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Article ; Online: Negative-Control Exposures: Adjusting for Unmeasured and Measured Confounders With Bounds for Remaining Bias.

Flanders, W Dana

2023 Volume 34, Issue 6, Page(s) 850–853

Abstract: Negative-control exposures can be used to detect and even adjust for confounding that remains after control of measured confounders. A newly described method allows the analyst to reduce residual confounding by unmeasured confounders U by using negative- ... ...

Abstract	Negative-control exposures can be used to detect and even adjust for confounding that remains after control of measured confounders. A newly described method allows the analyst to reduce residual confounding by unmeasured confounders U by using negative-control exposures to define and select a subcohort wherein the U-distribution among the exposed is similar to that among the unexposed. Here, we show that conventional methods can be used to control for measured confounders in conjunction with the new method to control for unmeasured ones. We also derive an expression for bias that remains after applying this approach. We express remaining bias in terms of a "balancing" parameter and show that this parameter is bounded by a summary variational distance between the U-distribution in the exposed and the unexposed. These measures describe and bound the extent of remaining confounding after using negative controls to adjust for unmeasured confounders with conventional control of measured confounders.
MeSH term(s)	Humans ; Bias
Language	English
Publishing date	2023-09-26
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1053263-8
ISSN	1531-5487 ; 1044-3983
ISSN (online)	1531-5487
ISSN	1044-3983
DOI	10.1097/EDE.0000000000001650
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Article ; Online: Estimated cytomegalovirus seroprevalence in the general population of the United States and Canada.

Dana Flanders, W / Lally, Cathy / Dilley, Anne / Diaz-Decaro, John

Journal of medical virology

2024 Volume 96, Issue 3, Page(s) e29525

Abstract: Seroprevalence data for cytomegalovirus (CMV), a widespread virus causing lifelong infection, vary widely, and contemporary data from the United States (US) and Canada are limited. Utilizing a modeling approach based on a literature review (conducted ... ...

Abstract	Seroprevalence data for cytomegalovirus (CMV), a widespread virus causing lifelong infection, vary widely, and contemporary data from the United States (US) and Canada are limited. Utilizing a modeling approach based on a literature review (conducted August, 2022) of data published since 2005, we determine age-, sex-, and country-specific CMV seroprevalence in the general US and Canadian populations. Sex-specific data were extracted by age categories, and a random-effects meta-regression model was used to fit the reported data (incorporating splines for the US). Seven studies reported US CMV seroprevalence (both sexes, aged 1‒89 years); all used National Health and Nutrition Examination Survey data. Due to limited population-based studies, Canadian estimates were modeled using other limited country data. In both countries, modeled seroprevalence estimates increased with age and were higher in females versus males (US: 49.0% vs. 41.6% at 18‒19 years; 61.5% vs. 50.0% at 38‒39 years; Canada: 23.7% vs. 13.7% at 18‒19 years; 32.6% vs. 22.6% at 38‒39 years). Notably, by young adulthood, one-half of US and one-quarter of Canadian females have acquired CMV. The observed differences in CMV seroprevalence in the US and Canada may partially reflect variations in general population characteristics.
MeSH term(s)	Male ; Female ; Humans ; United States/epidemiology ; Young Adult ; Adult ; Cytomegalovirus ; Cytomegalovirus Infections/epidemiology ; Nutrition Surveys ; Seroepidemiologic Studies ; Antibodies, Viral ; Canada/epidemiology
Chemical Substances	Antibodies, Viral
Language	English
Publishing date	2024-03-19
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	752392-0
ISSN	1096-9071 ; 0146-6615
ISSN (online)	1096-9071
ISSN	0146-6615
DOI	10.1002/jmv.29525
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Article ; Online: Medicaid Expansion and Health Care Use Among Adults With Asthma and Low Incomes: The Adult Asthma Call-Back Survey.

Qin, Xiaoting / Mirabelli, Maria C / Flanders, W Dana / Hsu, Joy

Public health reports (Washington, D.C. : 1974)

2024 , Page(s) 333549241228501

Abstract: Objectives: Asthma disproportionately affects Black people and people with low incomes, but Medicaid expansion (hereinafter, expansion) data on these populations are limited. We investigated health care use among adults with asthma, before and after ... ...

