Epidemiology Commons^™

Current Burden Of Steatotic Liver Disease And Fibrosis Among Adults In The United States, 2017-2023, Donghee Kim, Pojsakorn Danpanichkul, Karn Wijarnpreecha, George Cholankeril, Rohit Loomba, Aijaz Ahmed

Faculty, Staff and Students Publications

Background/aims: Multi-society experts proposed the adoption of new terminology, metabolic dysfunctionassociated steatotic liver disease (MASLD) and steatotic liver disease (SLD). We studied the current prevalence of SLD and its subcategories in the US.

Methods: Using the recent National Health and Nutrition Examination Survey from 2017 to 2023, we analyzed data from 12,199 participants (≥18 years) who completed transient elastography. SLD and its subcategories, including MASLD, metabolic and alcohol-related liver disease (MetALD), and alcohol-related liver disease (ALD), were categorized according to consensus nomenclature.

Results: The age-adjusted prevalence of SLD (cut-off: 285 dB/m) was 35.0% (95% confidence interval [CI] 33.4-36.7). Within this …

Opportunistic Measurement Of Sagittal Abdominal Diameter With Bone Densitometry Predicts Death And Cardiovascular Events, William D. Leslie, Fatima Zarzour, Lisa M. Lix, Neil Binkley, Joshua R. Lewis, John T. Schousboe

Research outputs 2022 to 2026

Supine sagittal abdominal diameter (SAD), also known as abdominal height, has been proposed as a simple measure for assessing abdominal adiposity. We aimed to determine whether SAD from DXA performed for osteoporosis assessment predicts major adverse cardiovascular events (MACEs) using the population-based DXA registry for the Province of Manitoba, Canada. The study population comprised 72 974 individuals aged 40 yr and older with baseline DXA assessment between February 1999 and March 2018. Incident MACE (composite of all-cause mortality, acute myocardial infarction [MI], non-hemorrhagic stroke) was ascertained from linked healthcare databases. During mean 8.4 yr follow-up (611 862 person-years), 14 457 …

Changing Age Profile And Incidence Of Injecting Drug Use Initiation Among People In Australia Who Inject Drugs: Evidence From Two National Repeated Cross-Sectional Studies, Olivia Price, Lisa Maher, Amy Peacock, Farzaneh Zolala, Louisa Degenhardt, Paul Dietze, Sarah Larney, Seraina Agramunt, Samantha Colledge-Frisby, Bradley Mathers, Dan Lewer, Rachel Sutherland

Research outputs 2022 to 2026

Background: The age of people who inject drugs appears to be increasing in some high-income countries. We aimed to explore trends in the age of people injecting and recently starting to inject drugs in Australia, and to model incidence of initiation over time. Methods: We obtained data from the Illicit Drug Reporting System (IDRS) and the Australian Needle Syringe Program Survey (ANSPS), which comprise annual cross-sectional surveys with people who inject drugs (2000–2019). Outcome measures were current age, age of initiation, and time since initiation (both surveys), and drug first injected (IDRS only). We estimated time trends in age using …

Estimation Of Therapeutic Threshold For Tuberculosis Using Adapted Nominal Group Technique And Clinical Vignettes In Clinical And Community Settings In Southern Africa, Alfred Kipyegon Keter, Alastair Van Heerden, Tom Decroo, Tom Boyles, Shannon Bosman, Thandanani Madonsela, Lindani Innocent Msimango, Lenika Naiken, Carlos Kiyan, Mashaete Kamele

Population Health, East Africa

Background: When confronted with diagnostic uncertainty and a decision on whether to start treatment or not, clinicians consider the potential harm and benefit of offering versus withholding treatment. Treatment can be offered if the probability of tuberculosis (TB) in the patient is above the “therapeutic threshold” (ThT): the probability of disease at which the expected utility of treating and not treating is the same. We estimated ThT for TB in clinical and community settings in Southern Africa using two methods: an adapted nominal group technique (aNGT), and decisions made based on clinical vignettes (CVs).

Methods: We enrolled health …

Mothers’ Characteristics And Children's Diarrhea Between 2010-2020 In Rwanda, Amans Ntakarutimana Dr., Patrick A. Tschida Dr.

