
           Among 0.5 Million Chinese Adults
    • Authors: Pan X; He M, Yu C, et al.
      Pages: 1380 - 1391
      Abstract: Using data from the China Kadoorie Biobank Study, we conducted a prospective investigation on the association between type 2 diabetes mellitus (T2DM) and cancer risk in Chinese adults. A total of 508,892 participants (mean age = 51.5 (standard deviation, 10.7) years) without prior cancer diagnosis at baseline (2004–2008) were included. We documented 17,463 incident cancer cases during follow-up through December 31, 2013. Participants with T2DM had increased risks of total and certain site-specific cancers; hazard ratios were 1.13 (95% confidence interval (CI): 1.07, 1.19) for total cancer, 1.51 (95% CI: 1.29, 1.76) for liver cancer, 1.86 (95% CI: 1.43, 2.41) for pancreatic cancer, and 1.21 (95% CI: 1.01, 1.47) for female breast cancer. The associations were largely consistent when physician-diagnosed and screen-detected T2DM were analyzed separately, except for colorectal cancer (for physician-diagnosed T2DM, HR = 0.91 (95% CI: 0.73, 1.13), and for screen-detected T2DM, HR = 1.44 (95% CI: 1.18, 1.77)). In participants without a prior diagnosis of T2DM, higher random blood glucose levels were positively associated with risks of total cancer, liver cancer, and female breast cancer (all P’s for trend ≤ 0.02). In conclusion, T2DM is associated with an increased risk of new-onset cancer in China, particularly cancers of the liver, pancreas, and female breast.
      PubDate: Wed, 03 Jan 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwx376
      Issue No: Vol. 187, No. 7 (2018)
       
  • Hyperhomocysteinemia and Risk of First Venous Thrombosis: The Influence of
           (Unmeasured) Confounding Factors
    • Authors: Ospina-Romero M; Cannegieter S, den Heijer M, et al.
      Pages: 1392 - 1400
      Abstract: Meta-analyses have reported a 2- to 3-fold increased risk of venous thrombosis (VT) in individuals with hyperhomocysteinemia. However, confounding factors were generally not considered. In contrast, randomized trials of homocysteine-lowering therapy and VT risk have been negative. We investigated whether hyperhomocysteinemia was associated with VT in the Multiple Environmental and Genetic Assessment of Risk Factors for Venous Thrombosis (MEGA) case-control study (1999–2004) from the Netherlands (1,689 cases and 1,726 controls), taking into account measured and unmeasured confounders. We compared patients with population controls to estimate odds ratios using unconditional logistic regression and adjusted for various potential confounders. We matched patients to their partners to additionally adjust for unmeasured confounders (e.g., lifestyle factors) using conditional logistic regression. We found that elevated homocysteine concentrations were not associated with an increased risk for VT when comparing patients with population controls, either as a continuous variable (odds ratio = 1.00, 95% confidence interval: 0.99, 1.01), in terms of 0.7-mg/L increase (odds ratio = 0.99, 95% confidence interval: 0.93, 1.05), or within different homocysteine categories. We obtained similar results when patients were compared with their partners. Stratification by sex, deep vein thrombosis, pulmonary embolism, provoked VT, and unprovoked VT also provided no evidence of an association. In conclusion, after extensive adjustments for confounding, hyperhomocysteinemia was not associated with an increased risk of venous thrombosis in this study.
      PubDate: Fri, 12 Jan 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy004
      Issue No: Vol. 187, No. 7 (2018)
       
