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Article ; Online: Statistical Methods to Evaluate Surrogate Markers.

Parast, Layla / Tian, Lu / Cai, Tianxi / Palaniappan, Latha

2023 Volume 62, Issue 2, Page(s) 102–108

Abstract: Background: There is tremendous interest in evaluating surrogate markers given their potential to decrease study time, costs, and patient burden.: Objectives: The purpose of this statistical workshop article is to describe and illustrate how to ... ...

Abstract	Background: There is tremendous interest in evaluating surrogate markers given their potential to decrease study time, costs, and patient burden. Objectives: The purpose of this statistical workshop article is to describe and illustrate how to evaluate a surrogate marker of interest using the proportion of treatment effect (PTE) explained as a measure of the quality of the surrogate marker for: (1) a setting with a general fully observed primary outcome (eg, biopsy score); and (2) a setting with a time-to-event primary outcome which may be censored due to study termination or early drop out (eg, time to diabetes). Methods: The methods are motivated by 2 randomized trials, one among children with nonalcoholic fatty liver disease where the primary outcome was a change in biopsy score (general outcome) and another study among adults at high risk for Type 2 diabetes where the primary outcome was time to diabetes (time-to-event outcome). The methods are illustrated using the Rsurrogate package with a detailed R code provided. Results: In the biopsy score outcome setting, the estimated PTE of the examined surrogate marker was 0.182 (95% confidence interval [CI]: 0.121, 0.240), that is, the surrogate explained only 18.2% of the treatment effect on the biopsy score. In the diabetes setting, the estimated PTE of the surrogate marker was 0.596 (95% CI: 0.404, 0.760), that is, the surrogate explained 59.6% of the treatment effect on diabetes incidence. Conclusions: This statistical workshop provides tools that will support future researchers in the evaluation of surrogate markers.
MeSH term(s)	Child ; Humans ; Treatment Outcome ; Diabetes Mellitus, Type 2 ; Biomarkers
Chemical Substances	Biomarkers
Language	English
Publishing date	2023-12-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	411646-x
ISSN	1537-1948 ; 0025-7079
ISSN (online)	1537-1948
ISSN	0025-7079
DOI	10.1097/MLR.0000000000001956
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Article ; Online: Improving diversity in medical research.

Sharma, Ashwarya / Palaniappan, Latha

Nature reviews. Disease primers

2021 Volume 7, Issue 1, Page(s) 74

MeSH term(s)	Biomedical Research ; Humans
Language	English
Publishing date	2021-10-14
Publishing country	England
Document type	Journal Article
ISSN	2056-676X
ISSN (online)	2056-676X
DOI	10.1038/s41572-021-00316-8
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Article ; Online: Patterns and gaps in guideline-directed statin use for atherosclerotic cardiovascular disease by race and ethnicity.

Sarraju, Ashish / Yan, Xiaowei / Huang, Qiwen / Dudum, Ramzi / Palaniappan, Latha / Rodriguez, Fatima

American journal of preventive cardiology

2024 Volume 17, Page(s) 100647

Abstract: Objective: There remain disparities by race and ethnicity in atherosclerotic cardiovascular disease (ASCVD). Statins reduce low-density lipoprotein cholesterol (LDL-c) and improve ASCVD outcomes. ASCVD treatment patterns across disaggregated race and ... ...