Journal of Social, Behavioral, and Health Sciences

Mothers’ characteristics influence children’s health and development. We conducted a cross-sectional study to assess the influence of mothers’ education level, employment status, and exposure to domestic violence on diarrhea among children under 5 years old using secondary data from 2010, 2015, and 2020 Rwanda Demographic Health Surveys. We used stratified descriptive statistics, pairwise comparisons, and logistic regression designs to assess (a) the prevalence of mothers per education level, employment status, and exposure to domestic violence; (b) their variation over time; and (c) their influence on diarrhea among children under 5 years old between 2010 and 2020 in Rwanda. According to …

Spatial And Seasonal Dynamics Of Mosquito Species In Harris County, Texas, Highlight Risk Of Arbovirus Introduction And Transmission, Morgan Jibowu, Maximea Vigilant, Andre Luis Costa-Da-Silva, Alisa Nelson, Heather T Essigmann, Eric L Brown, Sarah M Gunter

Faculty, Staff and Student Publications

Mosquito-borne diseases pose a significant public health threat, particularly in densely populated urban areas. Climate change, urbanization, and global connectivity have fueled the expansion of mosquitoes and their associated pathogens, increasing the disease burden. Harris County, Texas, is among the most vulnerable regions in the United States for mosquito-borne disease outbreaks, underscoring the critical need for localized insights into mosquito population dynamics to inform vector surveillance and control strategies. This study provides a comprehensive analysis of the population dynamics of mosquito species in Harris County by exploring their species composition, spatial distribution, and seasonal patterns. Our findings reveal the extensive …

Critical Appraisal Of Multidrug Therapy In The Ambulatory Management Of Patients With Covid-19 And Hypoxemia Part I. Evidence Supporting The Strength Of Association, Eleftherios Gkioulekas, Peter A. Mccullough, Colleen Aldous

School of Mathematical & Statistical Sciences Faculty Publications

This critical appraisal is focused on three published case series of 119 COVID-19 patients with hypoxemia who were successfully treated in the United States, Zimbabwe, and Nigeria with similar off-label ivermectin-based multidrug treatments that may include ivermectin, nebulized nanosilver, doxycycline, zinc, Vitamins C, and Vitamin D, resulting in rapid recovery of oxygen levels. We used a simplified self-controlled case series method to investigate the association between treatment and the existence of hospitalization rate reduction. External controls of hospitalized patients were compared against the subgroup of patients with baseline room air SpO2 ≤ 90% to investigate the association between treatment and …

Critical Appraisal Of Multidrug Therapy In The Ambulatory Management Of Patients With Covid-19 And Hypoxemia. Part Ii: Causal Inference Using The Bradford Hill Criteria, Eleftherios Gkioulekas, Peter A. Mccullough, Colleen Aldous

School of Mathematical & Statistical Sciences Faculty Publications

We continue the critical appraisal of three published case series of 119 COVID-19 patients with hypoxemia, treated in the United States, Zimbabwe, and Nigeria with similar ivermectin-based multidrug treatments, to assess the available evidence supporting a causal relationship between treatment and reduction in hospitalizations and mortality. A narrative review was conducted to assess the Bradford Hill criteria for a causal association. We used a previously proposed refinement of the Bradford Hill criteria that reorganized them into three categories of direct, mechanistic, and parallel evidence. The efficacy of the two most aggressive ivermectin-based multidrug protocols is supported by the Bradford Hill …

Racial And Ethnic Inequalities In Actual Vs Nearest Delivery Hospitals, Nansi S. Boghossian, Lucy T. Greenberg, Jeffrey S. Buzas, Joshua Radack, Molly Passarella, Jeannette Rogowski, George R. Saade, Ciaran S. Phibbs, Scott A. Lorch

Faculty Publications

IMPORTANCE Minoritized racial and ethnic groups, such as American Indian and Black individuals, often receive lower quality health care compared with White individuals. There is limited understanding of how these disparities extend to obstetric care, particularly when comparing the quality of care at the actual delivery hospital vs the nearest obstetric hospital based on the birthing individual’s residence. OBJECTIVE To examine inequality in care based on the actual delivery hospital and the closest delivery hospital to the birthing individual’s residential zip code centroid. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study used data from 5 states (2008 to 2020 …

Evaluating Medical Usage And Injury Prevalence At The 2024 College World Series, Roarick Schollmeyer, Jd Gregerson, Benjamin Stevens, Katie Weaver, Joseph Lippert

EMET Projects

Large-scale events such as the College World Series (CWS) pose unique challenges for medical services due to high crowd density, prolonged event durations, and variable environmental conditions. This study aimed to assess the medical usage rate (MUR) and injury prevalence at the 2024 CWS to inform future event planning and emergency medical preparedness. A retrospective analysis was conducted using patient encounter data collected between June 14 and June 24, 2024. Data sources included Union Medical event services, which documented on-site treatments and dispositions, and Omaha Fire Department EMS records detailing prehospital care. The MUR was calculated as the number of …

