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  1. Article ; Online: Pediatric and Young Adult Household Transmission of the Initial Waves of SARS-CoV-2 in the United States: Administrative Claims Study.

    Chung, Ming Kei / Hart, Brian / Santillana, Mauricio / Patel, Chirag J

    Journal of medical Internet research

    2024  Volume 26, Page(s) e44249

    Abstract: Background: The correlates responsible for the temporal changes of intrahousehold SARS-CoV-2 transmission in the United States have been understudied mainly due to a lack of available surveillance data. Specifically, early analyses of SARS-CoV-2 ... ...

    Abstract Background: The correlates responsible for the temporal changes of intrahousehold SARS-CoV-2 transmission in the United States have been understudied mainly due to a lack of available surveillance data. Specifically, early analyses of SARS-CoV-2 household secondary attack rates (SARs) were small in sample size and conducted cross-sectionally at single time points. From these limited data, it has been difficult to assess the role that different risk factors have had on intrahousehold disease transmission in different stages of the ongoing COVID-19 pandemic, particularly in children and youth.
    Objective: This study aimed to estimate the transmission dynamic and infectivity of SARS-CoV-2 among pediatric and young adult index cases (age 0 to 25 years) in the United States through the initial waves of the pandemic.
    Methods: Using administrative claims, we analyzed 19 million SARS-CoV-2 test records between January 2020 and February 2021. We identified 36,241 households with pediatric index cases and calculated household SARs utilizing complete case information. Using a retrospective cohort design, we estimated the household SARS-CoV-2 transmission between 4 index age groups (0 to 4 years, 5 to 11 years, 12 to 17 years, and 18 to 25 years) while adjusting for sex, family size, quarter of first SARS-CoV-2 positive record, and residential regions of the index cases.
    Results: After filtering all household records for greater than one member in a household and missing information, only 36,241 (0.85%) of 4,270,130 households with a pediatric case remained in the analysis. Index cases aged between 0 and 17 years were a minority of the total index cases (n=11,484, 11%). The overall SAR of SARS-CoV-2 was 23.04% (95% CI 21.88-24.19). As a comparison, the SAR for all ages (0 to 65+ years) was 32.4% (95% CI 32.1-32.8), higher than the SAR for the population between 0 and 25 years of age. The highest SAR of 38.3% was observed in April 2020 (95% CI 31.6-45), while the lowest SAR of 15.6% was observed in September 2020 (95% CI 13.9-17.3). It consistently decreased from 32% to 21.1% as the age of index groups increased. In a multiple logistic regression analysis, we found that the youngest pediatric age group (0 to 4 years) had 1.69 times (95% CI 1.42-2.00) the odds of SARS-CoV-2 transmission to any family members when compared with the oldest group (18 to 25 years). Family size was significantly associated with household viral transmission (odds ratio 2.66, 95% CI 2.58-2.74).
    Conclusions: Using retrospective claims data, the pediatric index transmission of SARS-CoV-2 during the initial waves of the COVID-19 pandemic in the United States was associated with location and family characteristics. Pediatric SAR (0 to 25 years) was less than the SAR for all age other groups. Less than 1% (n=36,241) of all household data were retained in the retrospective study for complete case analysis, perhaps biasing our findings. We have provided measures of baseline household pediatric transmission for tracking and comparing the infectivity of later SARS-CoV-2 variants.
    MeSH term(s) Adolescent ; Child ; Child, Preschool ; Humans ; Infant ; Infant, Newborn ; Young Adult ; COVID-19/epidemiology ; Family Characteristics ; Pandemics ; Retrospective Studies ; SARS-CoV-2 ; United States/epidemiology ; Disease Transmission, Infectious
    Language English
    Publishing date 2024-01-04
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 2028830-X
    ISSN 1438-8871 ; 1438-8871
    ISSN (online) 1438-8871
    ISSN 1438-8871
    DOI 10.2196/44249
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  2. Article ; Online: Spatio-temporal interpolation and delineation of extreme heat events in California between 2017 and 2021.

    Fard, Pedram / Chung, Ming Kei Jake / Estiri, Hossein / Patel, Chirag J

    Environmental research

    2023  Volume 237, Issue Pt 2, Page(s) 116984

    Abstract: Robust spatio-temporal delineation of extreme climate events and accurate identification of areas that are impacted by an event is a prerequisite for identifying population-level and health-related risks. In prior research, attributes such as temperature ...

