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Article: Estimating the Value of Public Insurance Using Complementary Private Insurance.

Cabral, Marika / Cullen, Mark R

American economic journal. Economic policy

2024 Volume 11, Issue 3, Page(s) 88–129

Abstract: The welfare associated with public insurance is often difficult to quantify because the demand for coverage is unobserved and thus cannot be used to analyze welfare. However, in many settings, individuals can purchase private insurance to supplement ... ...

Abstract	The welfare associated with public insurance is often difficult to quantify because the demand for coverage is unobserved and thus cannot be used to analyze welfare. However, in many settings, individuals can purchase private insurance to supplement public coverage. This paper outlines an approach to use data and variation from private complementary insurance to quantify welfare associated with counterfactuals related to compulsory public insurance. We then apply this approach using administrative data on disability insurance. Our findings suggests that public disability insurance generates substantial surplus for the sample population, and there may be gains to increasing the generosity of coverage.
Language	English
Publishing date	2024-01-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	2452647-2
ISSN	1945-774X ; 1945-7731
ISSN (online)	1945-774X
ISSN	1945-7731
DOI	10.1257/pol.20170118
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Article ; Online: Biology Is Not Destiny.

Horwitz, Ralph I / Cullen, Mark R

Psychotherapy and psychosomatics

2023 Volume 92, Issue 4, Page(s) 205–207

Language	English
Publishing date	2023-08-24
Publishing country	Switzerland
Document type	Editorial
ZDB-ID	209490-3
ISSN	1423-0348 ; 0033-3190
ISSN (online)	1423-0348
ISSN	0033-3190
DOI	10.1159/000533449
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Article ; Online: Retromer-dependent lysosomal stress in Parkinson's disease.

Alessi, Dario R / Cullen, Peter J / Cookson, Mark / Merchant, Kalpana M / Small, Scott A

Philosophical transactions of the Royal Society of London. Series B, Biological sciences

2024 Volume 379, Issue 1899, Page(s) 20220376

Abstract: While causative mutations in complex disorders are rare, they can be used to extract a biological pathway whose pathogenicity can generalize to common forms of the disease. Here we begin by relying on the biological consequences of mutations in LRRK2 and ...

Abstract	While causative mutations in complex disorders are rare, they can be used to extract a biological pathway whose pathogenicity can generalize to common forms of the disease. Here we begin by relying on the biological consequences of mutations in LRRK2 and VPS35, genetic causes of autosomal-dominant Parkinson's disease, to hypothesize that 'Retromer-dependent lysosomal stress' represents a pathway that can generalize to idiopathic Parkinson's disease. Next, we outline a series of studies that can test this hypothesis, including the development of biomarkers of pathway dysfunction. If validated, the hypothesis can suggest a unified mechanism of disease and might inform future diagnostic and therapeutic investigations. This article is part of a discussion meeting issue 'Understanding the endo-lysosomal network in neurodegeneration'.
MeSH term(s)	Humans ; Parkinson Disease/genetics ; Parkinson Disease/metabolism ; Vesicular Transport Proteins/genetics ; Vesicular Transport Proteins/metabolism ; Mutation ; Lysosomes/metabolism
Chemical Substances	Vesicular Transport Proteins
Language	English
Publishing date	2024-02-19
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	208382-6
ISSN	1471-2970 ; 0080-4622 ; 0264-3839 ; 0962-8436
ISSN (online)	1471-2970
ISSN	0080-4622 ; 0264-3839 ; 0962-8436
DOI	10.1098/rstb.2022.0376
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Article ; Online: Revisiting Associations Among Parent and Adolescent Religiosity and Early Adolescent Suicide Risk in the United States.

Mirza, Salahudeen / Wiglesworth, Andrea / Fiecas, Mark B / Cullen, Kathryn R / Klimes-Dougan, Bonnie

Journal of religion and health

2024 Volume 63, Issue 2, Page(s) 1017–1037

Abstract: The contributions of religion to reduced suicide risk have been studied in adults and adolescents, though to our knowledge no comprehensive investigation has been conducted in early adolescents, at a time coinciding with emergence of suicide risk ... ...

