A biweekly overview of recent studies published by Institute investigators and their collaborators spans a wide variety of topics, including:

Immunosuppressive biologics and COVID-19; physician voting behavior; complementary feeding; trends in palliative cancer care; PrEP preferences among cisgender Black Women; pediatric food insecurity; linked databases; effects of pediatric antibiotic use under the age of 2

For all faculty publications, see our Publications page. For up-to-date media coverage and research findings, visit In the Media, and follow us on Twitter. To search for a subject matter expert, visit our Investigator Directory.

A look at immunosuppressive biologics and risk of COVID-19
A new Research Letter published in Journal of the American Academy of Dermatology and co-authored by Maryam Asgari notes concerns that one third of patients with psoriasis discontinued their immunosuppressive biologics in light of the COVID-19 pandemic. These patients experienced disease progression – but at what cost? The study team looked at whether immunosuppressive biologics increased the risk of contracting or succumbing to COVID-19. Their findings were in line with published literature in finding that biologics did not increase the risk of being COVID-19+, nor was there an association between biologics and mortality. They suggest that dermatologists and patients should prioritize the well-established risk factors for COVID-19 when making decisions to continue therapy.

Institute Investigator(s): Maryam Asgari

Physician engagement in the political process
A new study senior-authored by Xiaojuan Li investigated changes in physicians’ voting behavior in modern day elections using nationally representative data. The team utilized data from U.S. Census Bureau Current Population Survey Voting and Registration Supplement, a biennial, nationally representative household survey, and examined U.S. physicians who participated in the survey between 2000 and 2020. The study provides a needed update on recent changes in physician voting behavior on a national level and across time. Results, published in JAMA Network Open, show that voter turnout among U.S. physicians has grown over the past two decades. Physicians were just as likely to vote as the general population in the recent midterm (2018) and more likely to vote in the latest presidential (2020) election. Physicians in states that allowed no-excuse mail-in voting had higher turnout than in those states that did not.

Institute Investigator(s): Xiaojuan Li

Aiming to decrease unnecessary prescription of antibiotics for Lyme disease
Up to half of antibiotics prescribed annually may be unnecessary, and could be avoided with an adjustment to testing protocols. A new study in JAMA Network Open led by Sarah Willis, with Noelle Cocoros and Michael Klompas, sought to determine whether a revision in the reporting of positive Lyme disease ELISA test results was associated with decreased frequency of antibiotic prescriptions for patients without confirmatory results. The team compared antibiotic prescribing behavior between 2 large practice groups in eastern Massachusetts: Atrius Health, which revised reporting of Lyme disease ELISA test results, and Cambridge Health Alliance (CHA), which did not. The revised Lyme disease ELISA test result text resulted in a 70% decrease in tests in which the patient was treated without confirmed Lyme disease at a practice using the standard 2-tiered testing algorithm, showing how a simple, low-cost intervention may be associated with a substantial reduction in unnecessary antibiotic use for Lyme disease.

Institute Investigator(s): Noelle Cocoros, Michael Klompas, Sarah Willis

Trends in Palliative Care for Cancer Patients
A new study led by former fellow Alessandra Ferrario and senior authored by Anita Wagner, assesses population-level trends in palliative care use among a large cohort of commercially insured patients with metastatic cancer, applying an expanded definition of palliative care services based on claims data. Using nationally representative commercial insurance claims data, Ferrario, et al identified patients with metastatic breast, colorectal, lung, bronchus, trachea, ovarian, esophageal, pancreatic, and liver cancers and melanoma between 2001 and 2016. The team assessed the annual proportions of these patients who received services specified as, or indicative of, palliative care. Findings, published in JCO Oncology Practice, show that the use of palliative care among commercially insured patients with advanced cancers has increased since 2001. However, even with an expanded definition of services specified as, or indicative of, palliative care, < 40% of patients with advanced cancers received palliative care in 2016.

Institute Investigator(s): Dennis Ross-Degnan, Anita K. Wagner, J. Frank Wharam, Fang Zhang

Breaking new ground on data regarding Black cisgender women’s preferences for PrEP products
Black women are disproportionately impacted by HIV, accounting for nearly 60% of new HIV infections among U.S. women while making up less than 15% of the female population. A new formulation of PrEP, with long-acting injections every 8 weeks, was approved in December 2021 and could improve uptake among Black women, but little is known about PrEP product preferences among Black women. Led by Whitney Irie, with Dr. Marcus as senior author, the study team assessed preferences for PrEP products, including injectable PrEP and daily oral PrEP, in a national sample of Black cisgender women. The study contributes some of the first data on Black women’s preferences for PrEP products, finding that injectable PrEP is preferred over oral PrEP in a subset of Black women, particularly those with anticipated stigma or cost concerns related to PrEP use. The study was published in AIDS and Behavior.

