This edition spans a month of recent studies published by Institute investigators and their collaborators, covering a wide variety of topics, including:

Sample standardization in multi-site studies; measuring health disparities; pathways between greenspace and mortality; health professional attitudes toward pharmacogenomic testing; links between menstrual cycles and menopause; using artificial intelligence to study COVID-19; the history and future of telemedicine for asthma and allergy care.

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Meta-analysis with sample-standardization in multi-site studies
Multi-site pharmacological studies within data networks are ideal to have larger, more representative study samples. However, many studies do not explicitly define the target population and estimand. Led by former Institute fellow Di Shu and senior author Darren Toh, a research team analytically examined standardization as a meta-analytic method for estimating the causal treatment effect for this network-wide target population and compared it with fixed effect and random-effects meta-analyses. The team concludes, in their study published in Pharmacoepidemiology and Drug Safety, that sample-standardization is a valid approach to generate causal inference in multi-site studies when the target population comprises all and only all individuals within the network, even in the presence of heterogeneity of treatment effect by site. They recommend that multi-site studies clearly specify the target population and estimand to help select the most appropriate meta-analytic methods.

Institute Investigator(s): Darren Toh
 

Expanding the potential for reporting hospital-level health disparities
As health disparities research grows, new, novel approaches for measuring disparities are needed to devise appropriate, effective means of resolving these disparities. A research team including Alon Peltz proposed and evaluated such a novel approach for measuring hospital-level disparities according to the effect of a continuous, polysocial risk factor on those outcomes. They adapted existing methodologies, and utilized Medicare Fee-for-Service claims for patients 65 years or older admitted to acute care hospitals for one of six common conditions or procedures. Results, published in Health Services Research, demonstrate the feasibility and utility of estimating hospital disparities of care using a continuous, polysocial risk factor, expanding the potential for reporting hospital-level disparities while better accounting for the multifactorial nature of social risk on hospital outcomes.

Institute Investigator(s): Alon Peltz

Possible pathways between greenspace and mortality: a study using the U.K. Biobank
The benefits of exposure and access to natural greenspace abound; but why, and how? In a new study published in SSM – Population Health, a team including Peter James systematically explores the potential pathways between greenspace and mortality by using data from the U.K. Biobank. Their findings strengthen the links between natural greenspace and lower risk of mortality. The team observed a lower risk of mortality associated with more availability of greenspace (especially among people with a lower socioeconomic status), and identified reduction in air pollution and social isolation, in addition to higher FEV1/FVC and vitamin D levels as potential pathways between greenspace and mortality.

Institute Investigator(s): Peter James

Clinical pharmacists’ knowledge of and attitudes toward pharmacogenomic testing in China
Uptake of pharmacogenomic (PGx) testing in routine clinical practices is currently slow in China. However, pharmacists have the potential to play a role in the uptake of such testing – but that depends on how they perceive its efficacy. A team, led by former fellow Xiaojuan Nie, with senior author Christine Lu, surveyed 1,005 clinical pharmacists across China. Results, published in Journal of Personalized Medicine, found that most Chinese clinical pharmacists who responded had a positive attitude toward PGx testing, but they cited numerous obstacles to uptake, including high cost of testing, shortage of relevant professionals, and lack of insurance coverage. The authors suggest that information about PGx testing be incorporated into health professional training.

Institute Investigator(s): Christine Lu

Are shorter menstrual cycles linked to earlier menopause?
A new Project Viva study investigated the potential association between menstrual cycle length and onset of menopause. The team, which included Sheryl Rifas-Shiman, Diana Soria-Contreras, Marie-France Hivert, and Emily Oken, evaluated data from 634 women enrolled in Project Viva during pregnancy (1999-2002). The women reported menstrual cycle length at enrollment (early pregnancy) and at midlife reported total and specific menopausal symptoms using the Menopause Rating Scale as well as age at natural menopause. Results, published in Menopause, suggest that, compared to women with normal menstrual cycle length, those with short cycles during their reproductive years had an earlier onset of menopause and higher frequency of menopausal symptoms at midlife.

Institute Investigator(s): Diana Soria-Conteras, Marie-France Hivert, Emily Oken

Using artificial intelligence to devise COVID-19 prevention strategies
Artificial intelligence (AI) methods are being used more widely by researchers to predict – and prevent – the incidence of disease. In one of the first studies to use vast amounts of survey data from 28 countries, senior author Christine Lu and colleagues provide a complete, detailed discussion of multiple factors possibly affecting COVID-19 infections around the world. The study, published in PLOS ONE, uses 52 different variables, categorized as basic characteristics, lifestyle habits, disease histories, and symptoms, to recommend five key COVID-19 strategies applicable to countries all around the world.

Institute Investigator(s): Christine Lu
 

Will getting outdoors keep you out of the hospital for cardiovascular or respiratory disease?
Many studies report the potential health benefits of exposure to natural environments. Large cohort studies have linked decreased risk of cardiovascular disease (CVD) and respiratory disease (RSD) mortality to green space exposure. However, knowledge gaps remain. A team including senior author Peter James evaluated associations of features of natural environments with first CVD and RSD hospitalization in a cohort of all fee-for-service Medicare beneficiaries living in the contiguous U.S. from 2000 through 2016 (∼63 million individuals). Results, published in Environmental Pollution, suggest that while natural environments may benefit health, these benefits may be limited to certain contexts and certain health outcomes.

Institute Investigator(s): Peter James
 

Examining the safety and effectiveness of weight loss surgeries across racial and ethnic groups
Bariatric surgery is the most effective treatment for severe obesity; yet it is unclear whether the long-term safety and comparative effectiveness of these operations differ across racial and ethnic groups. To help close this knowledge gap, a study team including Darren Toh compared outcomes of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) across racial and ethnic groups in the National Patient-Centered Clinical Research Network (PCORnet) Bariatric Study. Results, published in JAMA Surgery, suggest that while percentage of total weight loss and change in hemoglobin A1c levels varied very little across race and ethnicity,  differences in safety and utilization outcomes were clinically and statistically significant for Black and Hispanic patients who had RYGB compared with SG. These findings can inform shared decision-making regarding bariatric operation choice for different racial and ethnic groups of patients.

Institute Investigator(s): Darren Toh