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Article ; Online: Measuring and Promoting SARS-CoV-2 Vaccine Equity: Development of a COVID-19 Vaccine Equity Index.

Pressman, Alice R / Lockhart, Stephen H / Shen, Zijun / Azar, Kristen M J

Health equity

2021 Volume 5, Issue 1, Page(s) 476–483

Abstract: Purpose: ...

Abstract	Purpose:
Language	English
Publishing date	2021-07-13
Publishing country	United States
Document type	Journal Article
ISSN	2473-1242
ISSN (online)	2473-1242
DOI	10.1089/heq.2021.0047
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Article ; Online: Learning health system, positive deviance analysis, and electronic health records: Synergy for a learning health system.

Azar, Kristen M J / Pletcher, Mark J / Greene, Sarah M / Pressman, Alice R

Learning health systems

2022 Volume 7, Issue 3, Page(s) e10348

Abstract: Introduction: Over the past decade, numerous efforts have encouraged the realization of the learning health system (LHS) in the United States. Despite these efforts, and promising aims of the LHS, the full potential and value of research conducted ... ...

Abstract	Introduction: Over the past decade, numerous efforts have encouraged the realization of the learning health system (LHS) in the United States. Despite these efforts, and promising aims of the LHS, the full potential and value of research conducted within LHSs have yet to be realized. New technology coupled with a catalyzing global pandemic have spurred momentum. In addition, the LHS has lacked a consistent framework within which "best evidence" can be identified. Positive deviance analysis, itself reinvigorated by recent advances in health information technology (IT) and ubiquitous adoption of electronic health records (EHRs), may finally provide a framework through which LHSs can be operationalized and optimized. Methods: We describe the synergy between positive deviance and the LHS and how they may be integrated to achieve a continuous cycle of health system improvement. Results: As we describe below, the positive deviance approach focuses on learning from high-performing teams and organizations. Conclusion: Such learning can be enabled by EHRs and health IT, providing a lens into how digital clinical interventions are successfully developed and deployed.
Language	English
Publishing date	2022-10-11
Publishing country	United States
Document type	Journal Article
ISSN	2379-6146
ISSN (online)	2379-6146
DOI	10.1002/lrh2.10348
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Article ; Online: A population-health approach to characterizing migraine by comorbidity: Results from the Mindfulness and Migraine Cohort Study.

Sudat, Sylvia Ek / Jacobson, Alice S / Avins, Andrew L / Lipton, Richard B / Pressman, Alice R

Cephalalgia : an international journal of headache

2022 Volume 42, Issue 11-12, Page(s) 1255–1264

Abstract: Background: The heterogeneity of migraine has been reported extensively, with identified subgroups usually based on symptoms. Grouping individuals with migraine and similar comorbidity profiles has been suggested, however such segmentation methods have ... ...

Abstract	Background: The heterogeneity of migraine has been reported extensively, with identified subgroups usually based on symptoms. Grouping individuals with migraine and similar comorbidity profiles has been suggested, however such segmentation methods have not been tested using real-world clinical data. Objective: To gain insights into natural groupings of patients with migraine using latent class analysis based on electronic health record-determined comorbidities. Methods: Retrospective electronic health record data analysis of primary-care patients at Sutter Health, a large open healthcare system in Northern California, USA. We identified migraine patients over a five-year time period (2015-2019) and extracted 29 comorbidities. We then applied latent class analysis to identify comorbidity-based natural subgroups. Results: We identified 95,563 patients with migraine and found seven latent classes, summarized by their predominant comorbidities and population share: fewest comorbidities (61.8%), psychiatric (18.3%), some comorbidities (10.0%), most comorbidities - no cardiovascular (3.6%), vascular (3.1%), autoimmune/joint/pain (2.2%), and most comorbidities (1.0%). We found minimal demographic differences across classes. Conclusion: Our study found groupings of migraine patients based on comorbidity that have the potential to be used to guide targeted treatment strategies and the development of new therapies.
MeSH term(s)	Cohort Studies ; Comorbidity ; Humans ; Migraine Disorders/diagnosis ; Mindfulness ; Retrospective Studies
Language	English
Publishing date	2022-05-31
Publishing country	England
Document type	Journal Article
ZDB-ID	604567-4
ISSN	1468-2982 ; 0333-1024
ISSN (online)	1468-2982
ISSN	0333-1024
DOI	10.1177/03331024221104180
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Article ; Online: Transcriptome-wide association study identifies novel candidate susceptibility genes for migraine.