Abstract	The contributions of religion to reduced suicide risk have been studied in adults and adolescents, though to our knowledge no comprehensive investigation has been conducted in early adolescents, at a time coinciding with emergence of suicide risk trajectories. In this largest study to date on this topic, we aimed to characterise the contributions of various measures of "private" and "public" religiosity to early adolescent suicide ideation (SI) and suicide attempt (SA) histories using information from a large, epidemiologically informed U.S. sample of adolescents (N = 7068; mean age = 12.89 years, 47% female) and their parents. In all youth, parent-reported adolescent religious importance was associated with reduced odds of SA (OR = 0.75, CI = 0.61-0.92, P = .005). Muslim youth were more likely (OR = 1.52, CI = 1.02-2.22, P = .033), and Catholic youth were less likely (OR = 0.80, CI = 0.67-0.95, P = .014), to report SI. A variety of sex differences were noted, with significant protective associations of adolescent self-reported religiosity on SI and SA, religious service attendance on SI, and religious importance on SI, in female-but not male-youth; and significant protective associations of religious importance on SA in male-but not female-youth. Against expectations, there was no evidence that parent religiosity moderated the link between youth religiosity and SI or SA. These results shed light on the roles of cultural and familial context in youth suicide risk, which may ultimately be targeted in screening and interventional approaches.
MeSH term(s)	Adult ; Humans ; Male ; Adolescent ; Female ; United States/epidemiology ; Child ; Religion ; Suicide, Attempted ; Suicidal Ideation ; Parents ; Self Report
Language	English
Publishing date	2024-01-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	2017250-3
ISSN	1573-6571 ; 0022-4197
ISSN (online)	1573-6571
ISSN	0022-4197
DOI	10.1007/s10943-023-01981-7
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Article ; Online: Development of a Novel Clinical Risk Score for COVID-19 Infections.

Baker, James B / Ghatak, Arnab / Cullen, Mark R / Horwitz, Ralph I

The American journal of medicine

2023 Volume 136, Issue 12, Page(s) 1169–1178.e7

Abstract: Objective: The ongoing emergence of novel severe acute respiratory syndrome coronavirus 2 strains such as the Omicron variant amplifies the need for precision in predicting severe COVID-19 outcomes. This study presents a machine learning model, tailored ...

Abstract	Objective: The ongoing emergence of novel severe acute respiratory syndrome coronavirus 2 strains such as the Omicron variant amplifies the need for precision in predicting severe COVID-19 outcomes. This study presents a machine learning model, tailored to the evolving COVID-19 landscape, emphasizing novel risk factors and refining the definition of severe outcomes to predict the risk of a patient experiencing severe disease more accurately. Methods: Utilizing electronic health records from the Healthjump database, this retrospective study examined over 1 million US COVID-19 diagnoses from March 2020 to September 2022. Our model predicts severe outcomes, including acute respiratory failure, intensive care unit admission, or ventilator use, circumventing biases associated with hospitalization, which exhibited ∼4× geographical variance of the new outcome. Results: The model exceeded similar predictors with an area under the curve of 0.83 without lab data to predict patient risk. It identifies new risk factors, including acute care history, health care encounters, and distinct medication use. An increase in severe outcomes, typically 2-3× higher than subsequent months, was observed at the onset of each new strain era, followed by a plateau phase, but the risk factors remain consistent across strain eras. Conclusion: We offer an improved machine learning model and risk score for predicting severe outcomes during changing COVID-19 strain eras. By emphasizing a more clinically precise definition of severe outcomes, the study provides insights for resource allocation and intervention strategies, aiming to better patient outcomes and reduce health care strain. The necessity for regular model updates is highlighted to maintain relevance amidst the rapidly evolving COVID-19 epidemic.
MeSH term(s)	Humans ; COVID-19/epidemiology ; SARS-CoV-2 ; Retrospective Studies ; Risk Factors ; Hospitalization
Language	English
Publishing date	2023-09-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	80015-6
ISSN	1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
ISSN (online)	1555-7162 ; 1873-2178
ISSN	0002-9343 ; 1548-2766
DOI	10.1016/j.amjmed.2023.08.016
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Article: Optimizing the measurement of sample entropy in resting-state fMRI data.

