Vital and Health Statistics Commons^™

Stronger Instruments Via Integer Programming In An Observational Study Of Late Preterm Birth Outcomes, José R. Zubizarreta, Dylan S. Small, Neera K. Goyal, Scott A. Lorch, Paul R. Rosenbaum

Statistics Papers

In an optimal nonbipartite match, a single population is divided into matched pairs to minimize a total distance within matched pairs. Nonbipartite matching has been used to strengthen instrumental variables in observational studies of treatment effects, essentially by forming pairs that are similar in terms of covariates but very different in the strength of encouragement to accept the treatment. Optimal nonbipartite matching is typically done using network optimization techniques that can be quick, running in polynomial time, but these techniques limit the tools available for matching. Instead, we use integer programming techniques, thereby obtaining a wealth of new tools not …

Methods For Estimating Kidney Disease Stage Transition Probabilities Using Electronic Medical Records, Lola Luo, Dylan S. Small, Walter F. Stewart, Jason A. Roy

Statistics Papers

Chronic diseases are often described by stages of severity. Clinical decisions about what to do are influenced by the stage, whether a patient is progressing, and the rate of progression. For chronic kidney disease (CKD), relatively little is known about the transition rates between stages. To address this, we used electronic health records (EHR) data on a large primary care population, which should have the advantage of having both sufficient follow-up time and sample size to reliably estimate transition rates for CKD. However, EHR data have some features that threaten the validity of any analysis. In particular, the timing and …

Aging In Mice Reduces The Ability To Sustain Sleep/Wake States, Mathieu E. Wimmer, Justin Rising, Raymond J. Galante, Abraham J. Wyner, Allan I. Pack, Ted Abel

Statistics Papers

One of the most significant problems facing older individuals is difficulty staying asleep at night and awake during the day. Understanding the mechanisms by which the regulation of sleep/wake goes awry with age is a critical step in identifying novel therapeutic strategies to improve quality of life for the elderly. We measured wake, non-rapid eye movement (NREM) and rapid-eye movement (REM) sleep in young (2-4 months-old) and aged (22-24 months-old) C57BL6/NIA mice. We used both conventional measures (i.e., bout number and bout duration) and an innovative spike-and-slab statistical approach to characterize age-related fragmentation of sleep/wake. The short (spike) and long …

The Effects Of City Streets On An Urban Disease Vector., Corentin M. Barbu, Andrew Hong, Jennifer M. Manne, Dylan S. Small, Javier E. Quintanilla Calderón, Karthik Sethuraman, Víctor Quispe-Machaca, Jenny Ancca-Juárez, Juan G. Cornejo Del Carpio, Fernando S. Málaga Chavez, César Náquira, Michael Z. Levy

Statistics Papers

With increasing urbanization vector-borne diseases are quickly developing in cities, and urban control strategies are needed. If streets are shown to be barriers to disease vectors, city blocks could be used as a convenient and relevant spatial unit of study and control. Unfortunately, existing spatial analysis tools do not allow for assessment of the impact of an urban grid on the presence of disease agents. Here, we first propose a method to test for the significance of the impact of streets on vector infestation based on a decomposition of Moran’s spatial autocorrelation index; and second, develop a Gaussian Field Latent …

Analysis Of Alcohol Use Among Pregnant Women In San Luis Obispo County, Samantha Law

Statistics

Drinking alcohol during pregnancy is harmful to the fetus, and can lead to serious alcohol related developmental birth defects. Utilizing prenatal screening, such as the 4P’s Plus© screening tool, during a woman’s first prenatal doctors visit can help educate women and reduce continued alcohol use during pregnancy. Currently the CDC reports that 1 in 13 women in the US drink alcohol while pregnant compared to local reports that 1 in 3 women in San Luis Obispo County continue to drink alcohol during pregnancy. A primary concern for many local county health care experts and organizations is to raise awareness that …

Near/Far Matching: A Study Design Approach To Instrumental Variables, Mike Baiocchi, Dylan S. Small, Lin Yang, Daniel Polsky, Peter W. Groeneveld

Statistics Papers

Classic instrumental variable techniques involve the use of structural equation modeling or other forms of parameterized modeling. In this paper we use a nonparametric, matching-based instrumental variable methodology that is based on a study design approach. Similar to propensity score matching, though unlike classic instrumental variable approaches, near/far matching is capable of estimating causal effects when the outcome is not continuous. Unlike propensity score matching, though similar to instrumental variable techniques, near/far matching is also capable of estimating causal effects even when unmeasured covariates produce selection bias. We illustrate near/far matching by using Medicare data to compare the effectiveness of …

The Morbidity & Mortality Of Prevalent Heart Failure, Jennifer Kwon

Loma Linda University Electronic Theses, Dissertations & Projects

The first study population included 292 unselected consecutive patients from the LLUMC heart failure clinic who were enrolled in the study from January to July 2006 and were followed up through the end of December 2010. The treatment policy at the clinic was to uptitrate dosages of beta-adrenergic blockade (β-blockers), angiotensin-converting-enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) to the most tolerable levels in order to reach target dosages, as recommended by the Heart Failure Society of America (HFSA). Patients were classified into systolic heart failure (ejection fraction (EF) < 40%) or diastolic heart failure (EF≥40%). All dosages of β-blockers, ACEi and ARB were extracted through chart reviews and were used as the main predictors of the patients' survival. Results from analyses showed that reaching target dosages of β-blockers and ACEi/ARB may increase survival when compared to not reaching target among the systolic HF population (HR_{β_biockers}= 0.64, 95% CI 0.26-1.56 and HR_ACEi/ARB=0.50, …

A Descriptive Study Of Childhood Cancer Statistics: Montgomery County, Jamie L. Hartig

Master of Public Health Program Student Publications

Objective: This research describes childhood cancer and identifies variances in childhood cancer statistics in the United States, Ohio, and Montgomery County.

