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Article: Identifying and Addressing Confounding Bias in Violence Prevention Research.

Ranapurwala, Shabbar I

Current epidemiology reports

2019 Volume 6, Issue 2, Page(s) 200–207

Abstract: Purpose of review: Violence prevention research has enhanced our understanding of individual and community risk and protective factors for aggression and violence. However, our knowledge of risk and protective factors for violence is highly dependent on ...

Abstract	Purpose of review: Violence prevention research has enhanced our understanding of individual and community risk and protective factors for aggression and violence. However, our knowledge of risk and protective factors for violence is highly dependent on observational studies, since there are few randomized trials of risk and protective factors for violence. Observational studies are susceptible to systematic errors, specifically confounding, and may lack internal validity. Recent findings: Many violence prevention studies utilize methods that do not correctly identify the set of covariates needed for statistical adjustment. This results in unwarranted matching and restriction leading to further confounding or selection bias. Covariate adjustment based on purely statistical criteria generates inconsistent results and uncertain conclusions. Summary: Conventional methods used to identify confounding in violence prevention research are often inadequate. Causal diagrams have potential to improve the understanding and identification of potential confounding biases in observational violence prevention studies, and methods like sensitivity analysis using quantitative bias analysis can help to address unmeasured confounding. Violence research studies should make more use of these methods.
Language	English
Publishing date	2019-04-26
Publishing country	Switzerland
Document type	Journal Article
ISSN	2196-2995
ISSN	2196-2995
DOI	10.1007/s40471-019-00195-4
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Article ; Online: Heat-related fatalities in North Carolina 1999-2017.

McClure, Elizabeth S / Ranapurwala, Shabbar I / Nocera, Maryalice / Richardson, David B

American journal of industrial medicine

2024 Volume 67, Issue 6, Page(s) 551–555

Abstract: Objectives: Research shows the highest rates of occupational heat-related fatalities among farm laborers and among Black and Hispanic workers in North Carolina (NC). The Hispanic population and workforce in NC have grown substantially in the past 20 ... ...

Abstract	Objectives: Research shows the highest rates of occupational heat-related fatalities among farm laborers and among Black and Hispanic workers in North Carolina (NC). The Hispanic population and workforce in NC have grown substantially in the past 20 years. We describe the epidemiology of heat-related fatal injuries in the general population and among workers in NC. Methods: We reviewed North Carolina death records and records of the North Carolina Office of the Chief Medical Examiner to identify heat-related deaths (primary International Classification of Diseases, Tenth Revision diagnosis code: X30 or T67.0-T67.9) that occurred between January 1, 1999, and December 31, 2017. Decedent age, sex, race, and ethnicity were extracted from both the death certificate and the medical examiner's report as well as determinations of whether the death occurred at work. Results: In NC between 1999 and 2017, there were 225 deaths from heat-related injuries, and 25 occurred at work. The rates of occupational heat-related deaths were highest among males, workers of Hispanic ethnicity, workers of Black, multiple, or unknown race, and in workers aged 55-64. The highest rate of occupational heat-related deaths occurred in the agricultural industry. Conclusions: Since the last report (2001), the number of heat-related fatalities has increased, but fewer were identified as workplace fatalities. Rates of occupational heat-related deaths are highest among Hispanic workers. NC residents identifying as Black are disproportionately burdened by heat-related fatalities in general, with a wider apparent disparity in occupational deaths.
MeSH term(s)	Humans ; North Carolina/epidemiology ; Male ; Middle Aged ; Female ; Adult ; Aged ; Young Adult ; Heat Stress Disorders/mortality ; Adolescent ; Hispanic or Latino/statistics & numerical data ; Occupational Diseases/mortality ; Hot Temperature/adverse effects ; Black or African American/statistics & numerical data ; Sex Distribution ; Farmers/statistics & numerical data ; Age Distribution ; Occupational Exposure/adverse effects ; Occupational Exposure/statistics & numerical data
Language	English
Publishing date	2024-04-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	604538-8
ISSN	1097-0274 ; 0271-3586
ISSN (online)	1097-0274
ISSN	0271-3586
DOI	10.1002/ajim.23587
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Article ; Online: Trajectories and correlates of opioid prescription receipt among patients experiencing interpersonal violence.