    Abstract Robust spatio-temporal delineation of extreme climate events and accurate identification of areas that are impacted by an event is a prerequisite for identifying population-level and health-related risks. In prior research, attributes such as temperature and humidity have often been linearly assigned to the population of the study unit from the closest weather station. This could result in inaccurate event delineation and biased assessment of extreme heat exposure. We have developed a spatio-temporal model to dynamically delineate boundaries for Extreme Heat Events (EHE) across space and over time, using a relative measure of Apparent Temperature (AT). Our surface interpolation approach offers a higher spatio-temporal resolution compared to the standard nearest-station (NS) assignment method. We show that the proposed approach can provide at least 80.8 percent improvement in identification of areas and populations impacted by EHEs. This improvement in average adjusts the misclassification of about one million Californians per day of an extreme event, who would be either unidentified or misidentified under EHEs between 2017 and 2021.
    MeSH term(s) Extreme Heat/adverse effects ; Weather ; Temperature ; Climate ; California ; Climate Change
    Language English
    Publishing date 2023-08-28
    Publishing country Netherlands
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 205699-9
    ISSN 1096-0953 ; 0013-9351
    ISSN (online) 1096-0953
    ISSN 0013-9351
    DOI 10.1016/j.envres.2023.116984
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  3. Article ; Online: Systematic comparisons between Lyme disease and post-treatment Lyme disease syndrome in the U.S. with administrative claims data.

    Chung, Ming Kei / Caboni, Mariaelena / Strandwitz, Philip / D'Onofrio, Anthony / Lewis, Kim / Patel, Chirag J

    EBioMedicine

    2023  Volume 90, Page(s) 104524

    Abstract: Background: Post-treatment Lyme disease syndrome (PTLDS) is used to describe Lyme disease patients who have the infection cleared by antibiotic but then experienced persisting symptoms of pain, fatigue, or cognitive impairment. Currently, little is ... ...

    Abstract Background: Post-treatment Lyme disease syndrome (PTLDS) is used to describe Lyme disease patients who have the infection cleared by antibiotic but then experienced persisting symptoms of pain, fatigue, or cognitive impairment. Currently, little is known about the cause or epidemiology of PTLDS.
    Methods: We conducted a data-driven study with a large nationwide administrative dataset, which consists of more than 98 billion billing and 1.4 billion prescription records between 2008 and 2016, to identify unique aspects of PTLDS that could have diagnostic and etiologic values. We defined PTLDS based on its symptomatology and compared the demographic, longitudinal changes of comorbidity, and antibiotic prescriptions between patients who have Lyme with absence of prolonged symptoms (APS) and PTLDS.
    Findings: The age and temporal distributions were similar between Lyme APS and PTLDS. The PTLDS-to-Lyme APS case ratio was 3.42%. The co-occurrence of 3 out of 19 chronic conditions were significantly higher in PTLDS versus Lyme APS-odds ratio and 95% CI for anemia, hyperlipidemia, and osteoarthrosis were 1.46 (1.11-1.92), 1.39 (1.15-1.68), and 1.62 (1.23-2.12) respectively. We did not find significant differences between PTLDS and Lyme APS for the number of types of antibiotics prescribed (incidence rate ratio = 1.009, p = 0.90) and for the prescription of each of the five antibiotics (FDR adjusted p values 0.72-0.95).
    Interpretation: PTLDS cases have more codes corresponding to anemia, hyperlipidemia, and osteoarthrosis compared to Lyme APS. Our finding of hyperlipidemia is consistent with a dysregulation of fat metabolism reported by other researchers, and further investigation should be conducted to understand the potential biological relationship between the two.
    Funding: Steven & Alexandra Cohen Foundation, Global Lyme Alliance, and the Pazala Foundation; National Institutes of Health R01ES032470.
    MeSH term(s) Humans ; Post-Lyme Disease Syndrome/complications ; Post-Lyme Disease Syndrome/drug therapy ; Lyme Disease/diagnosis ; Lyme Disease/drug therapy ; Lyme Disease/epidemiology ; Anti-Bacterial Agents/therapeutic use ; Chronic Disease ; Pain/drug therapy
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2023-03-21
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2851331-9
    ISSN 2352-3964
    ISSN (online) 2352-3964
    DOI 10.1016/j.ebiom.2023.104524
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  4. Article ; Online: Corrigendum to "Systematic comparisons between Lyme disease and post-treatment Lyme disease syndrome in the U.S. with administrative claims data".

    Chung, Ming Kei / Caboni, Mariaelena / Strandwitz, Philip / D'Onofrio, Anthony / Lewis, Kim / Patel, Chirag J

    EBioMedicine

    2023  Volume 93, Page(s) 104652

    Language English
    Publishing date 2023-06-19
    Publishing country Netherlands
    Document type Published Erratum
    ZDB-ID 2851331-9
    ISSN 2352-3964
    ISSN (online) 2352-3964
    DOI 10.1016/j.ebiom.2023.104652
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  5. Article ; Online: The Associations of Prenatal Exposure to Fine Particulate Matter and Its Chemical Components with Allergic Rhinitis in Children and the Modification Effect of Polyunsaturated Fatty Acids: A Birth Cohort Study.