  • Variation of Caregiver Health and Mortality Risks by Age: A Census-Based
           Record Linkage Study
    • Authors: Tseliou F; Rosato M, Maguire A, et al.
      Pages: 1401 - 1410
      Abstract: Due to the focus of studies about caregiving responsibilities on older caregivers, there has been a deficit of research on young caregivers. We aimed to investigate the association between caregiving and health/mortality risk in young caregivers when compared with their noncaregiving peers and older caregivers. A census-based record linkage was implemented, linking all residents enumerated in the 2011 Northern Ireland Census with subsequently registered deaths data, until the end of 2015. Among those aged 5–24 years at the 2011 Census, approximately 4.5% (19,621) of the cohort reported that they were caregivers. The presence of a chronic physical condition (such as mobility difficulties) and/or mental health condition was measured through the Census; all-cause mortality was assessed by official mortality records. Young caregivers were less likely than their noncaregiving peers to report chronic mobility problems (adjusted odds ratio (OR) = 0.84, 95% confidence interval (CI): 0.73, 0.96) but more likely to report chronic poor mental health (adjusted OR = 1.44, 95% CI: 1.31, 1.58). They also differed from older caregivers (P < 0.001) and were at significantly higher mortality risk than their peers (adjusted hazard ratio = 1.54, 95% CI: 1.10, 2.14). A dose-response relationship between hours devoted to caregiving duties and mortality risk was evident. We found that young caregivers were at significantly increased risk of poor health outcomes.
      PubDate: Wed, 31 Jan 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwx384
      Issue No: Vol. 187, No. 7 (2018)
       
  • Dietary Protein and Preservation of Physical Functioning Among Middle-Aged
           and Older Adults in the Framingham Offspring Study
    • Authors: Mustafa J; Ellison R, Singer M, et al.
      Pages: 1411 - 1419
      Abstract: Dietary protein may help prevent age-related declines in strength and functional capacity. This study examines the independent relationship between dietary protein and longitudinal changes in physical functioning among adults participating in the Framingham Offspring Study from examination 5 (1991–1995) to examination 8 (2005–2008). Protein intakes were derived from 3-day diet records during examinations 3 and 5; functional status was determined over 12 years using 7 items selected from standardized questionnaires. Multivariable models adjusted for age, sex, education, physical activity, smoking, height, and energy intake. Functional tasks that benefitted most from a higher-protein diet (≥1.2 g/kg/day vs. <0.8 g/kg/day) were doing heavy work at home, walking 1/2 mile (0.8 km), going up and down stairs, stooping/kneeling/crouching, and lifting heavy items. Those with higher protein intakes were 41% less likely (95% CI: 0.43, 0.82) to become dependent in 1 or more of the functional tasks over follow-up. Higher physical activity and lower body mass index were both independently associated with less functional decline. The greatest risk reductions were found among those with higher protein intakes combined with either higher physical activity, more skeletal muscle mass, or lower body mass index. This study demonstrates that dietary protein intakes above the current US Recommended Daily Allowance may slow functional decline in older adults.
      PubDate: Sat, 24 Mar 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy014
      Issue No: Vol. 187, No. 7 (2018)
       
  • Association of Degree of European Genetic Ancestry With Serum Vitamin D
           Levels in African Americans
    • Authors: Haddad S; Ruiz-Narváez E, Cozier Y, et al.
      Pages: 1420 - 1423
      Abstract: Circulating levels of vitamin D are generally lower in African Americans than in US whites, and 1 prior analysis carried out in a small number of African Americans suggested that, within this population, vitamin D levels may be related to the degree of genetic admixture. We assessed the association between percentage of European ancestry and serum vitamin D level (assessed in 2013–2015) among 2,183 African-American women from the Black Women’s Health Study whose DNA had been genotyped for ancestry-informative markers. ADMIXMAP software was used to estimate the percentage of European ancestry versus African ancestry in each individual. In linear regression analyses with adjustment for genotype batch, age, body mass index, supplemental vitamin D use, ultraviolet B radiation flux in the participant’s state of residence, and season of blood draw, each 10% increase in European ancestry was associated with a 0.67-ng/mL increase in serum vitamin D concentration (95% confidence interval: 0.17, 1.17). The association was statistically significant only among women who were not taking vitamin D supplements (for each 10% increase in European ancestry, β = 0.86, 95% confidence interval: 0.14, 1.57). Among African Americans, use of vitamin D supplements may help to reduce vitamin D deficiency associated with genetic ancestry.
      PubDate: Tue, 30 Jan 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy015
      Issue No: Vol. 187, No. 7 (2018)
       