Meyers, Travis J / Yin, Jie / Herrera, Victor A / Pressman, Alice R / Hoffmann, Thomas J / Schaefer, Catherine / Avins, Andrew L / Choquet, Hélène

HGG advances

2023 Volume 4, Issue 3, Page(s) 100211

Abstract: Genome-wide association studies (GWASs) have identified more than 130 genetic susceptibility loci for migraine; however, how most of these loci impact migraine development is unknown. To identify novel genes associated with migraine and interpret the ... ...

Abstract	Genome-wide association studies (GWASs) have identified more than 130 genetic susceptibility loci for migraine; however, how most of these loci impact migraine development is unknown. To identify novel genes associated with migraine and interpret the transcriptional products of those genes, we conducted a transcriptome-wide association study (TWAS). We performed tissue-specific and multi-tissue TWAS analyses to assess associations between imputed gene expression from 53 tissues and migraine susceptibility using FUSION software. Meta-analyzed GWAS summary statistics from 26,052 migraine cases and 487,214 controls, all of European ancestry and from two cohorts (the Kaiser Permanente GERA and the UK Biobank), were used. We evaluated the associations for genes after conditioning on variant-level effects from GWAS, and we tested for colocalization of GWAS migraine-associated loci and expression quantitative trait loci (eQTLs). Across tissue-specific and multi-tissue analyses, we identified 53 genes for which genetically predicted gene expression was associated with migraine after correcting for multiple testing. Of these 53 genes, 10 (
MeSH term(s)	Humans ; Transcriptome/genetics ; Genetic Predisposition to Disease/genetics ; Genome-Wide Association Study ; Quantitative Trait Loci/genetics ; Migraine Disorders/genetics ; Membrane Proteins/genetics ; DNA Glycosylases/genetics ; Phosphotransferases (Alcohol Group Acceptor)/genetics ; DNA Repair Enzymes/genetics
Chemical Substances	KTN1 protein, human ; Membrane Proteins ; NEIL1 protein, human (EC 3.2.2.-) ; DNA Glycosylases (EC 3.2.2.-) ; PNKP protein, human (EC 2.7.1.-) ; Phosphotransferases (Alcohol Group Acceptor) (EC 2.7.1.-) ; DNA Repair Enzymes (EC 6.5.1.-)
Language	English
Publishing date	2023-06-09
Publishing country	United States
Document type	Journal Article
ISSN	2666-2477
ISSN (online)	2666-2477
DOI	10.1016/j.xhgg.2023.100211
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Article ; Online: Mind the clinical-analytic gap: Electronic health records and COVID-19 pandemic response.

Sudat, Sylvia E K / Robinson, Sarah C / Mudiganti, Satish / Mani, Aravind / Pressman, Alice R

Journal of biomedical informatics

2021 Volume 116, Page(s) 103715

Abstract: Data quality is essential to the success of the most simple and the most complex analysis. In the context of the COVID-19 pandemic, large-scale data sharing across the US and around the world has played an important role in public health responses to the ...

Abstract	Data quality is essential to the success of the most simple and the most complex analysis. In the context of the COVID-19 pandemic, large-scale data sharing across the US and around the world has played an important role in public health responses to the pandemic and has been crucial to understanding and predicting its likely course. In California, hospitals have been required to report a large volume of daily data related to COVID-19. In order to meet this need, electronic health records (EHRs) have played an important role, but the challenges of reporting high-quality data in real-time from EHR data sources have not been explored. We describe some of the challenges of utilizing EHR data for this purpose from the perspective of a large, integrated, mixed-payer health system in northern California, US. We emphasize some of the inadequacies inherent to EHR data using several specific examples, and explore the clinical-analytic gap that forms the basis for some of these inadequacies. We highlight the need for data and analytics to be incorporated into the early stages of clinical crisis planning in order to utilize EHR data to full advantage. We further propose that lessons learned from the COVID-19 pandemic can result in the formation of collaborative teams joining clinical operations, informatics, data analytics, and research, ultimately resulting in improved data quality to support effective crisis response.
MeSH term(s)	COVID-19/epidemiology ; COVID-19/mortality ; COVID-19/therapy ; California/epidemiology ; Data Accuracy ; Delivery of Health Care, Integrated/statistics & numerical data ; Electronic Health Records/statistics & numerical data ; Health Information Exchange/statistics & numerical data ; Hospital Bed Capacity/statistics & numerical data ; Humans ; Information Dissemination/methods ; Medical Informatics ; Pandemics/statistics & numerical data ; SARS-CoV-2
Language	English
Publishing date	2021-02-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	2057141-0
ISSN	1532-0480 ; 1532-0464
ISSN (online)	1532-0480
ISSN	1532-0464
DOI	10.1016/j.jbi.2021.103715
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Article ; Online: Racial Disparities in Pulse Oximeter Device Inaccuracy and Estimated Clinical Impact on COVID-19 Treatment Course.