    Chen, Yujing / Guo, Cuihua / Chung, Ming Kei / Yi, Quanying / Wang, Xin / Wang, Yuxuan / Jiang, Bibo / Liu, Yu / Lan, Minyan / Lin, Lizi / Cai, Li

    Environmental health perspectives

    2024  Volume 132, Issue 4, Page(s) 47010

    Abstract: Background: Polyunsaturated fatty acids (PUFAs) have been shown to protect against fine particulate matter : Objectives: We aimed to investigate the association of prenatal exposure to : Methods: This prospective birth cohort study involved 657 ... ...

    Abstract Background: Polyunsaturated fatty acids (PUFAs) have been shown to protect against fine particulate matter
    Objectives: We aimed to investigate the association of prenatal exposure to
    Methods: This prospective birth cohort study involved 657 mother-child pairs from Guangzhou, China. Prenatal exposure to residential
    Results: Approximately
    Conclusion: Prenatal exposure to
    MeSH term(s) Humans ; Female ; Child, Preschool ; Pregnancy ; Particulate Matter/analysis ; Cohort Studies ; Air Pollutants/analysis ; Prenatal Exposure Delayed Effects/chemically induced ; Prospective Studies ; Fatty Acids, Unsaturated/analysis ; Rhinitis, Allergic/chemically induced ; China ; Air Pollution/analysis ; Environmental Exposure/analysis
    Chemical Substances Particulate Matter ; Air Pollutants ; Fatty Acids, Unsaturated
    Language English
    Publishing date 2024-04-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 195189-0
    ISSN 1552-9924 ; 0091-6765 ; 1078-0475
    ISSN (online) 1552-9924
    ISSN 0091-6765 ; 1078-0475
    DOI 10.1289/EHP13524
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  6. Article ; Online: Characterising the relationships between physiological indicators and all-cause mortality (NHANES): a population-based cohort study.

    Nguyen, Vy Kim / Colacino, Justin / Chung, Ming Kei / Goallec, Alan Le / Jolliet, Olivier / Patel, Chirag J

    The lancet. Healthy longevity

    2021  Volume 2, Issue 10, Page(s) e651–e662

    Abstract: Background: Mortality risk stratification based on dichotomising a physiological indicator with a cutoff point might not adequately capture increased mortality risk and might not account for non-linear associations. We aimed to characterise the linear ... ...

    Abstract Background: Mortality risk stratification based on dichotomising a physiological indicator with a cutoff point might not adequately capture increased mortality risk and might not account for non-linear associations. We aimed to characterise the linear and non-linear relationships of 27 physiological indicators with all-cause mortality to evaluate whether the current clinical thresholds are suitable in distinguishing patients at high risk for mortality from those at low risk.
    Methods: For this observational cohort study of the US non-institutionalised population, we used data from adults (≥18 years) included in the 1999-2014 National Health and Nutrition Examination Survey (NHANES) linked with National Death Index mortality data collected from Jan 1, 1999, up until Dec 31, 2015. We used Cox proportional hazards regression models adjusted for age, sex, and race or ethnicity to assess associations of physiological indicators with all-cause mortality. We assessed non-linear associations by discretising the physiological indicator into nine quantiles (termed novemtiles) and by using a weighted sum of cubic polynomials (spline). We used ten-fold cross validation to select the most appropriate model using the concordance index, Nagelkerke R
    Findings: We included 47 266 adults of 82 091 assessed for eligibility. 25 (93%) of 27 indicators showed non-linear associations with substantial increases compared with linear models in mortality risk (1·5-2·5-times increase). Height and 60 s pulse were the only physiological indicators to show linear associations. For example, participants with an estimated glomerular filtration rate (GFR) of less than 65 mL/min per 1·73 m
    Interpretation: Most clinical indicators were shown to have non-linear associations with all-cause mortality. Furthermore, considering these non-linear associations can help derive reliable cutoffs to complement risk stratification and help inform clinical care delivery. Given the poor alignment with our proposed cutoffs, the current clinical thresholds might not adequately capture mortality risk.
    MeSH term(s) Adult ; Body Height ; Cohort Studies ; Glomerular Filtration Rate ; Humans ; Nutrition Surveys ; Proportional Hazards Models
    Language English
    Publishing date 2021-09-20
    Publishing country England
    Document type Journal Article ; Observational Study ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ISSN 2666-7568
    ISSN (online) 2666-7568
    DOI 10.1016/s2666-7568(21)00212-9
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  7. Article ; Online: The demographic and socioeconomic correlates of behavior and HIV infection status across sub-Saharan Africa.