Abstract	Objectives: Asthma disproportionately affects Black people and people with low incomes, but Medicaid expansion (hereinafter, expansion) data on these populations are limited. We investigated health care use among adults with asthma, before and after expansion, and examined whether asthma-related health care use after expansion varied by demographic characteristics. Methods: We analyzed data from the 2011-2013 and 2015-2019 Behavioral Risk Factor Surveillance System Adult Asthma Call-Back Survey on participants aged 18-64 years with current asthma and low incomes in 23 US states. We assessed 5 asthma-related outcomes, including medical visits (routine and emergency) and medication use, for expansion and nonexpansion groups. We used Results: Primary analyses (N = 10 796) found no significant associations between expansion and any outcome. Analyses stratified by race and ethnicity found no significant changes (eg, asthma controller medication use among non-Hispanic Black participants in the expansion group was 24.1% [95% CI, 14.4%-37.5%] in 2011-2013 and 35.5% [95% CI, 27.0%-45.1%] in 2015-2019; Conclusions: Investigating factors other than health insurance (eg, social determinants of health) that influence the use of asthma-related health care could advance knowledge of potential strategies to advance health equity for adults with asthma and lower incomes.
Language	English
Publishing date	2024-02-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	120953-x
ISSN	1468-2877 ; 0033-3549
ISSN (online)	1468-2877
ISSN	0033-3549
DOI	10.1177/00333549241228501
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Article ; Online: Invited Commentary: Two-Phase, Generalized Case-Control Designs for Quantitative Longitudinal Outcomes and Evolution of the Case-Control Study.

Flanders, W Dana

American journal of epidemiology

2019 Volume 189, Issue 2, Page(s) 91–94

Abstract: The case-control study design has evolved substantially over the past half century. The design has long been recognized as a way to increase efficiency by studying fewer subjects than would be required for a full cohort study. Historically, it was ... ...

Abstract	The case-control study design has evolved substantially over the past half century. The design has long been recognized as a way to increase efficiency by studying fewer subjects than would be required for a full cohort study. Historically, it was thought that case-control studies required a rare disease assumption for valid risk ratio estimation, but it was later realized that rare disease was not necessary. Over time, the design and analysis methods were further modified to allow estimation of rate ratios or to allow each person to serve as his/her own control (as we see with case-cohort and case-crossover studies, for example). We now understand that efficiency can be increased through the use of outcome-dependent sampling not only for dichotomous outcomes but also for continuous outcomes in longitudinal studies with repeated outcome measurement during follow-up. In their accompanying paper, Schildcrout et al. (Am J Epidemiol. 2019;000(00):000-000) contribute to our understanding, clearly summarizing many recent advances in study design and analyses that allow more general and efficient use of case-control studies. Their simulations demonstrate that improved efficiency is achieved with these methods when the goal is to estimate associations of exposure with trajectories and patterns of change over time. Here we comment on application of some of these generalized case-control methods to causal inference.
MeSH term(s)	Case-Control Studies ; Cohort Studies ; Cross-Over Studies ; Female ; Longitudinal Studies ; Male ; Odds Ratio
Language	English
Publishing date	2019-09-30
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	2937-3
ISSN	1476-6256 ; 0002-9262
ISSN (online)	1476-6256
ISSN	0002-9262
DOI	10.1093/aje/kwz200
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Article ; Online: The Authors Respond.

Flanders, W Dana / Garber, Michael D

Epidemiology (Cambridge, Mass.)

2019 Volume 30, Issue 6, Page(s) e38

MeSH term(s)	Lifting ; Smog
Chemical Substances	Smog
Language	English
Publishing date	2019-10-03
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	1053263-8
ISSN	1531-5487 ; 1044-3983
ISSN (online)	1531-5487
ISSN	1044-3983
DOI	10.1097/EDE.0000000000001074
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Article ; Online: Is the Smog Lifting?: Causal Inference in Environmental Epidemiology.

Flanders, W Dana / Garber, Michael D

Epidemiology (Cambridge, Mass.)