  • The Great Recession and the Health of Young Children: A Fixed-Effects
           Analysis in Ireland
    • Authors: Reinhard E; Layte R, McCrory C, et al.
      Pages: 1438 - 1448
      Abstract: Economic recessions have been linked to adult health, but few studies have examined how recessions influence the health of young children. This study examined the impact of life transitions linked to the recent financial crisis on the health of young children in Ireland. Data came from the Growing Up in Ireland Infant Cohort Study (n = 11,134), which assessed children before (2008), during (2011), and after (2013) the Great Recession that followed the financial crisis of 2008 and incorporated questions on the impacts of the financial crisis on families. Using fixed-effects models to control for confounding, we found that a reduction in welfare benefits during the recession was associated with a significant increase in the risks of asthma (β = 0.014, 95% confidence interval (95% CI): 0.004, 0.023) and atopy (β = 0.014, 95% CI: 0.001, 0.027). While parental job loss was not associated with child health, a reduction in working hours was associated with increased reports of child health problems (β = 0.024, 95% CI: 0.004, 0.043), as were difficulties affording basic necessities (β = 0.019, 95% CI: 0.001, 0.038). Results suggest that failing to protect vulnerable families and children during economic recessions may have long-lasting implications for child health.
      PubDate: Fri, 12 Jan 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy001
      Issue No: Vol. 187, No. 7 (2018)
       
  • Targeted Estimation of the Relationship Between Childhood Adversity and
           Fluid Intelligence in a US Population Sample of Adolescents
    • Authors: Platt J; McLaughlin K, Luedtke A, et al.
      Pages: 1456 - 1466
      Abstract: Many studies have shown inverse associations between childhood adversity and intelligence, although most are based on small clinical samples and fail to account for the effects of multiple co-occurring adversities. Using data from the 2001–2004 National Comorbidity Survey Adolescent Supplement, a cross-sectional US population study of adolescents aged 13–18 years (n = 10,073), we examined the associations between 11 childhood adversities and intelligence, using targeted maximum likelihood estimation. Targeted maximum likelihood estimation incorporates machine learning to identify the relationships between exposures and outcomes without overfitting, including interactions and nonlinearity. The nonverbal score from the Kaufman Brief Intelligence Test was used as a standardized measure of fluid reasoning. Childhood adversities were grouped into deprivation and threat types based on recent conceptual models. Adjusted marginal mean differences compared the mean intelligence score if all adolescents experienced each adversity to the mean in the absence of the adversity. The largest associations were observed for deprivation-type experiences, including poverty and low parental education, which were related to reduced intelligence. Although lower in magnitude, threat events related to intelligence included physical abuse and witnessing domestic violence. Violence prevention and poverty-reduction measures would likely improve childhood cognitive outcomes.
      PubDate: Tue, 16 Jan 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy006
      Issue No: Vol. 187, No. 7 (2018)
       
  • Residential Racial Isolation and Spatial Patterning of Type 2 Diabetes
           Mellitus in Durham, North Carolina
    • Authors: Bravo M; Anthopolos R, Kimbro R, et al.
      Pages: 1467 - 1476
      Abstract: Neighborhood characteristics such as racial segregation may be associated with type 2 diabetes mellitus, but studies have not examined these relationships using spatial models appropriate for geographically patterned health outcomes. We constructed a local, spatial index of racial isolation (RI) for black residents in a defined area, measuring the extent to which they are exposed only to one another, to estimate associations of diabetes with RI and examine how RI relates to spatial patterning in diabetes. We obtained electronic health records from 2007–2011 from the Duke Medicine Enterprise Data Warehouse. Patient data were linked to RI based on census block of residence. We used aspatial and spatial Bayesian models to assess spatial variation in diabetes and relationships with RI. Compared with spatial models with patient age and sex, residual geographic heterogeneity in diabetes in spatial models that also included RI was 29% and 24% lower for non-Hispanic white and black residents, respectively. A 0.20-unit increase in RI was associated with an increased risk of diabetes for white (risk ratio = 1.24, 95% credible interval: 1.17, 1.31) and black (risk ratio = 1.07, 95% credible interval: 1.05, 1.10) residents. Improved understanding of neighborhood characteristics associated with diabetes can inform development of policy interventions.
      PubDate: Mon, 14 May 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy026
      Issue No: Vol. 187, No. 7 (2018)
       