    Patel, Chirag J / Claypool, Kajal T / Chow, Eric / Chung, Ming-Kei / Mai, Don / Chen, Jessie / Bendavid, Eran

    Communications medicine

    2022  Volume 2, Page(s) 104

    Abstract: Background: Predisposition to become HIV positive (HIV + ) is influenced by a wide range of correlated economic, environmental, demographic, social, and behavioral factors. While evidence among a candidate handful have strong evidence, there is lack of ... ...

    Abstract Background: Predisposition to become HIV positive (HIV + ) is influenced by a wide range of correlated economic, environmental, demographic, social, and behavioral factors. While evidence among a candidate handful have strong evidence, there is lack of a consensus among the vast array of variables measured in large surveys.
    Methods: We performed a comprehensive data-driven search for correlates of HIV positivity in >600,000 participants of the Demographic and Health Survey across 29 sub-Saharan African countries from 2003 to 2017. We associated a total of 7251 and of 6,288 unique variables with HIV positivity in females and males respectively in each of the 50 surveys. We performed a meta-analysis within countries to attain 29 country-specific associations.
    Results: Here we identify 344 (5.4% out possible) and 373 (5.1%) associations with HIV + in males and females, respectively, with robust statistical support. The associations are consistent in directionality across countries and sexes. The association sizes among individual correlates and their predictive capability were low to modest, but comparable to established factors. Among the identified associations, variables identifying being head of household among females was identified in 17 countries with a mean odds ratio (OR) of 2.5 (OR range: 1.1-3.5, R
    Conclusions: Our continent-wide search for variables has identified under-recognized variables associated with being HIV + that are consistent across the continent and sex. Many of the association sizes are as high as established risk factors for HIV positivity, including male circumcision.
    Language English
    Publishing date 2022-08-18
    Publishing country England
    Document type Journal Article
    ISSN 2730-664X
    ISSN (online) 2730-664X
    DOI 10.1038/s43856-022-00170-z
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  8. Article ; Online: Decoding the exposome: data science methodologies and implications in exposome-wide association studies (ExWASs).

    Chung, Ming Kei / House, John S / Akhtari, Farida S / Makris, Konstantinos C / Langston, Michael A / Islam, Khandaker Talat / Holmes, Philip / Chadeau-Hyam, Marc / Smirnov, Alex I / Du, Xiuxia / Thessen, Anne E / Cui, Yuxia / Zhang, Kai / Manrai, Arjun K / Motsinger-Reif, Alison / Patel, Chirag J

    Exposome

    2024  Volume 4, Issue 1, Page(s) osae001

    Abstract: This paper explores the exposome concept and its role in elucidating the interplay between environmental exposures and human health. We introduce two key concepts critical for exposomics research. Firstly, we discuss the joint impact of genetics and ... ...

    Abstract This paper explores the exposome concept and its role in elucidating the interplay between environmental exposures and human health. We introduce two key concepts critical for exposomics research. Firstly, we discuss the joint impact of genetics and environment on phenotypes, emphasizing the variance attributable to shared and nonshared environmental factors, underscoring the complexity of quantifying the exposome's influence on health outcomes. Secondly, we introduce the importance of advanced data-driven methods in large cohort studies for exposomic measurements. Here, we introduce the exposome-wide association study (ExWAS), an approach designed for systematic discovery of relationships between phenotypes and various exposures, identifying significant associations while controlling for multiple comparisons. We advocate for the standardized use of the term "exposome-wide association study, ExWAS," to facilitate clear communication and literature retrieval in this field. The paper aims to guide future health researchers in understanding and evaluating exposomic studies. Our discussion extends to emerging topics, such as FAIR Data Principles, biobanked healthcare datasets, and the functional exposome, outlining the future directions in exposomic research. This abstract provides a succinct overview of our comprehensive approach to understanding the complex dynamics of the exposome and its significant implications for human health.
    Language English
    Publishing date 2024-01-17
    Publishing country England
    Document type Journal Article
    ISSN 2635-2265
    ISSN (online) 2635-2265
    DOI 10.1093/exposome/osae001
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  9. Article ; Online: Characteristics of undiagnosed diabetes in men and women under the age of 50 years in the Indian subcontinent: the National Family Health Survey (NFHS-4)/Demographic Health Survey 2015-2016.