A Geospatial Analysis Of The Lung Cancer Burden In Philadelphia, Using Pennsylvania Cancer Registry Data From 2008-2017, Russell K. Mcintire, Katherine Senter, Christine S. Shusted, Rickisa Yearwood, Julie Barta, Scott W. Keith, Charnita Zeigler-Johnson

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

(1) Background: Lung cancer is the deadliest and second most prevalent cancer in Pennsylvania (PA), and African American patients are disproportionately affected. Lung cancer morbidity and mortality in Philadelphia County are among the highest in PA. Geographic information systems (GIS) are useful to explore geospatial variations in the cancer burden and risk factors. Therefore, we used GIS to analyze the lung cancer burden in Philadelphia to assess which areas of the city have the highest morbidity and mortality, identify potential clusters, and determine which census tract-level characteristics were associated with higher tract-level cancer burden. (2) Methods: Using secondary data from …

Precision Phenotyping For Curating Research Cohorts Of Patients With Unexplained Post-Acute Sequelae Of Covid-19, Alaleh Azhir, Jonas Hügel, Jiazi Tian, Jingya Cheng, Ingrid V Bassett, Douglas S Bell, Elmer V Bernstam, Maha R Farhat, Darren W Henderson, Emily S Lau, Michele Morris, Yevgeniy R Semenov, Virginia A Triant, Shyam Visweswaran, Zachary H Strasser, Jeffrey G Klann, Shawn N Murphy, Hossein Estiri

Faculty, Staff and Student Publications

BACKGROUND: Scalable identification of patients with post-acute sequelae of COVID-19 (PASC) is challenging due to a lack of reproducible precision phenotyping algorithms, which has led to suboptimal accuracy, demographic biases, and underestimation of the PASC.

METHODS: In a retrospective case-control study, we developed a precision phenotyping algorithm for identifying cohorts of patients with PASC. We used longitudinal electronic health records data from over 295,000 patients from 14 hospitals and 20 community health centers in Massachusetts. The algorithm employs an attention mechanism to simultaneously exclude sequelae that prior conditions can explain and include infection-associated chronic conditions. We performed independent chart reviews …

Understanding Hereditary Breast And Ovarian Cancer Syndrome In Black/African American Women: Implications For Equitable Outcomes And Interventions, Alexandria E. Fletcher

Walden Dissertations and Doctoral Studies

Black/African American women face significant health disparities in hereditary breast and ovarian cancer syndrome (HBOC) due to systemic barriers to genetic counseling and testing, leading to poorer survival outcomes. Guided by the Social Determinants of Health (SDH) framework and Intersectionality Theory, this quantitative descriptive study examined disparities in access to genetic services, socioeconomic barriers, and healthcare biases. Data from the 2023 National Health Interview Survey (NHIS) included 1,357 Black/African American and White women aged 25–65 with a family history of HBOC. The Surveillance, Epidemiology, and End Results (SEER) dataset analyzed 15,684 Black/African American and 105,547 White women with breast cancer, …

Does Travel Time Matter?: Predictors Of Transportation Vulnerability And Access To Hiv Care Among People Living With Hiv In South Carolina, Sayward Elizabeth Harrison, Peiyin Hung, Katherine Green, Sarah J. Miller, Mariajosé Patron, Divya Ahuja, Sharon Weissman, Caroline Rudisill, Tammeka Evans

Faculty Publications

Background

People living with HIV (PLHIV) in the southern United States (US) are at high risk for poor outcomes across the HIV care continuum leading to low rates of viral suppression. Understanding structural barriers to care—including transportation vulnerability—is critical to improve HIV outcomes. This study investigated relationships between travel time to HIV care, transportation vulnerability, and HIV care disruptions to inform future transportation interventions for PLHIV residing in South Carolina and other southern US states.

Methods

A total of 160 PLHIV (N = 160) were recruited from a large immunology center in South Carolina. Participants reported on transportation experiences, transportation …

Patterns And Outcomes In Urotrauma: An Analysis Of Fatality Trends And Contributing Factors, Neharika Penmetcha, Aun Bangash, Kelsey Baker

Research Symposium

Background: Urotrauma, involving injuries to the kidneys, ureters, and bladder, represents a critical subset of trauma cases, significantly impacting patient morbidity and mortality. Renal and urogenital injuries account for 10–20% of abdominal trauma in adults and children. Understanding urotrauma's epidemiology is vital for improving care protocols and resource allocation. Despite its impact, data on injury mechanisms, intent, and care modalities specific to urotrauma remain limited. This study investigates patterns in injury mechanisms, intent, transport modalities, and facility transfer status to identify factors influencing patient outcomes and inform trauma care improvements.