Sudat, Sylvia E K / Wesson, Paul / Rhoads, Kim F / Brown, Stephanie / Aboelata, Noha / Pressman, Alice R / Mani, Aravind / Azar, Kristen M J

American journal of epidemiology

2022 Volume 192, Issue 5, Page(s) 703–713

Abstract: Arterial blood oxygen saturation as measured by pulse oximetry (peripheral oxygen saturation (SpO2)) may be differentially less accurate for people with darker skin pigmentation, which could potentially affect the course of coronavirus disease 2019 ( ... ...

Abstract	Arterial blood oxygen saturation as measured by pulse oximetry (peripheral oxygen saturation (SpO2)) may be differentially less accurate for people with darker skin pigmentation, which could potentially affect the course of coronavirus disease 2019 (COVID-19) treatment. We analyzed pulse oximeter accuracy and its association with COVID-19 treatment outcomes using electronic health record data from Sutter Health, a large, mixed-payer, integrated health-care delivery system in Northern California. We analyzed 2 cohorts: 1) 43,753 non-Hispanic White (NHW) or non-Hispanic Black/African-American (NHB) adults with concurrent arterial blood gas oxygen saturation/SpO2 measurements taken between January 2020 and February 2021; and 2) 8,735 adults who went to a hospital emergency department with COVID-19 between July 2020 and February 2021. Pulse oximetry systematically overestimated blood oxygenation by 1% more in NHB individuals than in NHW individuals. For people with COVID-19, this was associated with lower admission probability (-3.1 percentage points), dexamethasone treatment (-3.1 percentage points), and supplemental oxygen treatment (-4.5 percentage points), as well as increased time to treatment: 37.2 minutes before dexamethasone initiation and 278.5 minutes before initiation of supplemental oxygen. These results call for additional investigation of pulse oximeters and suggest that current guidelines for development, testing, and calibration of these devices should be revisited, investigated, and revised.
MeSH term(s)	Adult ; Humans ; COVID-19/therapy ; COVID-19 Drug Treatment ; Dexamethasone/therapeutic use ; Oximetry/methods ; Oxygen/therapeutic use ; Healthcare Disparities ; Electronic Health Records ; Health Equity
Chemical Substances	Dexamethasone (7S5I7G3JQL) ; Oxygen (S88TT14065)
Language	English
Publishing date	2022-09-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2937-3
ISSN	1476-6256 ; 0002-9262
ISSN (online)	1476-6256
ISSN	0002-9262
DOI	10.1093/aje/kwac164
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Article ; Online: Effectiveness of a Group-Based Lifestyle Change Program Versus Usual Care: An Electronic Health Record, Propensity Score-Matched Cohort Study.

Romanelli, Robert J / Huang, Hsiao-Ching / Sudat, Sylvia / Pressman, Alice R / Azar, Kristen M J

American journal of preventive medicine

2020 Volume 59, Issue 6, Page(s) 850–859

Abstract: Introduction: Translational lifestyle change programs for community and clinical settings have been available for a decade, yet there are limited data on their comparative effectiveness. This study examines the effectiveness of a Centers for Disease ... ...