    Claypool, Kajal T / Chung, Ming-Kei / Deonarine, Andrew / Gregg, Edward W / Patel, Chirag J

    BMJ open diabetes research & care

    2020  Volume 8, Issue 1

    Abstract: Objective: Prior studies examining diabetes prevalence in India have found that nearly 50% of the diabetes population remains undiagnosed; however, the specific populations at risk are unclear.: Research design and methods: First, we estimated the ... ...

    Abstract Objective: Prior studies examining diabetes prevalence in India have found that nearly 50% of the diabetes population remains undiagnosed; however, the specific populations at risk are unclear.
    Research design and methods: First, we estimated the prevalence of undiagnosed diabetes in India for 750 924 persons between the ages of 15 years and 50 years who participated in the National Family Health Survey (NFHS-4)/Demographic Health Survey (2015-2016), a cross-sectional survey of all 29 states and 7 union territories of India. We defined 'undiagnosed diabetes' as individuals who did not know about their diabetes status but had high random (≥200 mg/dL) or fasting (≥126 mg/dL) blood glucose levels. Second, using Poisson regression, we associated 10 different factors, including the role of healthcare access, and undiagnosed diabetes. Third, we examined the association of undiagnosed diabetes with other potential comorbid conditions.
    Results: The crude prevalence of diabetes for women and men aged 15-50 years was 2.9%, 95% CI 2.9% to 3.1%, with self-reported diabetes prevalence at 1.7%, 95% CI 1.6 to 1.8. The overall prevalence of undiagnosed diabetes for 15-50 year olds was at 1.2%, 95% CI 1.2% to 1.3%. Forty-two per cent, 95% CI 40.7% to 43.4% of the individuals with high glucose levels were unaware of their diabetes status. Approximately 45%, 95% CI 42.9% to 46.4% of undiagnosed diabetes population had access to healthcare. Men, younger individuals, and those with lower levels of education were most at risk of being undiagnosed. Geographically, the Southern states in India had a significantly higher prevalence of undiagnosed diabetes despite having nearly universal access to healthcare. Risk factors combined with random glucose could predict undiagnosed diabetes (area under the curve of 97.8%, 95% CI 97.7% to 97.8%), Nagelkerke R
    Conclusion: Close to half (42%) of the people with diabetes in India are not aware of their disease status, and a large subset of these people are at risk of poor detection, despite having health insurance and/or having access to healthcare. Younger age groups and men are the most vulnerable.
    MeSH term(s) Adolescent ; Adult ; Age Factors ; Blood Glucose/analysis ; Cohort Studies ; Cross-Sectional Studies ; Diabetes Mellitus/blood ; Diabetes Mellitus/diagnosis ; Diabetes Mellitus/epidemiology ; Fasting/blood ; Female ; Health Surveys ; Humans ; India/epidemiology ; Male ; Middle Aged ; Prevalence ; Risk Factors ; Self Report ; Sex Factors ; Undiagnosed Diseases/blood ; Undiagnosed Diseases/diagnosis ; Undiagnosed Diseases/epidemiology ; Young Adult
    Chemical Substances Blood Glucose
    Language English
    Publishing date 2020-03-25
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2732918-5
    ISSN 2052-4897 ; 2052-4897
    ISSN (online) 2052-4897
    ISSN 2052-4897
    DOI 10.1136/bmjdrc-2019-000965
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  10. Article ; Online: Toward Capturing the Exposome: Exposure Biomarker Variability and Coexposure Patterns in the Shared Environment.

    Chung, Ming Kei / Kannan, Kurunthachalam / Louis, Germaine M / Patel, Chirag J

    Environmental science & technology

    2018  Volume 52, Issue 15, Page(s) 8801–8810

    Abstract: Many factors affect the variation in the exposome. We examined the influence of shared household and partner's sex in relation to the variation in 128 endocrine disrupting chemical (EDC) exposures among couples. In a cohort comprising of 501 couples ... ...

    Abstract Many factors affect the variation in the exposome. We examined the influence of shared household and partner's sex in relation to the variation in 128 endocrine disrupting chemical (EDC) exposures among couples. In a cohort comprising of 501 couples trying for pregnancy, we measured 128 (13 chemical classes) persistent and nonpersistent EDCs and estimated 1) sex-specific differences; 2) variance explained by shared household; and 3) Spearman's rank correlation coefficients ( r
    MeSH term(s) Biomarkers ; Cohort Studies ; Female ; Humans ; Male ; Pregnancy
    Chemical Substances Biomarkers
    Language English
    Publishing date 2018-07-20
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, N.I.H., Intramural
    ISSN 1520-5851
    ISSN (online) 1520-5851
    DOI 10.1021/acs.est.8b01467
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