Williams, Jessica R / Alam, Ishrat Z / Ranapurwala, Shabbar I

PloS one

2022 Volume 17, Issue 9, Page(s) e0273846

Abstract: Interpersonal violence increases vulnerability to the deleterious effects of opioid use. Increased opioid prescription receipt is a major contributor to the opioid crisis; however, our understanding of prescription patterns and risk factors among those ... ...

Abstract	Interpersonal violence increases vulnerability to the deleterious effects of opioid use. Increased opioid prescription receipt is a major contributor to the opioid crisis; however, our understanding of prescription patterns and risk factors among those with a history of interpersonal violence remains elusive. This study sought to identify 5-year longitudinal patterns of opioid prescription receipt among patients experiencing interpersonal violence within a large healthcare system and sociodemographic and clinical characteristics associated with prescription patterns. This secondary analysis examined electronic health record data from January 2004-August 2019 for a cohort of patients (N = 1,587) referred for interpersonal violence services. Latent class growth analysis was used to estimate trajectories of opioid prescription receipt over a 5-year period. Standardized differences were calculated to assess variation in sociodemographic and clinical characteristics between classes. Our cohort had a high prevalence of prescription opioid receipt (73.3%) and underlying co-morbidities, including chronic pain (54.6%), substance use disorders (39.0%), and mental health diagnoses (76.9%). Six prescription opioid receipt classes emerged, characterized by probability of any prescription opioid receipt at the start and end of the study period (high, medium, low, never) and change in probability over time (increasing, decreasing, stable). Classes with the highest probability of prescription opioids also had the highest proportions of males, chronic pain diagnoses, substance use disorders, and mental health diagnoses. Black, non-Hispanic and Hispanic patients were more likely to be in low or no prescription opioid receipt classes. These findings highlight the importance of monitoring for synergistic co-morbidities when providing pain management and offering treatment that is trauma-informed, destigmatizing, and integrated into routine care.
MeSH term(s)	Analgesics, Opioid/adverse effects ; Chronic Pain/psychology ; Humans ; Male ; Opioid-Related Disorders/drug therapy ; Prescriptions ; Violence
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2022-09-09
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0273846
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Article ; Online: Forty years of struggle in North Carolina: Workplace segregation and fatal occupational injury rates.

McClure, Elizabeth S / Martin, Amelia T / Ranapurwala, Shabbar I / Nocera, Maryalice / Cantrell, John / Marshall, Stephen / Richardson, David B

American journal of industrial medicine

2024 Volume 67, Issue 6, Page(s) 539–550

Abstract: Objective: To assess workplace segregation in fatal occupational injury from 1992 to 2017 in North Carolina.: Methods: We calculated occupational fatal injury rates within categories of occupation, industry, race, age, and sex; and estimated expected ...

Abstract	Objective: To assess workplace segregation in fatal occupational injury from 1992 to 2017 in North Carolina. Methods: We calculated occupational fatal injury rates within categories of occupation, industry, race, age, and sex; and estimated expected numbers of fatalities among Black and Hispanic male workers had they experienced the rates of White male workers. We also estimated the contribution of workforce segregation to disparities by estimating the expected number of fatalities among Black and Hispanic male workers had they experienced the industry and occupation patterns of White male workers. We assessed person-years of life-lost, using North Carolina life expectancy estimates. Results: Hispanic workers contributed 32% of their worker-years and experienced 58% of their fatalities in construction. Black workers were most overrepresented in the food manufacturing industry. Hispanic males experienced 2.11 (95% CI: 1.86-2.40) times the mortality rate of White males. The Black-White and Hispanic-White disparities were widest among workers aged 45 and older, and segregation into more dangerous industries and occupations played a substantial role in driving disparities. Hispanic workers who suffered occupational fatalities lost a median 47 life-years, compared to 37 among Black workers and 36 among White workers. Conclusions: If Hispanic and Black workers experienced the workplace safety of their White counterparts, fatal injury rates would be substantially reduced. Workforce segregation reflects structural racism, which also contributes to mortality disparities. Root causes must be addressed to eliminate disparities.
MeSH term(s)	Humans ; North Carolina/epidemiology ; Male ; Middle Aged ; Adult ; Occupational Injuries/mortality ; Hispanic or Latino/statistics & numerical data ; White People/statistics & numerical data ; Black or African American/statistics & numerical data ; Workplace/statistics & numerical data ; Female ; Social Segregation ; Young Adult ; Occupations/statistics & numerical data ; Aged ; Accidents, Occupational/mortality ; Accidents, Occupational/statistics & numerical data ; Industry/statistics & numerical data
Language	English
Publishing date	2024-04-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	604538-8
ISSN	1097-0274 ; 0271-3586
ISSN (online)	1097-0274
ISSN	0271-3586
DOI	10.1002/ajim.23586
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Article ; Online: Immigration Policy and the Health of Latina Mothers and Their Infants.