2019 Volume 30, Issue 3, Page(s) 317–320

MeSH term(s)	Environmental Health ; Lifting ; Smog
Chemical Substances	Smog
Language	English
Publishing date	2019-02-21
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	1053263-8
ISSN	1531-5487 ; 1044-3983
ISSN (online)	1531-5487
ISSN	1044-3983
DOI	10.1097/EDE.0000000000000986
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Article ; Online: Ambient Air Quality and Fatal Asthma Exacerbations among Children in North Carolina.

Mirabelli, Maria C / Flanders, W Dana / Vaidyanathan, Ambarish / Beavers, Daniel P / Gower, W Adam

Epidemiology (Cambridge, Mass.)

2023 Volume 34, Issue 6, Page(s) 888–891

Abstract: Background: Little is known about the role of air quality in fatal asthma exacerbations among children.: Methods: We collected information about 80 deaths that occurred in North Carolina from 2001 through 2016, among children aged 5-17 years, with ... ...

Abstract	Background: Little is known about the role of air quality in fatal asthma exacerbations among children. Methods: We collected information about 80 deaths that occurred in North Carolina from 2001 through 2016, among children aged 5-17 years, with asthma identified as the primary cause of death. We linked information about each death with county-level estimates of particulate matter ≤2.5 µm (PM2.5) and ozone (O3). Using the linked data, we conducted a case-crossover analysis of associations between PM2.5 and O3 lagged by 3-5 days with the odds of fatal asthma exacerbations. Results: In the highest tertile of PM2.5 lag(3-5), the odds of a fatal exacerbation of asthma were more than twice the odds in the lowest tertile (odds ratio = 2.2; 95% confidence interval = 1.1, 4.6). Conclusion: These findings from North Carolina provide evidence to support the hypothesis that ambient air pollution increases the risk of fatal exacerbations of asthma among children.
MeSH term(s)	Child ; Humans ; North Carolina/epidemiology ; Air Pollution/adverse effects ; Asthma/epidemiology ; Ozone/adverse effects ; Particulate Matter/adverse effects
Chemical Substances	Ozone (66H7ZZK23N) ; Particulate Matter
Language	English
Publishing date	2023-09-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	1053263-8
ISSN	1531-5487 ; 1044-3983
ISSN (online)	1531-5487
ISSN	1044-3983
DOI	10.1097/EDE.0000000000001648
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Article ; Online: The association of voter turnout with county-level coronavirus disease 2019 occurrence early in the pandemic.

Flanders, W Dana / Flanders, William D / Goodman, Michael

Annals of epidemiology

2020 Volume 49, Page(s) 42–49

Abstract: Purpose: The ongoing coronavirus disease 2019 (COVID-19) severely impacted both health and the economy. Absent an effective vaccine, preventive measures used, some of which are being relaxed, have included school closures, restriction of movement, and ... ...

Abstract	Purpose: The ongoing coronavirus disease 2019 (COVID-19) severely impacted both health and the economy. Absent an effective vaccine, preventive measures used, some of which are being relaxed, have included school closures, restriction of movement, and banning of large gatherings. Our goal was to estimate the association of voter turnout with county-level COVID-19 risks. Methods: We used publicly available data on voter turnout in the March 10 primary in three states, COVID-19 confirmed cases by day and county, and county-level census data. We used zero-inflated negative binomial regression to estimate the association of voter turnout with COVID-19 incidence, adjusted for county-level population density and proportions: over age 65 years, female, Black, with college education, with high school education, poor, obese, and smokers. Results: COVID-19 risk was associated with voter turnout, most strongly in Michigan during the week starting 3 days postelection (risk ratio, 1.24; 95% confidence interval, 1.16-1.33). For longer periods, the association was progressively weaker (risk ratio 0.98-1.03). Conclusions: Despite increased absentee-ballot voting in the primary, our results suggest an association of voter turnout in at least one state with a detectable increase in risks associated with and perhaps due to greater exposures related to the primary.
MeSH term(s)	COVID-19/epidemiology ; Coronavirus Infections/epidemiology ; Humans ; Incidence ; Local Government ; Pandemics ; Physical Distancing ; Pneumonia, Viral/epidemiology ; Politics ; Residence Characteristics ; Risk Factors ; Socioeconomic Factors
Keywords	covid19
Language	English
Publishing date	2020-07-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	1074355-8
ISSN	1873-2585 ; 1047-2797
ISSN (online)	1873-2585
ISSN	1047-2797
DOI	10.1016/j.annepidem.2020.06.011
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Article ; Online: A definition of the causal effect of a political party's nominee on the U.S. general presidential election using counterfactual response types.