Abstract	Introduction: Translational lifestyle change programs for community and clinical settings have been available for a decade, yet there are limited data on their comparative effectiveness. This study examines the effectiveness of a Centers for Disease Control and Prevention-aligned lifestyle change program relative to usual care in clinical practice. Methods: This was an electronic health record-based retrospective cohort study conducted in a community-based healthcare system. Investigators identified adult program participants and usual-care patients in the electronic health record between 2010 and 2018 and defined their index date (baseline) as the first lifestyle change program encounter or a random encounter date, respectively. Participants were matched 1:2 to usual-care patients on baseline demographics and clinical characteristics using propensity-score methods. Changes in body weight and blood pressure were examined from baseline through 24 months. Results: The authors identified 2,833 program participants and 438,432 usual-care patients meeting study eligibility criteria. A total of 2,833 program participants were matched to 4,776 usual-care patients; the average age was 54 years, and 80% of the participants were female. Program participation was associated with a 1.9- and 1.6-fold higher prevalence of clinically meaningful (≥5%) weight loss at 12- and 24-month follow-up than usual care and a higher prevalence of blood pressure control at 12 months but not at 24 months. Patients without type 2 diabetes at baseline had more pronounced outcomes than those with type 2 diabetes. Conclusions: This study demonstrates the effectiveness of an evidence-based, Centers for Disease Control and Prevention-aligned lifestyle change program in reducing cardiometabolic risk factors compared with usual care in clinical practice, with long-term reductions in weight and transient reductions in blood pressure.
MeSH term(s)	Adult ; Cohort Studies ; Diabetes Mellitus, Type 2 ; Electronic Health Records ; Female ; Humans ; Life Style ; Male ; Middle Aged ; Propensity Score ; Retrospective Studies
Language	English
Publishing date	2020-11-18
Publishing country	Netherlands
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	632646-8
ISSN	1873-2607 ; 0749-3797
ISSN (online)	1873-2607
ISSN	0749-3797
DOI	10.1016/j.amepre.2020.07.002
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Article ; Online: Impact of a Statewide Livestock Antibiotic Use Policy on Resistance in Human Urine

Casey, Joan A / Tartof, Sara Y / Davis, Meghan F / Nachman, Keeve E / Price, Lance / Liu, Cindy / Yu, Kalvin / Gupta, Vikas / Innes, Gabriel K / Tseng, Hung Fu / Do, Vivian / Pressman, Alice R / Rudolph, Kara E

Environmental health perspectives

2023 Volume 131, Issue 2, Page(s) 27007

Abstract: Background: On 1 January 2018, California implemented Senate Bill 27 (SB27), banning, for the first time in the United States, routine preventive use of antibiotics in food-animal production and any antibiotic use without a veterinarian's prescription.!# ...

Abstract	Background: On 1 January 2018, California implemented Senate Bill 27 (SB27), banning, for the first time in the United States, routine preventive use of antibiotics in food-animal production and any antibiotic use without a veterinarian's prescription. Objectives: Our objective was to assess whether SB27 was associated with decreased antimicrobial resistance among Methods: We used U.S. nationwide monthly state-level data from BD Insights Research Database (Becton, Dickinson, and Co.) spanning 1 January 2013 to 30 June 2021 on antibiotic-resistance patterns of 30-d nonduplicate Findings: We included Discussion: Further research is needed to determine the role of SB27 in the observed reduction in ESC resistance
MeSH term(s)	Animals ; Humans ; Female ; United States ; Anti-Bacterial Agents/pharmacology ; Escherichia coli ; Livestock ; Escherichia coli Infections/epidemiology ; Escherichia coli Infections/drug therapy ; Drug Resistance, Multiple, Bacterial ; Cephalosporins/pharmacology ; Aminoglycosides/pharmacology ; Fluoroquinolones/therapeutic use ; Fluoroquinolones/pharmacology ; Tetracyclines/pharmacology ; Microbial Sensitivity Tests
Chemical Substances	Anti-Bacterial Agents ; Cephalosporins ; Aminoglycosides ; Fluoroquinolones ; Tetracyclines
Language	English
Publishing date	2023-02-22
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	195189-0
ISSN	1552-9924 ; 0091-6765 ; 1078-0475
ISSN (online)	1552-9924
ISSN	0091-6765 ; 1078-0475
DOI	10.1289/EHP11221
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Article ; Online: New and sex-specific migraine susceptibility loci identified from a multiethnic genome-wide meta-analysis.

Choquet, Hélène / Yin, Jie / Jacobson, Alice S / Horton, Brandon H / Hoffmann, Thomas J / Jorgenson, Eric / Avins, Andrew L / Pressman, Alice R

Communications biology

2021 Volume 4, Issue 1, Page(s) 864

Abstract: Migraine is a common disabling primary headache disorder that is ranked as the most common neurological cause of disability worldwide. Women present with migraine much more frequently than men, but the reasons for this difference are unknown. Migraine ... ...