Raffa, Brittany J / Swartz, Jonas J / Ranapurwala, Shabbar I / Zhao, Congwen / Cholera, Rushina

Journal of immigrant and minority health

2023 Volume 25, Issue 4, Page(s) 775–789

Abstract: Restrictive immigration policies may adversely affect the health of Latina mothers and their infants. We hypothesized that undocumented Latina mothers and their US born children would have worse birth outcomes and healthcare utilization following the ... ...

Abstract	Restrictive immigration policies may adversely affect the health of Latina mothers and their infants. We hypothesized that undocumented Latina mothers and their US born children would have worse birth outcomes and healthcare utilization following the November 2016 election. We used a controlled interrupted time series to estimate the impact of the 2016 presidential election on low birth weight (LBW), preterm birth, maternal depression, well child visit attendance, cancelled visits, and emergency department (ED) visits among infants born to Latina mothers on emergency Medicaid, a proxy for undocumented immigration status. There was a 5.8% (95% CI: -0.99%, 12.5%) increase in LBW and 4.6% (95% CI: -1.8%, 10.9%) increase in preterm births immediately after the 2016 election compared to controls. While these findings were not statistically significant at p < 0.05, the majority of our data suggest worsened birth outcomes among undocumented Latina mothers after the election, consistent with larger prior studies. There was no difference in well child or ED visits. While restrictive policies may have contributed to worse birth outcomes among undocumented Latina mothers, our findings suggest that Latino families still attend infants' scheduled visits.
MeSH term(s)	Female ; Child ; United States/epidemiology ; Infant, Newborn ; Infant ; Humans ; Mothers ; Emigration and Immigration ; Premature Birth ; Infant, Low Birth Weight ; Hispanic or Latino
Language	English
Publishing date	2023-04-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	2220162-2
ISSN	1557-1920 ; 1557-1912
ISSN (online)	1557-1920
ISSN	1557-1912
DOI	10.1007/s10903-023-01476-3
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Article ; Online: State firearm laws, race and law enforcement-related deaths in 16 US states: 2010-2016.

Sivaraman, Josie J / Marshall, Stephen W / Ranapurwala, Shabbar I

Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention

2020 Volume 26, Issue 6, Page(s) 569–572

Abstract: The aim of this study was to assess the association between state firearm legislation and law enforcement-related deaths (LEDs) and its modification by race. We used secondary data from an ecological cohort of 16 states (2010 to 2016), using the National ...

Abstract	The aim of this study was to assess the association between state firearm legislation and law enforcement-related deaths (LEDs) and its modification by race. We used secondary data from an ecological cohort of 16 states (2010 to 2016), using the National Violent Death Reporting System (NVDRS), the State Firearm Law Database and additional public sources. Poisson regression with generalised estimating equations and inverse probability of exposure weights to account for time-varying confounding were used to quantify the association. LEDs were also disaggregated by race (Black vs non-Black). A total of 1593 LEDs took place during the 6-year study period. After adjusting for confounders, the IRR among non-Blacks was 0.48 (95% CI 0.26 to 0.89) and 1.53 (95% CI 0.93 to 2.54) among Blacks. Our findings highlight the fact that increased firearm provisions may decrease rates of LED among non-Black American individuals-an association not observed among Black Americans.
MeSH term(s)	Cause of Death ; Firearms ; Homicide ; Humans ; Law Enforcement ; Population Surveillance ; Suicide ; United States/epidemiology ; Violence ; Wounds, Gunshot
Language	English
Publishing date	2020-09-16
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	1433667-4
ISSN	1475-5785 ; 1353-8047
ISSN (online)	1475-5785
ISSN	1353-8047
DOI	10.1136/injuryprev-2020-043681
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Article ; Online: Disparities in Fatal Occupational Injury Rates in North Carolina, 1978-2017: Comparing Nonmanagerial Employees to Managers.