Roediger, Donovan J / Butts, Jessica / Falke, Chloe / Fiecas, Mark B / Klimes-Dougan, Bonnie / Mueller, Bryon A / Cullen, Kathryn R

Frontiers in neurology

2024 Volume 15, Page(s) 1331365

Abstract: Introduction: The complexity of brain signals may hold clues to understand brain-based disorders. Sample entropy, an index that captures the predictability of a signal, is a promising tool to measure signal complexity. However, measurement of sample ... ...

Abstract	Introduction: The complexity of brain signals may hold clues to understand brain-based disorders. Sample entropy, an index that captures the predictability of a signal, is a promising tool to measure signal complexity. However, measurement of sample entropy from fMRI signals has its challenges, and numerous questions regarding preprocessing and parameter selection require research to advance the potential impact of this method. For one example, entropy may be highly sensitive to the effects of motion, yet standard approaches to addressing motion (e.g., scrubbing) may be unsuitable for entropy measurement. For another, the parameters used to calculate entropy need to be defined by the properties of data being analyzed, an issue that has frequently been ignored in fMRI research. The current work sought to rigorously address these issues and to create methods that could be used to advance this field. Methods: We developed and tested a novel windowing approach to select and concatenate (ignoring connecting volumes) low-motion windows in fMRI data to reduce the impact of motion on sample entropy estimates. We created utilities (implementing autoregressive models and a grid search function) to facilitate selection of the matching length Results: When applying these optimized methods to the ABCD data (from the subset of individuals who had enough windows of continuous "usable" volumes), we found that the novel windowing procedure successfully mitigated the large inverse correlation between entropy values and head motion seen when using a standard approach. Furthermore, using the windowed approach, entropy values calculated early in the scan (runs 1 and 2) are largely reproducible when measured later in the scan (runs 3 and 4), although there is some regional variability in reproducibility. Discussion: We developed an optimized approach to measuring sample entropy that addresses concerns about motion and that can be applied across datasets through user-identified adaptations that allow the method to be tailored to the dataset at hand. We offer preliminary results regarding reproducibility. We also include recommendations for fMRI data acquisition to optimize sample entropy measurement and considerations for the field.
Language	English
Publishing date	2024-02-15
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564214-5
ISSN	1664-2295
ISSN	1664-2295
DOI	10.3389/fneur.2024.1331365
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Article ; Online: Distribution of working hour characteristics by race, age, gender, and shift schedule among U.S. manufacturing workers.

Ferguson, Jacqueline M / Bradshaw, Patrick T / Eisen, Ellen A / Rehkopf, David / Cullen, Mark R / Costello, Sadie

Chronobiology international

2023 Volume 40, Issue 3, Page(s) 310–323

Abstract: Shift work is a common occupational exposure, however, few studies have examined aspects of shift work beyond night work and long hours, such as rotational patterns or weekend work, which may contribute to poor health through disruption of the body's ... ...

Abstract	Shift work is a common occupational exposure, however, few studies have examined aspects of shift work beyond night work and long hours, such as rotational patterns or weekend work, which may contribute to poor health through disruption of the body's circadian rhythms. In this manuscript, we calculated the prevalence of working hour characteristics using algorithms for type (e.g., day), duration, intensity, rotational direction, and social aspects (e.g., weekend work) in a nationwide cohort of American manufacturing workers (N = 23,044) between 2003 and 2014. Distributions of working hour characteristics were examined by schedules (e.g., permanent day, day/night) and demographics, and were cross-classified in a matrix to examine co-occurrence. Approximately 55% of shifts may cause circadian rhythm disruption as they were non-day shifts or day shifts with a quick return or rotation, or were 13 h or longer. Older workers, female workers, and White workers worked permanent day shifts most often, while workers of color worked more day/night schedules. Night and evening shifts had more frequent shift rotations, quick returns, and longer hours than day shifts. Yet, day shifts, which are presumed to have little negative circadian impact, may cause circadian rhythm disruption as long hours, quick returns and rotations also occurred within day shifts.
MeSH term(s)	Humans ; Female ; Circadian Rhythm ; Work Schedule Tolerance ; Sleep Disorders, Circadian Rhythm ; Sleep
Language	English
Publishing date	2023-01-24
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	998996-1
ISSN	1525-6073 ; 0742-0528
ISSN (online)	1525-6073
ISSN	0742-0528
DOI	10.1080/07420528.2023.2168200
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Article: Disease-Specific Health Disparities: A Targeted Review Focusing on Race and Ethnicity.