  • Resistance and Susceptibility to Mycobacterium tuberculosis Infection and
           Disease in Tuberculosis Households in Kampala, Uganda
    • Authors: Stein C; Zalwango S, Malone L, et al.
      Pages: 1477 - 1489
      Abstract: Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), remains a major public health problem. Household contact studies identify children and adults along the spectrum from Mtb exposure to disease. In the Kawempe Community Health Study (conducted in Kampala, Uganda), 872 culture-confirmed pulmonary TB cases and their 2,585 contacts were enrolled during 2002–2012 and followed for up to 2 years each. Risk factors identified by time-to-event analysis for secondary TB differed among children, women, and men. Younger age (P = 0.0061), human immunodeficiency virus (HIV) (P = 0.0002), thinness (P = 0.01), absent bacille Calmette-Guérin vaccination (P = 0.002), and epidemiologic risk score (P < 0.0001) were risks for children. For women, risks were HIV (P < 0.0001), thinness (World Health Organization criteria; P < 0.0001), and epidemiologic risk score (P = 0.003). For men, HIV (P = 0.0007) and low body mass index (P = 0.008) resulted in faster progression to TB. Tuberculin skin testing (TST) identified contacts with Mtb infection and those with persistently negative TST. Risks for faster time to Mtb infection were identified, and included age (P = 0.0007), baseline TST induration (P < 0.0001), and epidemiologic risk score (P < 0.0001) only in children. Those with persistently negative TST comprised 10% of contacts but had no unique epidemiologic characteristics among adults. The burden of Mtb infection and disease is high in TB households, and risk factors for progression from exposure to infection and disease differ among children, women, and men.
      PubDate: Wed, 03 Jan 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwx380
      Issue No: Vol. 187, No. 7 (2018)
       
  • Effectiveness of Respiratory Syncytial Virus Immunoprophylaxis in Reducing
           Bronchiolitis Hospitalizations Among High-Risk Infants
    • Authors: Wu P; Escobar G, Gebretsadik T, et al.
      Pages: 1490 - 1500
      Abstract: We sought to determine the real-world effectiveness of respiratory syncytial virus (RSV) immunoprophylaxis in a population-based cohort to inform policy. The study population included infants born during 1996–2008 and enrolled in the Kaiser Permanente Northern California integrated health-care delivery system. During the RSV season (November–March), the date of RSV immunoprophylaxis administration and the following 30 days were defined as RSV immunoprophylaxis protected period(s), and all other days were defined as unprotected period(s). Numbers of bronchiolitis hospitalizations were determined using International Classification of Diseases, Ninth Revision, codes during RSV season. We used a proportional hazards model to estimate risk of bronchiolitis hospitalization when comparing infants’ protected period(s) with unprotected period(s). Infants who had ever received RSV immunoprophylaxis had a 32% decreased risk of bronchiolitis hospitalization (adjusted hazard ratio = 0.68, 95% confidence interval: 0.46, 1.00) when protected periods were compared with unprotected periods. Infants with chronic lung disease (CLD) had a 52% decreased risk of bronchiolitis hospitalization (adjusted hazard ratio = 0.48, 95% confidence interval: 0.25, 0.94) when protected periods were compared with unprotected periods. Under the new 2014 American Academy of Pediatrics (AAP) guidelines, 48% of infants eligible for RSV immunoprophylaxis on the basis of AAP guidelines in place at birth would no longer be eligible, but nearly all infants with CLD would remain eligible. RSV immunoprophylaxis is effective in decreasing hospitalization. This association is greatest for infants with CLD, a group still recommended for receipt of RSV immunoprophylaxis under the new AAP guidelines.
      PubDate: Wed, 17 Jan 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy008
      Issue No: Vol. 187, No. 7 (2018)
       