Methods: This is a descriptive analysis of childhood cancer statistics using the Ohio Cancer Incidence Surveillance System (OCISS) (Ohio Department of Health, 2010) and CDC Wonder database (United States Department of Health and Human Services [USDHHS], Centers for Disease Control and Prevention [CDC], & National Cancer Institute [NCI], 2008 & 2011.) Cancer incidences between white children and black children were compared for the years 1999-2009. The OCISS database was also used to compare vital status by race, cancer stage …

Use Of Individual-Level Covariates To Improve Latent Class Analysis Of Trypanosoma Cruzi Diagnostic Tests, Aaron W. Tustin, Dylan S. Small, Stephen Delgado, Ricardo Castillo Neyra, Manuela R. Verastegui, Jenny M. Ancca Juárez, Victor R. Quispe Machaca, Robert H. Gilman, Caryn Bern, Michael Z. Levy

Statistics Papers

Statistical methods such as latent class analysis can estimate the sensitivity and specificity of diagnostic tests when no perfect reference test exists. Traditional latent class methods assume a constant disease prevalence in one or more tested populations. When the risk of disease varies in a known way, these models fail to take advantage of additional information that can be obtained by measuring risk factors at the level of the individual. We show that by incorporating complex field-based epidemiologic data, in which the disease prevalence varies as a continuous function of individual-level covariates, our model produces more accurate sensitivity and specificity …

Analysis Of Dietary Patterns Over Freshman Year Of College, Chelsea Lofland

Statistics

This analysis is an investigation of changes in Cal Poly students’ eating habits over freshman year. The motivation behind this was an interest in college students’ lifestyles; college is the first time most students live on their own and it can be an important maturation period. College is stressful, exciting, liberating, and terrifying all at the same time. This distinctive life experience, along with my desire to handle big and messy data, led me to this research question.

The response variable analyzed was food consumption and the explanatory variables were: sex, race, quarter, food group, stress, exercise, BMI, sleep quality …

Racial Disparities In Cancer Screening Among Women With Chronic Joint Pain, Edith M. Williams, Laurene Tumiel-Berhalter, Christopher Purdy, Adrianne Ransom, Judith Anderson

Journal of Health Disparities Research and Practice

Chronic pain related disorders and breast and cervical cancer are more prevalent among African-American women compared with non-Hispanic White women. However, few studies address how racial differences in the context of comorbidity may compound these disparities. This study used secondary analysis of the National Health Interview Survey (NHIS) to assess racial differences in breast and cervical cancer screening and patient education among adult women with chronic joint pain conditions. Statistical analyses included chi-square and independent samples t-tests. African-American women compared with non-Hispanic White women were less likely to receive a pap smear or mammogram within the last two years and …

Not Always Black And White: Racial Bias For Birth Disparities From Excluding Hispanic Identification, Barbara L. Wilson, Cristi Coursen, Matthew Butler

Journal of Health Disparities Research and Practice

Despite gains in prenatal care (PNC) usage and birth outcomes for minority women during the past few decades, observed disparities between non-Hispanic Whites, Blacks, and Hispanics persist. Using the National Center for Health Statistics’ (NCHS) natality files from 1981 through 1998, Alexander, Kogan, & Nabukera (2002) examined live births of U.S. residents by trimester in which PNC was initiated and the appropriateness of that care based on the Adequacy of Prenatal Care Utilization Index (APNCU) (Kotelchuck, 1994). They found racial disparities between White and Black women in both the trimester of PNC initiation and the number of PNC visits made. …

Ranking Usrds Provider-Specific Smrs From 1998-2001, Rongheng Lin, Thomas A. Louis, Susan M. Paddock, Greg Ridgeway

Rongheng Lin

Provider profiling (ranking, "league tables") is prevalent in health services research. Similarly, comparing educational institutions and identifying differentially expressed genes depend on ranking. Effective ranking procedures must be structured by a hierarchical (Bayesian) model and guided by a ranking-specific loss function, however even optimal methods can perform poorly and estimates must be accompanied by uncertainty assessments. We use the 1998-2001 Standardized Mortality Ratio (SMR) data from United States Renal Data System (USRDS) as a platform to identify issues and approaches. Our analyses extend Liu et al. (2004) by combining evidence over multiple years via an AR(1) model; by considering estimates …