Cullen, Mark R / Lemeshow, Adina R / Russo, Leo J / Barnes, David M / Ababio, Yaa / Habtezion, Aida

Healthcare (Basel, Switzerland)

2022 Volume 10, Issue 4

Abstract: Background: Wide disparities in health status exist in the United States across race and ethnicity, broadly driven by social determinants of health-most notably race and ethnic group differences in income, education, and occupational status. However, ... ...

Abstract	Background: Wide disparities in health status exist in the United States across race and ethnicity, broadly driven by social determinants of health-most notably race and ethnic group differences in income, education, and occupational status. However, disparities in disease frequency or severity remain underappreciated for many individual diseases whose distribution in the population varies. Such information is not readily accessible, nor emphasized in treatment guidelines or reviews used by practitioners. Specifically, a summary on disease-specific evidence of disparities from population-based studies is lacking. Our goal was to summarize the published evidence for specific disease disparities in the United States so that this knowledge becomes more widely available "at the bedside". We hope this summary stimulates health equity research at the disease level so that these disparities can be addressed effectively. Methods: A targeted literature review of disorders in Pfizer's current pipeline was conducted. The 38 diseases included metabolic disorders, cancers, inflammatory conditions, dermatologic disorders, rare diseases, and infectious targets of vaccines under development. Online searches in Ovid and Google were performed to identify sources focused on differences in disease rates and severity between non-Hispanic Whites and Black/African Americans, and between non-Hispanic Whites and Hispanics. As a model for how this might be accomplished for all disorders, disparities in disease rates and disease severity were scored to make the results of our review most readily accessible. After primary review of each condition by one author, another undertook an independent review. Differences between reviewers were resolved through discussion. Results: For Black/African Americans, 29 of the 38 disorders revealed a robust excess in incidence, prevalence, or severity. After sickle cell anemia, the largest excesses in frequency were identified for multiple myeloma and hidradenitis suppurativa. For Hispanics, there was evidence of disparity in 19 diseases. Most notable were metabolic disorders, including non-alcoholic steatohepatitis (NASH). Conclusions: This review summarized recent disease-specific evidence of disparities based on race and ethnicity across multiple diseases, to inform clinicians and health equity research. Our findings may be well known to researchers and specialists in their respective fields but may not be common knowledge to health care providers or public health and policy institutions. Our hope is that this effort spurs research into the causes of the many disease disparities that exist in the United States.
Language	English
Publishing date	2022-03-23
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2721009-1
ISSN	2227-9032
ISSN	2227-9032
DOI	10.3390/healthcare10040603
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Article ; Online: Race/ethnicity reporting and representation in US clinical trials: a cohort study.

Turner, Brandon E / Steinberg, Jecca R / Weeks, Brannon T / Rodriguez, Fatima / Cullen, Mark R

Lancet Regional Health. Americas

2022 Volume 11

Abstract: Background: Systemic progress in improving trial representation is uncertain, and previous analyses of minority trial participation have been limited to small cohorts with limited exploration of driving factors.: Methods: We analyzed detailed trial ... ...