Abstract	Migraine is a common disabling primary headache disorder that is ranked as the most common neurological cause of disability worldwide. Women present with migraine much more frequently than men, but the reasons for this difference are unknown. Migraine heritability is estimated to up to 57%, yet much of the genetic risk remains unaccounted for, especially in non-European ancestry populations. To elucidate the etiology of this common disorder, we conduct a multiethnic genome-wide association meta-analysis of migraine, combining results from the GERA and UK Biobank cohorts, followed by a European-ancestry meta-analysis using public summary statistics. We report 79 loci associated with migraine, of which 45 were novel. Sex-stratified analyses identify three additional novel loci (CPS1, PBRM1, and SLC25A21) specific to women. This large multiethnic migraine study provides important information that may substantially improve our understanding of the etiology of migraine susceptibility.
MeSH term(s)	Adult ; Black or African American/genetics ; Aged ; Asian/genetics ; Chromosome Mapping ; Cohort Studies ; Female ; Genetic Association Studies/methods ; Genetic Association Studies/statistics & numerical data ; Genetic Loci/genetics ; Genetic Predisposition to Disease/ethnology ; Genetic Predisposition to Disease/genetics ; Genome-Wide Association Study/methods ; Genome-Wide Association Study/statistics & numerical data ; Hispanic or Latino/genetics ; Humans ; Male ; Meta-Analysis as Topic ; Middle Aged ; Migraine Disorders/ethnology ; Migraine Disorders/genetics ; Polymorphism, Single Nucleotide ; Sex Factors ; White People/genetics
Language	English
Publishing date	2021-07-22
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ISSN	2399-3642
ISSN (online)	2399-3642
DOI	10.1038/s42003-021-02356-y
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Article ; Online: Persistence of Disparities Among Racially/Ethnically Marginalized Groups in the Coronavirus Disease 2019 Pandemic Regardless of Statewide Shelter-in-Place Policies: An Analysis From Northern California.

Azar, Kristen M J / Lockhart, Stephen H / Shen, Zijun / Romanelli, Robert / Brown, Stephanie / Smits, Kelly / Pressman, Alice R

American journal of epidemiology

2021 Volume 190, Issue 11, Page(s) 2300–2313

Abstract: To measure disparities in coronavirus disease 2019 (COVID-19) hospitalization and intensive care unit (ICU) transfer among racially/ethnically marginalized groups before and after implementation of the California statewide shelter-in-place (SIP) policy, ... ...

Abstract	To measure disparities in coronavirus disease 2019 (COVID-19) hospitalization and intensive care unit (ICU) transfer among racially/ethnically marginalized groups before and after implementation of the California statewide shelter-in-place (SIP) policy, we conducted a retrospective cohort study within a health-care system in California. COVID-19 patients diagnosed from January 1, 2020, to August 31, 2020, were identified from electronic health records. We examined hospitalizations and ICU transfers by race/ethnicity and pandemic period using logistic regression. Among 16,520 people with COVID-19 (mean age = 46.6 (standard deviation, 18.4) years; 54.2% women), during the post-SIP period, patients were on average younger and a larger proportion were Hispanic. In adjusted models, odds of hospitalization were 20% lower post-SIP as compared with the SIP period, yet all non-White groups had higher odds (odds ratios = 1.6-2.1) than non-Hispanic White individuals, regardless of period. Among hospitalized patients, odds of ICU transfer were 33% lower post-SIP than during SIP. Hispanic and Asian patients had higher odds than non-Hispanics. Disparities in hospitalization persisted and ICU risk became more pronounced for Asian and Hispanic patients post-SIP. Policy-makers should consider ways to proactively address racial/ethnic inequities in risk when considering future population-level policy interventions for public health crises.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; COVID-19/epidemiology ; COVID-19/ethnology ; COVID-19/therapy ; COVID-19/virology ; California/epidemiology ; Comorbidity ; Continental Population Groups/statistics & numerical data ; Female ; Health Policy ; Health Status Disparities ; Hospitalization/statistics & numerical data ; Humans ; Intensive Care Units/statistics & numerical data ; Male ; Middle Aged ; Pandemics ; SARS-CoV-2 ; Young Adult
Language	English
Publishing date	2021-06-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2937-3
ISSN	1476-6256 ; 0002-9262
ISSN (online)	1476-6256
ISSN	0002-9262
DOI	10.1093/aje/kwab191
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