Abstract	Objective: There remain disparities by race and ethnicity in atherosclerotic cardiovascular disease (ASCVD). Statins reduce low-density lipoprotein cholesterol (LDL-c) and improve ASCVD outcomes. ASCVD treatment patterns across disaggregated race and ethnicity groups are incompletely understood. We aimed to evaluate statin use and LDL-c control for ASCVD by race and ethnicity. Methods: From an electronic health record (EHR)-based cohort from a multisite Northern California health system, we included adults with an ASCVD diagnosis from 2010 to 2021 and at least 2 primary care visits, stratified by race and ethnicity (Non-Hispanic White [NHW], Non-Hispanic Black [Black], Hispanic, and Asian). Hispanic (Mexican, Puerto Rican, Other) and Asian (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other) groups were disaggregated. Primary outcomes were 1-year post-ASCVD statin use (prescription) and LDL-c control (at least one value <70 mg/dL). Adjusted odds ratios (ORs) were estimated using logistic regression. Results: Of 133,158 patients, there were 89,944 NHW, 6,294 Black, 12,478 (9.4 %) Hispanic and 13,179 (9.9 %) Asian patients. At 1 year after incident ASCVD, there was suboptimal statin use (any statins <60 %, high-intensity <25 %) and LDL-c control (<30 %) across groups, with lowest proportions in Black patients for statin use (46.7 %, any statin) and LDL-c control (10.7 %, OR 0.89 (0.81-0.97), referent NHW). Disaggregation of Asian and Hispanic groups unmasked within-group heterogeneity. Conclusions: In patients with incident ASCVD, we describe suboptimal and heterogenous 1-year post-ASCVD guideline-directed statin use and 1-year post-ASCVD LDL-c control across disaggregated race and ethnicity groups. Findings may improve understanding of ASCVD treatment disparities and guide implementation.
Language	English
Publishing date	2024-03-11
Publishing country	Netherlands
Document type	Journal Article
ISSN	2666-6677
ISSN (online)	2666-6677
DOI	10.1016/j.ajpc.2024.100647
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Article ; Online: Can earlier biomarker measurements explain a treatment effect on diabetes incidence? A robust comparison of five surrogate markers.

Parast, Layla / Tian, Lu / Cai, Tianxi / Palaniappan, Latha P

BMJ open diabetes research & care

2023 Volume 11, Issue 5

Abstract: Introduction: We measured and compared five individual surrogate markers-change from baseline to 1 year after randomization in hemoglobin A1c (HbA1c), fasting glucose, 2-hour postchallenge glucose, triglyceride-glucose index (TyG) index, and homeostatic ...

Abstract	Introduction: We measured and compared five individual surrogate markers-change from baseline to 1 year after randomization in hemoglobin A1c (HbA1c), fasting glucose, 2-hour postchallenge glucose, triglyceride-glucose index (TyG) index, and homeostatic model assessment of insulin resistance (HOMA-IR)-in terms of their ability to explain a treatment effect on reducing the risk of type 2 diabetes mellitus at 2, 3, and 4 years after treatment initiation. Research design and methods: Study participants were from the Diabetes Prevention Program study, randomly assigned to either a lifestyle intervention (n=1023) or placebo (n=1030). The surrogate markers were measured at baseline and 1 year, and diabetes incidence was examined at 2, 3, and 4 years postrandomization. Surrogacy was evaluated using a robust model-free estimate of the proportion of treatment effect explained (PTE) by the surrogate marker. Results: Across all time points, change in fasting glucose and HOMA-IR explained higher proportions of the treatment effect than 2-hour glucose, TyG index, or HbA1c. For example, at 2 years, glucose explained the highest (80.1%) proportion of the treatment effect, followed by HOMA-IR (77.7%), 2-hour glucose (76.2%), and HbA1c (74.6%); the TyG index explained the smallest (70.3%) proportion. Conclusions: These data suggest that, of the five examined surrogate markers, glucose and HOMA-IR were the superior surrogate markers in terms of PTE, compared with 2-hour glucose, HbA1c, and TyG index.
MeSH term(s)	Humans ; Diabetes Mellitus, Type 2/epidemiology ; Diabetes Mellitus, Type 2/prevention & control ; Blood Glucose ; Glycated Hemoglobin ; Incidence ; Insulin Resistance ; Biomarkers ; Glucose
Chemical Substances	Blood Glucose ; Glycated Hemoglobin ; Biomarkers ; Glucose (IY9XDZ35W2)
Language	English
Publishing date	2023-11-20
Publishing country	England
Document type	Randomized Controlled Trial ; Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S. ; 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-2023-003585
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Article ; Online: Proportional Mortality From Ischemic Heart Disease Among Asian American Subgroups, From 2018 to 2020.

Shah, Nilay S / Palaniappan, Latha P / Khan, Sadiya S

JAMA internal medicine

2022 Volume 182, Issue 10, Page(s) 1101–1103

MeSH term(s)	Asian ; Asian People ; Humans ; Minority Health ; Myocardial Ischemia/mortality ; White People
Language	English
Publishing date	2022-08-29
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Comment
ZDB-ID	2699338-7
ISSN	2168-6114 ; 2168-6106
ISSN (online)	2168-6114
ISSN	2168-6106
DOI	10.1001/jamainternmed.2022.3616
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Article ; Online: Diabetes-Related Cardiovascular and All-Cause Mortality in Asian American Subgroups.