  • Examining Nonparticipation in the Maternal Follow-up Within the Danish
           National Birth Cohort
    • Authors: Bliddal M; Liew Z, Pottegård A, et al.
      Pages: 1511 - 1519
      Abstract: A follow-up questionnaire on maternal health was distributed within the Danish National Birth Cohort (established in 1996–2002) 14 years after the index birth. Responses were obtained from 41,466 (53.2%) of 78,010 eligible mothers. To ensure the appropriate use of these data, the possibility of selection bias due to nonparticipation had to be evaluated. We estimated 4 selected exposure-outcome associations (prepregnancy weight–depression; exercise–degenerative musculoskeletal conditions; smoking–heart disease; and alcohol consumption–breast cancer). We adjusted for several factors associated with participation and applied inverse probability weighting. To estimate the degree of selection bias, we calculated relative odds ratios for the relationship between the baseline cohort and the subset participating in the Maternal Follow-up. Participating women were generally healthier, of higher social status, and older than the baseline cohort. However, selection bias in the chosen scenarios was limited; ratios of the odds ratios ranged from −14% to 5% after adjustment for age, parity, social status, and, if the variable was not the exposure variable, prepregnancy body mass index, exercise, smoking, and alcohol consumption. Applying inverse probability weighting did not further reduce bias. In conclusion, while participants differed somewhat from the baseline cohort, selection bias was limited after factors associated with participation status were accounted for.
      PubDate: Tue, 16 Jan 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy002
      Issue No: Vol. 187, No. 7 (2018)
       
  • Hemoglobin A1c Level and Cardiovascular Disease Incidence in Persons With
           Type 1 Diabetes: An Application of Joint Modeling of Longitudinal and
           Time-to-Event Data in the Pittsburgh Epidemiology of Diabetes
           Complications Study
    • Authors: Miller R; Anderson S, Costacou T, et al.
      Pages: 1520 - 1529
      Abstract: Type 1 diabetes (T1D) is associated with increased risk of cardiovascular disease (CVD), but hyperglycemia (measured by hemoglobin A1c (HbA1c) level), which characterizes T1D, has itself been an inconsistent predictor of CVD incidence. However, only baseline HbA1c or a summary measure (e.g., mean level over follow-up) is usually analyzed. Joint models allow simultaneous modeling of repeatedly measured longitudinal covariates, using random effects, and time-to-event data. We evaluated data from the Pittsburgh Epidemiology of Diabetes Complications Study, an ongoing prospective cohort study of childhood-onset T1D that has followed participants since 1986–1988 and has repeatedly found little association between baseline HbA1c or mean follow-up HbA1c and coronary artery disease incidence. Of 561 participants without CVD at baseline, 263 (46.9%) developed CVD over a period of 25 years (1986–2014). In joint models, each 1% unit increase in HbA1c trajectory was associated with a 1.26-fold increased risk of CVD (95% confidence interval: 1.07, 1.45), after adjustment for baseline levels of other CVD risk factors, and a 1.13-fold increased risk (95% confidence interval: 0.99, 1.32) after adjustment for updated mean levels of other CVD risk factors. These findings, which support the need for good glycemic control to prevent CVD in persons with T1D, underscore the importance of utilizing methods incorporating within-subject variation over time when analyzing and interpreting longitudinal cohort study data.
      PubDate: Wed, 31 Jan 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwx386
      Issue No: Vol. 187, No. 7 (2018)
       