Breast Cancer Screening Practices Among American Indians And Alaska Natives In The Midwest, Christine M. Daley, Melissa Filippi, Aimee S. James, Sarah Brokenleg, Stacy Braiuca, K. A. Greiner, Won S. Choi

Journal of Health Disparities Research and Practice

American Indian and Alaska Native (AI/AN) women currently have some of the highest mortality rates from breast cancer for any racial/ethnic group in the United States and some of the lowest screening rates. However, current data are not available for regional differences in screening, which can result in dramatically different stage at diagnosis and mortality. We conducted surveys with 120 focus group participants in a needs assessment of mammography among AI/AN in the greater Kansas City metropolitan area and parts of Northeast Kansas. We found that among women under age 40, for whom recommended screenings include only annual clinical breast …

Race And Hepatitis C Management Within The Veterans Administration, Joahd Toure, Joshua Metlay, Sandford Schwartz, Knashawn Morales, David Kaplan, Peter Groeneveld

Journal of Health Disparities Research and Practice

Objective: To examine black-white differences in hepatitis C treatment within the Veterans Administration (VA) and determine whether racial variation in specialty consultation explains differences in hepatitis C treatment between blacks and whites.

Methods: We performed a retrospective cohort study of 1040 veterans meeting VA eligibility criteria for hepatitis C treatment. We used multiple imputation to handle missing race data. Specialty consultation was determined from the VA outpatient medical dataset and hepatitis C treatment was determined from the VA decision support system. Conditional logistic regression was used to examine the association between race and hepatitis C treatment as well as race …

Poverty And Mortality Disparities In Central Appalachia: Mountaintop Mining And Environmental Justice, Michael Hendryx

Journal of Health Disparities Research and Practice

Objectives. This study investigated the associations between poverty rates, Appalachian mountaintop coal mining, and age-adjusted total mortality rates to determine if persons exposed to this form of mining experience greater poverty and higher death rates compared to other types of mining or other areas of Appalachia.

Methods. Mortality rates, poverty rates, Appalachian designation and mining activity were examined for counties in Kentucky, Tennessee, Virginia and West Virginia (N=403). Linear least squares models tested for annual group differences from 2000-2007 in total and child poverty, and total mortality, based on mining type and Appalachian location. Nested linear models accounting for state-level …

Health Effects Associated With Foreclosure: A Secondary Analysis Of Hospital Discharge Data, Nancy Menzel, Sheniz Moonie, Melva V. Thompson-Robinson

Nursing Faculty Publications

Objectives. The purpose of this study was to assess the health effects of high home foreclosure rates in an area of the United States of America and the utility of hospital discharge data for this purpose. Methods. We analyzed hospital discharge data from three postal zip codes using the principal diagnosis for 25 Diagnostic Related Groups associated with stress. Descriptive statistics were used to characterize hospital discharge rates for each condition by year and zip code. To test for differences across time, the Cochran-Armitage trend test was performed. Results. Most conditions did not demonstrate a statistical change between …

Geographic Disparities Associated With Stroke And Myocardial Infarction In East Tennessee, Ashley Pedigo Golden

Doctoral Dissertations

Stroke and myocardial infarction (MI) are serious conditions whose burdens vary by socio-demographic and geographic factors. Although several studies have investigated and identified disparities in burdens of these conditions at the county and state levels, little is known regarding their geographic epidemiology at the neighborhood level. Both conditions require emergency treatments and therefore timely geographic accessibility to appropriate care is critical. Investigation of disparities in geographic accessibility to stroke and MI care and the role of Emergency Medical Services (EMS) in reducing treatment delays are vital in improving health outcomes. Therefore, the objectives of this work were to: (i) classify …

The Application Of Dialectical Behavior Therapy To Chronic Pain Management, Jacob S. Iwaszewski

Loma Linda University Electronic Theses, Dissertations & Projects

Pain affects more than 50 million Americans annually, costs over 150 billion dollars each year in healthcare and legal expenses, and results in decreased work productivity and missed work days (Ballantyne, 2006; Boll, Raczynski, & Leviton, 2004; Thom, 2004). It is estimated that chronic pain negatively impacts 15% to 33% of the US population (Bokarius et al., 2008). Third-wave acceptance-based therapies, such as Dialectical Behavior Therapy (DBT), have demonstrated significant improvements in mental health functioning for a variety of populations (Carmody & Baer, 2008; Cusens, Duggan, Thome, & Burch, 2010). DBT, one of the primary treatment modalities for Borderline Personality …

Modeling Mortality Rates For Leukemia Between Men And Women In The United States, Blessed Quansah

UNLV Theses, Dissertations, Professional Papers, and Capstones

Leukemia related deaths increased dramatically over the last forty years. Leukemia is a malignant disease or cancer of the bone marrow and blood. It is characterized by the uncontrolled accumulation of blood cells. Leukemia is divided into two categories: myelogenous or lymphocytic, each of which can be acute or chronic. The terms, myelogenous or lymphocytic denote the cell type involved.

In this thesis, the proposed modeling techniques are applied to leukemia deaths data from the Surveillance Epidemiology and End Results (SEER). In particular, annual deaths data from 1969 to 2007 are used in the data analysis, which includes three major …