Shah, Nilay S / Khan, Sadiya S / Carnethon, Mercedes R / Bacong, Adrian M / Palaniappan, Latha P

JACC. Asia

2023 Volume 3, Issue 3, Page(s) 365–372

Abstract: Background: Asian Americans experience heterogeneity in cardiovascular risk factors and cardiovascular disease, with a particularly high burden of diabetes in several Asian subgroups.: Objectives: The objectives of this study were to quantify ... ...

Abstract	Background: Asian Americans experience heterogeneity in cardiovascular risk factors and cardiovascular disease, with a particularly high burden of diabetes in several Asian subgroups. Objectives: The objectives of this study were to quantify diabetes-related mortality in Asian American subgroups and compare this with Hispanic, non-Hispanic Black, and non-Hispanic White individuals. Methods: Using national-level vital statistics data and concurrent population estimates, age-standardized mortality rates and proportional mortality from diabetes-related mortality were calculated for non-Hispanic Asian (and subgroups: Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese), Hispanic, non-Hispanic Black, and non-Hispanic White populations in the United States, 2018-2021. Results: Diabetes-related deaths numbered 45,249 in non-Hispanic Asian, 159,279 in Hispanic, 209,281 in non-Hispanic Black, and 904,067 in non-Hispanic White individuals. Among Asian Americans, age-standardized mortality rates of diabetes-related mortality with cardiovascular disease as underlying cause ranged from 10.8 (95% CI: 9.9-11.6) per 100,000 in Japanese females to 19.9 (95% CI: 18.9-20.9) per 100,000 in Filipina females, and from 15.3 (95% CI: 13.9-16.8) per 100,000 in Korean males to 37.8 (95% CI: 36.1-39.5) per 100,000 in Filipino males. The proportion of all deaths related to diabetes was higher in all Asian subgroups (9.7%-16.4% for females; 11.8%-19.2% for males) compared with non-Hispanic Whites (8.5% for females; 10.7% for males). The highest proportion of diabetes-related deaths occurred in Filipino adults. Conclusions: There was an approximately 2-fold variation in diabetes-related mortality among Asian American subgroups, with Filipino adults experiencing the greatest burden. All Asian subgroups experienced higher proportional mortality for diabetes-related mortality compared with non-Hispanic White individuals.
Language	English
Publishing date	2023-03-28
Publishing country	United States
Document type	Journal Article
ISSN	2772-3747
ISSN (online)	2772-3747
DOI	10.1016/j.jacasi.2022.12.010
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Article ; Online: Associations Between Ultra-processed Food Consumption and Cardiometabolic Health Among Older US Adults: Comparing Older Asian Americans to Older Adults From Other Major Race-Ethnic Groups.

Elfassy, Tali / Juul, Filippa / Mesa, Robert A / Palaniappan, Latha / Srinivasan, Malathi / Yi, Stella S

Research on aging

2023 Volume 46, Issue 3-4, Page(s) 228–240

Abstract: Using data from the National Health and Nutrition Examination Survey (2001-2018; ...

Abstract	Using data from the National Health and Nutrition Examination Survey (2001-2018;
MeSH term(s)	Aged ; Humans ; Middle Aged ; Asian ; Cardiovascular Diseases/epidemiology ; Cholesterol ; Diabetes Mellitus/epidemiology ; Ethnicity ; Fast Foods ; Food, Processed ; Nutrition Surveys ; Obesity/epidemiology ; United States
Chemical Substances	Cholesterol (97C5T2UQ7J)
Language	English
Publishing date	2023-12-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	424452-7
ISSN	1552-7573 ; 0164-0275
ISSN (online)	1552-7573
ISSN	0164-0275
DOI	10.1177/01640275231222928
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Article ; Online: Why Are We Going Backward? Barriers to Disaggregated Racial Information in Federal Data Sets.