  • Landmark Models for Optimizing the Use of Repeated Measurements of Risk
           Factors in Electronic Health Records to Predict Future Disease Risk
    • Authors: Paige E; Barrett J, Stevens D, et al.
      Pages: 1530 - 1538
      Abstract: The benefits of using electronic health records (EHRs) for disease risk screening and personalized health-care decisions are being increasingly recognized. Here we present a computationally feasible statistical approach with which to address the methodological challenges involved in utilizing historical repeat measures of multiple risk factors recorded in EHRs to systematically identify patients at high risk of future disease. The approach is principally based on a 2-stage dynamic landmark model. The first stage estimates current risk factor values from all available historical repeat risk factor measurements via landmark-age–specific multivariate linear mixed-effects models with correlated random intercepts, which account for sporadically recorded repeat measures, unobserved data, and measurement errors. The second stage predicts future disease risk from a sex-stratified Cox proportional hazards model, with estimated current risk factor values from the first stage. We exemplify these methods by developing and validating a dynamic 10-year cardiovascular disease risk prediction model using primary-care EHRs for age, diabetes status, hypertension treatment, smoking status, systolic blood pressure, total cholesterol, and high-density lipoprotein cholesterol in 41,373 persons from 10 primary-care practices in England and Wales contributing to The Health Improvement Network (1997–2016). Using cross-validation, the model was well-calibrated (Brier score = 0.041, 95% confidence interval: 0.039, 0.042) and had good discrimination (C-index = 0.768, 95% confidence interval: 0.759, 0.777).
      PubDate: Fri, 23 Mar 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy018
      Issue No: Vol. 187, No. 7 (2018)
       
  • Exposure-Lag-Response in Longitudinal Studies: Application of
           Distributed-Lag Nonlinear Models in an Occupational Cohort
    • Authors: Neophytou A; Picciotto S, Brown D, et al.
      Pages: 1539 - 1548
      Abstract: Prolonged exposures can have complex relationships with health outcomes, as timing, duration, and intensity of exposure are all potentially relevant. Summary measures such as cumulative exposure or average intensity of exposure may not fully capture these relationships. We applied penalized and unpenalized distributed-lag nonlinear models (DLNMs) with flexible exposure-response and lag-response functions in order to examine the association between crystalline silica exposure and mortality from lung cancer and nonmalignant respiratory disease in a cohort study of 2,342 California diatomaceous earth workers followed during 1942–2011. We also assessed associations using simple measures of cumulative exposure assuming linear exposure-response and constant lag-response. Measures of association from DLNMs were generally higher than those from simpler models. Rate ratios from penalized DLNMs corresponding to average daily exposures of 0.4 mg/m3 during lag years 31–50 prior to the age of observed cases were 1.47 (95% confidence interval (CI): 0.92, 2.35) for lung cancer mortality and 1.80 (95% CI: 1.14, 2.85) for nonmalignant respiratory disease mortality. Rate ratios from the simpler models for the same exposure scenario were 1.15 (95% CI: 0.89, 1.48) and 1.23 (95% CI: 1.03, 1.46), respectively. Longitudinal cohort studies of prolonged exposures and chronic health outcomes should explore methods allowing for flexibility and nonlinearities in the exposure-lag-response.
      PubDate: Tue, 13 Feb 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy019
      Issue No: Vol. 187, No. 7 (2018)
       
  • Longitudinal Patterns of Physical Activity Among Older Adults: A Latent
           Transition Analysis
    • Authors: Mooney S; Joshi S, Cerdá M, et al.
      Pages: 1549 - 1558
      Abstract: Most epidemiologic studies of physical activity measure either total energy expenditure or engagement in a single type of activity, such as walking. These approaches may gloss over important nuances in activity patterns. We performed a latent transition analysis to identify patterns of activity, as well as neighborhood and individual determinants of changes in those activity patterns, over 2 years in a cohort of 2,023 older adult residents of New York, New York, surveyed between 2011 and 2013. We identified 7 latent classes: 1) mostly inactive, 2) walking, 3) exercise, 4) household activities and walking, 5) household activities and exercise, 6) gardening and household activities, and 7) gardening, household activities, and exercise. The majority of subjects retained the same activity patterns between waves (54% unchanged between waves 1 and 2, 66% unchanged between waves 2 and 3). Most latent class transitions were between classes distinguished only by 1 form of activity, and only neighborhood unemployment was consistently associated with changing between activity latent classes. Future latent transition analyses of physical activity would benefit from larger cohorts and longer follow-up periods to assess predictors of and long-term impacts of changes in activity patterns.
      PubDate: Fri, 11 May 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy027
      Issue No: Vol. 187, No. 7 (2018)
       