Institute Investigator(s): Whitney Irie, Julia Marcus

Food insecurity among children during the COVID-19 pandemic
A new review in Current Opinion in Pediatrics senior-authored by Alon Peltz focuses on one of the many critical public health issues exacerbated during the COVID-19 pandemic: food insecurity among children. The review aims to synthesize current knowledge to (a) describe impacts of food insecurity on child health, (b) outline clinical and public policy interventions to mitigate FI in children, and (c) define new paradigms in population health to ameliorate the harmful effects of FI in children. The authors conclude that clinicians and policymakers have opportunities to leverage clinical and community-based integration to improve service delivery opportunities to ameliorate childhood hunger and racial and socioeconomic inequity in the United States.

Institute Investigator(s): Alon Peltz

Use of Linked Databases for Improved Confounding Control: Considerations for Potential Selection Bias
A new study published in American Journal of Epidemiology, led by former fellow Jenny Sun with Dongdong Li, Darren Toh, and Rui Wang, takes a closer look at the possible pitfalls of conducting pharmacoepidemiologic studies within linked databases. Sometimes, in these databases, linked data is only available for a subset of patients. They highlight the importance of accounting for potential selection bias by evaluating the association between antipsychotics and type 2 diabetes in youths within a claims database linked to a smaller laboratory database. Results confirm that without properly adjusting for potential selection bias, linked database studies may generate biased estimates.

Institute Investigator(s): Dongdong Li, Darren Toh, Rui Wang

Antibiotics prior to age 2 years have limited association with preschool growth trajectory
Prior studies of early antibiotic use and growth have shown mixed results, primarily on cross-sectional outcomes. This study, co-authored by Jason Block, Pi-I Debby Lin, and Darren Toh, examined the effect of oral antibiotics before age 24 months on growth trajectory at age 2-5 years. Using PCORnet data, the team captured oral antibiotic prescriptions and anthropometrics for 430,376 children from 29 U.S. health systems, grouping prescriptions into episodes by time and by antimicrobial spectrum and assessing differences in growth rate from 25 to 72 months of age. Models were adjusted for sex, race/ethnicity, steroid use, diagnosed asthma, complex chronic conditions, and infections. Findings, published in International Journal of Obesity, show that oral antibiotic use prior to 24 months of age was associated with very small changes in average growth rate at ages 2-5 years. The small effect size is unlikely to affect individual prescribing decisions, though it may reflect a biologic effect that can combine with others.

Institute Investigator(s): Jason Block, Pi-I Debby Lin, Darren Toh

Association of Cutaneous Immune-Related Adverse Events With Increased Survival in Patients Treated With Anti-Programmed Cell Death 1 and Anti-Programmed Cell Death Ligand 1 Therapy
To our knowledge, little is known about the predictive value of cutaneous immune-related adverse events (cirAEs), which occur in 20-40% of all treated patients and their subtypes regarding cancer survival. A team including Maryam Asgari sought to determine the association of developing cirAEs following treatment with anti-programmed cell death 1 (PD-1) or anti-programmed cell death ligand 1 (PD-L1) therapy with patient survival. Results of this cohort study, published in JAMA Dermatology, suggest that the development of cirAEs is strongly associated with response to ICI therapy and patient survival.

Institute Investigator(s): Maryam Asgari

Setting good habits early: a look at the benefits of complementary feeding
Dietary habits begin early and are influenced by early childhood feeding practices. Innate preferences tend to veer toward sweet tastes from birth, though complementary feeding (introducing solids and liquids outside of breast milk or formula) provides an opportunity to override these preferences.  A DPM team led by Karen Switkowski with Izzuddin Aris, Emily Oken, and Jessica Young, used Project Viva data to estimate effects of 3 complementary behaviors on early childhood diet quality using inverse probability (IP) weighting of marginal structural models (MSMs). Results, published in The American Journal of Clinical Nutrition, suggest that delaying sweets/juice, continually offering of refused foods, and varying flavor/texture variety early may all result in higher childhood diet quality. These effects may depend on child sex and infant breastfeeding status.

Institute Investigator(s): Izzuddin Aris, Emily Oken, Karen Switkowski, Jessica Young
 

Human plasma pregnancy-associated miRNAs and their temporal variation within the first trimester of pregnancy

During pregnancy, maternal metabolism undergoes substantial changes to support the developing fetus. These metabolic changes are finely regulated by different mechanisms carried out by effectors such as microRNAs (miRNAs) and regulate numerous biological functions, mostly through post-transcriptional repression of gene expression. Though miRNAs are also secreted in circulation by numerous organs, such as the placenta, the complete plasmatic microtranscriptome of pregnant women has still not been fully described. In a new study published in Reproductive Biology and Endocrinology, a team including Marie-France Hivert describe the plasma microtranscriptome during the first trimester of pregnancy, by assessing the differences with non-pregnant women, and how it varies between the 4th and the 16th week of pregnancy. They identified circulating miRNAs specific to pregnancy and/or that varied with gestational age in first trimester.
 

Institute Investigator(s): Marie-France Hivert