Abstract	Background: Systemic progress in improving trial representation is uncertain, and previous analyses of minority trial participation have been limited to small cohorts with limited exploration of driving factors. Methods: We analyzed detailed trial records from all US clinical trials registered in ClinicalTrials.gov from March 2000 to March 2020. Minority enrollment was compared to 2010 US Census demographic estimates using Wilcoxon test. We utilized logistic regression and generalized linear regression with a logit link to assess the association of possible drivers (including trials' funding source, size, phase, and design) with trials' disclosure of and amount of minority enrollment respectively. Findings: Among 20,692 US-based trials with reported results (representing ~4·76 million enrollees), only 43% (8,871/20,692) reported any race/ethnicity data. The majority of enrollees were White (median 79·7%; interquartile range [IQR] 61·9-90·0%), followed by Black (10·0%; IQR 2·5-23·5%), Hispanic/Latino (6·0%; IQR 0·43-15·4%), Asian (1·0%; IQR 0·0-4·1%), and American Indian (0·0%; IQR 0·0-0·2%). Median combined enrollment of minority race/ethnicity groups (Black, Hispanic/Latino, Asian, American Indian, Other/Multi) was below census estimates (27·6%) (p<0·001) however increased at an annual rate of 1·7%. Industry and Academic funding were negatively associated with race/ethnicity reporting (Industry adjusted odds ratio [aOR]: 0·42, 95% confidence interval [CI]: 0·38 to 0·46, p<0.0001; Academic aOR: 0·45, CI: 0·41 to 0·50, p<0.0001). Industry also had a negative association with the proportion of minority ethnicity enrollees (aOR: 0·69, CI: 0·60 to 0·79) compared to US Government-funded trials. Interpretation: Over the past two decades, the majority of US trials in ClinicalTrials.gov do not report race/ethnicity enrollment data, and minorities are underrepresented in trials with modest improvement over time. Funding: Stanford Medical Scholars Research Funding, the National Heart, Lung, and Blood Institute, NIH (1K01HL144607) and the American Heart Association/Robert Wood Johnson Medical Faculty Development Program.
Language	English
Publishing date	2022-04-10
Publishing country	England
Document type	Journal Article
ISSN	2667-193X
ISSN (online)	2667-193X
DOI	10.1016/j.lana.2022.100252
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Article ; Online: Disparities in job characteristics by race and sex in a Southern aluminum smelting facility.

McClure, Elizabeth S / Robinson, Whitney R / Vasudevan, Pavithra / Cullen, Mark R / Marshall, Stephen W / Noth, Elizabeth / Richardson, David

American journal of industrial medicine

2023 Volume 66, Issue 4, Page(s) 307–319

Abstract: Background: Former workers at a Southern aluminum smelting facility raised concerns that the most hazardous jobs were assigned to Black workers, but the role of workplace segregation had not been quantified or examined in the company town. Prior studies ...

Abstract	Background: Former workers at a Southern aluminum smelting facility raised concerns that the most hazardous jobs were assigned to Black workers, but the role of workplace segregation had not been quantified or examined in the company town. Prior studies discuss race and gender disparities in working conditions, but few have documented them in the aluminum industry. Methods: We obtained workers' company records for 1985-2007 and characterized four job metrics: prestige (sociologic rankings), worker-defined danger (worker assessments), annual wage (1985 dollars), and estimated total particulate matter (TPM) exposure (job exposure matrix). Characteristics of job at hire and trajectories were compared by race and sex using linear binomial models. Results: Non-White males had the highest percentage of workers in low prestige and high danger jobs at hire and up to 20 years after. After 20 years tenure, 100% of White workers were in higher prestige and lower danger jobs. Most female workers, regardless of race, entered and remained in low-wage jobs, while 50% of all male workers maintained their initial higher-wage jobs. Non-White females had the highest prevalence of workers in low-wage jobs at hire and after 20 years-increasing from 63% (95% CI: 59-67) to 100% (95% CI: 78-100). All female workers were less likely to be in high TPM exposure jobs. Non-White males were most likely to be hired into high TPM exposure jobs, and this exposure prevalence increased as time accrued, while staying constant for other race-sex groups. Conclusions: There is evidence of job segregation by race and sex in this cohort of aluminum smelting workers. Documentation of disparities in occupational hazards is important for informing health interventions and research.
MeSH term(s)	Humans ; Male ; Female ; Aluminum ; Occupations ; Industry ; Workplace ; Particulate Matter ; Occupational Exposure/analysis
Chemical Substances	Aluminum (CPD4NFA903) ; Particulate Matter
Language	English
Publishing date	2023-02-07
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	604538-8
ISSN	1097-0274 ; 0271-3586
ISSN (online)	1097-0274
ISSN	0271-3586
DOI	10.1002/ajim.23464
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