Jamal, Armaan / Srinivasan, Malathi / Kim, Gloria / Huang, Robert J / Palaniappan, Latha

American journal of public health

2023 Volume 113, Issue 8, Page(s) 852–855

MeSH term(s)	Humans ; Racial Groups ; Demography ; United States
Language	English
Publishing date	2023-06-15
Publishing country	United States
Document type	Editorial
ZDB-ID	121100-6
ISSN	1541-0048 ; 0090-0036 ; 0002-9572
ISSN (online)	1541-0048
ISSN	0090-0036 ; 0002-9572
DOI	10.2105/AJPH.2023.307339
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Article ; Online: Disparities in COVID-19 testing and outcomes among Asian American and Pacific Islanders: an observational study in a large health care system.

Li, Jiang / Chhoa, Davis / Palaniappan, Latha / Hays, Kevin J / Pressman, Alice / Wang, Nancy E

BMC public health

2023 Volume 23, Issue 1, Page(s) 251

Abstract: Background: The COVID-19 pandemic has disproportionately impacted racial and ethnic minorities in the United States, including Asian Americans, Native Hawaiians and Pacific Islanders (Asian Americans and NH/PIs). However, few studies have highlighted ... ...

Abstract	Background: The COVID-19 pandemic has disproportionately impacted racial and ethnic minorities in the United States, including Asian Americans, Native Hawaiians and Pacific Islanders (Asian Americans and NH/PIs). However, few studies have highlighted nor disaggregated these disparities by Asian Americans and NH/PIs ethnic subgroups. Methods: This retrospective, cross-sectional observational study aimed to assess variation of Asian Americans and NH/PIs COVID-19 testing and outcomes compared to non-Hispanic Whites (NHW). The study utilized data from the electronic health records (EHR) and the COVID-19 Universal Registry for Vital Evaluations (CURVE) from all patients tested for SARS-CoV-2 (n = 556,690) at a large, health system in Northern and Central California between February 20, 2020 and March 31, 2021. Chi-square tests were used for testing differences in the severity of COVID-19 (hospitalization, ICU admission, death) and patient demographic and clinical characteristics across the Asian Americans and NH/PIs subgroups and NHW. Unadjusted and adjusted Odds Ratios (ORs) were estimated for measuring effect of race ethnicity on severity of COVID-19 using multivariable logistic regression. Results: Of the entire tested population, 70,564/556,690 (12.7%) tested positive for SARS-CoV-2. SARS-CoV-2 positivity of Asian subgroups varied from 4% in the Chinese and Korean populations, to 11.2%, 13.5%, and 12.5% for Asian Indian, Filipino, and "other Asian" populations respectively. Pacific Islanders had the greatest subgroup test positivity at 20.1%. Among Asian Americans and NH/PIs patients with COVID-19 disease, Vietnamese (OR = 2.06, 95% CI = 1.30-3.25), "Other Asian" (OR = 2.13, 95% CI = 1.79-2.54), Filipino (OR = 1.78, 95% CI = 1.34-2.23), Japanese (OR = 1.78, 95% CI = 1.10-2.88), and Chinese (OR = 1.73, 95% CI = 1.34-2.23) subgroups had almost double the odds of hospitalization compared to NHW. Pacific Islander (OR = 1.58, 95% CI = 1.19-2.10) and mixed race subgroups (OR = 1.55, 95% CI = 1.10-2.20) had more than one and a half times odds of hospitalization compared to NHW. Adjusted odds of ICU admission or death among hospitalized patients by different Asian subgroups varied but were not statistically significant. Conclusions: Variation of COVID-19 testing and hospitalization by Asian subgroups was striking in our study. A focus on the Asian Americans and NH/PIs population with disaggregation of subgroups is crucial to understand nuances of health access, utilization, and outcomes among subgroups to create health equity for these underrepresented populations.
MeSH term(s)	Humans ; COVID-19/diagnosis ; COVID-19 Testing/statistics & numerical data ; Cross-Sectional Studies ; Delivery of Health Care ; Healthcare Disparities/ethnology ; Healthcare Disparities/statistics & numerical data ; Pandemics ; Retrospective Studies ; SARS-CoV-2 ; United States ; Asian American Native Hawaiian and Pacific Islander/statistics & numerical data
Language	English
Publishing date	2023-02-06
Publishing country	England
Document type	Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2041338-5
ISSN	1471-2458 ; 1471-2458
ISSN (online)	1471-2458
ISSN	1471-2458
DOI	10.1186/s12889-023-15089-w
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Article ; Online: Obesity Disparities Among Adult Single-Race and Multiracial Asian and Pacific Islander Populations.