  • Applying Multiple Statistical Methods to Derive an Index of Dietary
           Behaviors Most Related to Obesity
    • Authors: Barrington W; Beresford S.
      Pages: 1559 - 1569
      Abstract: To evaluate the success of dietary interventions, we need measures that are more easily assessed and that closely align with intervention messaging. An index of obesogenic dietary behaviors (e.g., consumption of fast food and soft drinks, low fruit and vegetable consumption, and task eating (eating while engaging in other activities)) may serve this purpose and could be derived via data-driven methods typically used to describe nutrient intake. We used behavioral and physical measurement (i.e., body mass index, waist circumference) data from a subset of 2 independent cross-sectional samples of employees enrolled in the Promoting Activity and Changes in Eating (PACE) Study (Seattle, Washington) who were selected at baseline (2005–2007) (n = 561) and during follow-up (2007–2009) (n = 155). Index derivation methods, including principal components regression, partial least squares regression, and reduced rank regression, were compared. The best-fitting index for predicting physical measurements included consumption of fast food, French fries, and soft drinks. In linear mixed models, each 1-quartile increase in index score was associated with a 5% higher baseline body mass index (ratio of geometric means = 1.053, 95% confidence interval: 1.031, 1.075) and an approximately 4% higher baseline waist circumference (ratio = 1.036, 95% confidence interval: 1.019, 1.054) after adjustment for covariates. Results were similar at follow-up before and after adjustment for baseline measures. This index may be useful in evaluating public health or clinic-based dietary interventions to reduce obesity, especially given the ubiquity of these behaviors in the general population.
      PubDate: Mon, 12 Mar 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwx370
      Issue No: Vol. 187, No. 7 (2018)
       
  • RE: “DIETARY INTAKE OF ANTIOXIDANT VITAMINS AND CAROTENOIDS AND RISK OF
           DEVELOPING ACTIVE TUBERCULOSIS IN A PROSPECTIVE POPULATION-BASED COHORT”
           
    • Authors: Yew W; Chan D, Leung C, et al.
      Pages: 1570 - 1571
      PubDate: Fri, 12 Jan 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwx381
      Issue No: Vol. 187, No. 7 (2018)
       
  • RE: “DIETARY INTAKE OF ANTIOXIDANT VITAMINS AND CAROTENOIDS AND RISK OF
           DEVELOPING ACTIVE TUBERCULOSIS IN A PROSPECTIVE POPULATION-BASED COHORT”
           
    • Authors: Griffin I; Algarin A, White S, et al.
      Pages: 1571 - 1572
      PubDate: Fri, 12 Jan 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwx382
      Issue No: Vol. 187, No. 7 (2018)
       
  • THE AUTHORS REPLY
    • Authors: Soh A; Chee C, Wang Y, et al.
      Pages: 1572 - 1573
      PubDate: Fri, 12 Jan 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwx383
      Issue No: Vol. 187, No. 7 (2018)
       
  • RE: “A DECADE OF WAR: PROSPECTIVE TRAJECTORIES OF POSTTRAUMATIC STRESS
           DISORDER SYMPTOMS AMONG DEPLOYED US MILITARY PERSONNEL AND THE INFLUENCE
           OF COMBAT EXPOSURE”
    • Authors: Nevin R.
      Pages: 1573 - 1574
      PubDate: Fri, 04 May 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy072
      Issue No: Vol. 187, No. 7 (2018)
       
  • FOUR AUTHORS REPLY
    • Authors: Donoho C; Bonanno G, Porter B, et al.
      Pages: 1574 - 1575
      PubDate: Fri, 04 May 2018 00:00:00 GMT
      DOI: 10.1093/aje/kwy074
      Issue No: Vol. 187, No. 7 (2018)
       
 
 
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