Methods: A retrospective review analyzed 3,492 trauma cases, filtered for …

Heart Failure In Black Populations: Epidemiology, Pathophysiology, And Treatment Disparities, Kazi N. Islam, Rahib K. Islam, Ivan Nguyen, Yasmeen Magherahabed, Humza Pirzadah, M. Bazlur Rashid

School of Medicine Faculty Publications

Heart failure (HF) remains a significant health challenge globally, placing a heavy burden on individuals, families, and healthcare systems. The prevalence of HF continues to rise, posing substantial public health concerns. This burden is particularly pronounced among the Black Population, who face higher prevalence, earlier onset, and greater severity of HF compared to other racial and ethnic groups. This review explores the multifaceted landscape of HF in Black individuals by examining epidemiological patterns, pathophysiological mechanisms, clinical presentations, treatment disparities, and clinical outcomes. Black individuals exhibit distinct pathophysiological characteristics, such as genetic variations contributing to heightened susceptibility and severity of HF. …

Outcomes Of Double Free Flap Reconstruction For Advanced Head And Neck Tumors In A Safety-Net Hospital Population, Yossef Alsabawi, John M. Gaddis, Angela D. Haskins, Jonathan Shum, David J. Hernandez

Research Symposium

Background: Double-free flap reconstruction has emerged as a viable option for addressing more complicated defects after oncologic resection. We aim to report the feasibility of this approach at a single-institutional safety net hospital.

Methods: A retrospective chart review was performed between November 2020 and October 2023 for adult patients who underwent multiple, simultaneous free tissue transfers for head and neck defects following tumor resection. This study occurs at Ben Taub Hospital, a safety net hospital in Houston, Texas. Data collected included demographics, risk factors, oncologic and operative details, complications, and functional and disease outcomes. Socioeconomic status was assessed …

Targets To Increase Hiv Pre-Exposure Prophylaxis (Prep) Uptake Among Communities In Northeast Georgia, Kaley E. Parchinski, Molly Hirsh, Andrew Cheng, Nia Kalifa, Manvi Manyam

Journal of the Georgia Public Health Association

Background: This study seeks to identify targets to increase HIV pre-exposure prophylaxis (PrEP) uptake in Athens-Clarke County, GA, a non-urban area with high HIV burden and poor PrEP utilization.

Methods: A cross sectional survey of adults attending HIV outreach screenings in Athens, GA between November 2022 and March 2023 describes participant demographics and validated scales measuring PrEP knowledge, attitudes, stigma, descriptive norms, and intentions.

Results: Of 136 total participants, key demographic groups included Black (N=84, 61.8%), Latinx (N=10, 8.1%), LGBTQ+ (N=25, 18.4%), and persons who use injection drugs (N=19, 15%); overall, less than half of the PrEP knowledge items were …

Pre-Exposure Prophylaxis Uptake Among Black/African American Men Who Have Sex With Other Men In Midwestern, United States: A Systematic Review, Oluwafemi Adeagbo, Oluwaseun Abdulganiyu Badru, Prince Addo, Amber Hawkins, Monique J. Brown Ph.D., Mph, Xiaoming Li, Rima Afifi

Faculty Publications

Introduction: Black/African American men who have sex with other men (BMSM) are disproportionately affected by HIV, experience significant disparities in HIV incidence, and face significant barriers to accessing HIV treatment and care services, including pre-exposure prophylaxis (PrEP). Despite evidence of individual and structural barriers to PrEP use in the Midwest, no review has synthesized this finding to have a holistic view of PrEP uptake and barriers. This review examines patterns of, barriers to, and facilitators of PrEP uptake among BMSM in the Midwest, United States (US).

Methods: Five databases (CINAHL Plus, PUBMED, PsycINFO, SCOPUS, and Web of Science) were searched …

From Crisis To Action: Investigation, Research, And Response In The Rio Grande Valley Following The Anencephaly Cluster Of 1990-1991, Jonathan Hebert, Miguel Lopez, Padmanabhan Rengasamy

MEDI 9331 Scholarly Activities Clinical Years

The 1990-1991 birth defect cluster of anencephaly in the Rio Grande Valley has had lasting effects on Texas public health and birth defect prevention nationwide. The purpose of this study is to clearly illuminate public health efforts to investigate, identify, and combat the rise of anencephaly and other neural tube defects (NTDs) in the Rio Grande Valley and other border counties following the 1990-1991 cluster, as well as to report the findings of each branch of environmental, infectious, and genetic investigation into the possible causes of the disaster. Information was gathered via a literature review and from other sources including …