Bacong, Adrian M / Gibbs, Sophia L / Rosales, A Gabriela / Frankland, Timothy B / Li, Jiang / Daida, Yihe G / Fortmann, Stephen P / Palaniappan, Latha

JAMA network open

2024 Volume 7, Issue 3, Page(s) e240734

Abstract: Importance: Despite increasing numbers of multiracial individuals, they are often excluded in studies or aggregated within larger race and ethnicity groups due to small sample sizes.: Objective: To examine disparities in the prevalence of obesity ... ...

Abstract	Importance: Despite increasing numbers of multiracial individuals, they are often excluded in studies or aggregated within larger race and ethnicity groups due to small sample sizes. Objective: To examine disparities in the prevalence of obesity among single-race and multiracial Asian and Pacific Islander individuals compared with non-Hispanic White (hereafter, White) individuals. Design, setting, and participants: This cross-sectional study used electronic health record (EHR) data linked to social determinants of health and health behavior data for adult (age ≥18 years) members of 2 large health care systems in California and Hawai'i who had at least 1 ambulatory visit to a primary care practitioner between January 1, 2006, and December 31, 2018. Data were analyzed from October 31, 2022, to July 31, 2023. Exposure: Self-identified race and ethnicity provided in the EHR as a single-race category (Asian Indian, Chinese, Filipino, Japanese, Native Hawaiian only, Other Pacific Islander, or White) or a multiracial category (Asian and Pacific Islander; Asian, Pacific Islander, and White; Asian and White; or Pacific Islander and White). Main outcomes and measures: The main outcome was obesity (body mass index [BMI] ≥30.0), based on last measured height and weight from the EHR. Logistic regression was used to examine the association between race and ethnicity and odds of obesity. Results: A total of 5229 individuals (3055 [58.4%] male; mean [SD] age, 70.73 [11.51] years) were examined, of whom 444 (8.5%) were Asian Indian; 1091 (20.9%), Chinese; 483 (9.2%), Filipino; 666 (12.7%), Japanese; 91 (1.7%), Native Hawaiian; 95 (1.8%), Other Pacific Islander; and 888 (17.0%), White. The percentages of individuals who identified as multiracial were as follows: 417 (8.0%) were Asian and Pacific Islander; 392 (7.5%), Asian, Pacific Islander, and White; 248 (4.7%), Asian and White; and 414 (7.9%), Pacific Islander and White. A total of 1333 participants (25.5%) were classified as having obesity based on standard BMI criteria. Obesity was highest among people who identified as Asian, Pacific Islander, and White (204 of 392 [52.0%]) followed by those who identified as Other Pacific Islander (47 of 95 [49.5%]), Native Hawaiian (44 of 91 [48.4%]), and Pacific Islander and White (186 of 414 [44.9%]). After accounting for demographic, socioeconomic, and health behavior factors, people who identified as Asian, Pacific Islander, and White (odds ratio [OR], 1.80; 95% CI, 1.37-2.38) or Pacific Islander and White (OR, 1.55; 95% CI, 1.18-2.04) had increased odds of obesity compared with White individuals. All single-race Asian groups had lower odds of obesity compared with White individuals: Asian Indian (OR, 0.29; 95% CI, 0.20-0.40), Chinese (OR, 0.22; 95% CI, 0.17-0.29), Filipino (OR, 0.46; 95% CI, 0.35-0.62), and Japanese (OR, 0.38, 95% CI, 0.29-0.50). Conclusions and relevance: In this study, multiracial Asian and Pacific Islander individuals had an increased prevalence of obesity compared with many of their single-race counterparts. As the number of multiracial individuals increases, it will be important for clinical and public health systems to track disparities in these populations.
MeSH term(s)	Adult ; Male ; Humans ; Aged ; Adolescent ; Female ; Native Hawaiian or Other Pacific Islander ; Cross-Sectional Studies ; Asian ; Pacific Island People ; Obesity/epidemiology
Language	English
Publishing date	2024-03-04
Publishing country	United States
Document type	Journal Article
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2024.0734
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