Garber, Michael D / Collin, Lindsay J / Dana Flanders, W

Annals of epidemiology

2020 Volume 47, Page(s) 4–7

Abstract: The electability of the candidates for the 2020 Democratic U.S. presidential nomination was frequently debated. Arguments regarding a candidate's electability often claimed that they would affect the general election by changing the behavior of a certain ...

Abstract	The electability of the candidates for the 2020 Democratic U.S. presidential nomination was frequently debated. Arguments regarding a candidate's electability often claimed that they would affect the general election by changing the behavior of a certain subset of eligible voters. For example, is it more important electorally that a candidate drive turnout or swing voting? As lay consumers of political opinion, we were having difficulty weighing these questions from a strategic standpoint. Although candidate electability is a nebulous term that might be interpreted in various ways, one interpretation of the term is a population-based causal question: What would the effect of the Democratic nominee be on the presidential election result? Population-based causal questions are commonly studied in epidemiology. To aid interpretation of electability arguments, we frame the question through a counterfactual model used in epidemiology. Specifically, we define the causal effect by characterizing the population of eligible voters into nine counterfactual response types. The definition clarifies our ability to interpret arguments regarding the electability of the candidates. For example, the causal effect can be subdivided into three parts: the effect of the nominee on (1) Democratic turnout, (2) Republican turnout, and (3) swing voting. We show using notation that the third part has twice the weight as the other two. The definition follows intuition. However, we hope its formalization using counterfactual response types may foster interdisciplinary communication.
MeSH term(s)	Causality ; Choice Behavior ; Decision Making ; Humans ; Politics ; United States
Language	English
Publishing date	2020-05-12
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1074355-8
ISSN	1873-2585 ; 1047-2797
ISSN (online)	1873-2585
ISSN	1047-2797
DOI	10.1016/j.annepidem.2020.05.002
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Article ; Online: Using Randomized Controlled Trials to Estimate the Effect of Community Interventions for Childhood Asthma.

Flanders, W Dana / Nurmagambetov, Tursynbek A / Cornwell, Cheryl R / Kosinski, Andrzej S / Sircar, Kanta

Preventing chronic disease

2023 Volume 20, Page(s) E44

Abstract: Introduction: The Centers for Disease Control and Prevention's Controlling Childhood Asthma and Reducing Emergencies initiative aims to prevent 500,000 emergency department (ED) visits and hospitalizations within 5 years among children with asthma ... ...

Abstract	Introduction: The Centers for Disease Control and Prevention's Controlling Childhood Asthma and Reducing Emergencies initiative aims to prevent 500,000 emergency department (ED) visits and hospitalizations within 5 years among children with asthma through implementation of evidence-based interventions and policies. Methods are needed for calculating the anticipated effects of planned asthma programs and the estimated effects of existing asthma programs. We describe and illustrate a method of using results from randomized control trials (RCTs) to estimate changes in rates of adverse asthma events (AAEs) that result from expanding access to asthma interventions. Methods: We use counterfactual arguments to justify a formula for the expected number of AAEs prevented by a given intervention. This formula employs a current rate of AAEs, a measure of the increase in access to the intervention, and the rate ratio estimated in an RCT. Results: We justified a formula for estimating the effect of expanding access to asthma interventions. For example, if 20% of patients with asthma in a community with 20,540 annual asthma-related ED visits were offered asthma self-management education, ED visits would decrease by an estimated 1,643; and annual hospitalizations would decrease from 2,639 to 617. Conclusion: Our method draws on the best available evidence from RCTs to estimate effects on rates of AAEs in the community of interest that result from expanding access to asthma interventions.
MeSH term(s)	Humans ; Child ; Randomized Controlled Trials as Topic ; Asthma/therapy ; Emergency Service, Hospital ; Hospitalization
Language	English
Publishing date	2023-06-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2135684-1
ISSN	1545-1151 ; 1545-1151
ISSN (online)	1545-1151
ISSN	1545-1151
DOI	10.5888/pcd20.220351
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