Richardson, David B / Cole, Stephen R / Martin, Amelia T / McClure, Elizabeth S / Nocera, Maryalice / Cantrell, John / Ranapurwala, Shabbar I / Marshall, Stephen W

Epidemiology (Cambridge, Mass.)

2023 Volume 34, Issue 5, Page(s) 741–746

Abstract: Background: We examined fatal occupational injuries among private-sector workers in North Carolina during the 40-year period 1978-2017, comparing the occurrence of fatal injuries among nonmanagerial employees to that experienced by managers.: Methods!# ...

Abstract	Background: We examined fatal occupational injuries among private-sector workers in North Carolina during the 40-year period 1978-2017, comparing the occurrence of fatal injuries among nonmanagerial employees to that experienced by managers. Methods: We estimated a standardized fatal occupational injury ratio by inverse probability of exposure weighting, taking nonmanagerial workers as the target population. When this ratio measure takes a value greater than unity it signals settings in which nonmanagerial employees are not provided as safe a work environment as that provided for managers. Results: Across all industries, nonmanagerial workers in North Carolina experienced fatal occupational injury rates 8.2 (95% CI = 7.0, 10.0) times the rate experienced by managers. Disparities in fatal injury rates between managers and the employees they supervise were greatest in forestry, rubber and metal manufacturing, wholesale trade, fishing and extractive industries, and construction. Conclusions: The results may help focus discussion about workplace safety between labor and management upon equity, with a goal of providing a work environment for nonmanagerial employees as safe as the one provided for managers.
MeSH term(s)	Humans ; Occupational Injuries/epidemiology ; North Carolina/epidemiology ; Accidents, Occupational ; Workplace ; Industry ; Occupational Health
Language	English
Publishing date	2023-07-31
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	1053263-8
ISSN	1531-5487 ; 1044-3983
ISSN (online)	1531-5487
ISSN	1044-3983
DOI	10.1097/EDE.0000000000001632
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Article ; Online: Fatal occupational injuries in North Carolina, 1992-2017.

Martin, Amelia T / McClure, Elizabeth S / Ranapurwala, Shabbar I / Nocera, Maryalice / Cantrell, John / Marshall, Stephen W / Richardson, David B

Occupational and environmental medicine

2023 Volume 80, Issue 12, Page(s) 680–686

Abstract: Objectives: After declining for several decades, fatal occupational injury rates have stagnated in the USA since 2009. To revive advancements in workplace safety, interventions targeting at-risk worker groups must be implemented. Our study aims to ... ...

Abstract	Objectives: After declining for several decades, fatal occupational injury rates have stagnated in the USA since 2009. To revive advancements in workplace safety, interventions targeting at-risk worker groups must be implemented. Our study aims to identify these at-risk populations by evaluating disparities in unintentional occupational fatalities occurring in North Carolina (NC) from 1992 to 2017. Methods: Our retrospective cohort study drew on both the NC Office of the Chief Medical Examiner system and the NC death certificate data system to identify unintentional fatal occupational injuries occurring from 1992 to 2017. Unintentional fatal occupational injury rates were reported across industries, occupations and demographic groups, and rate ratios were calculated to assess disparities. Results: Among those aged 18 and older, 2645 unintentional fatal occupational injuries were identified. Fatal occupational injury rates declined by 0.82 injuries/100 000 person-years over this period, falling consistently from 2004 to 2009 and increasing from 2009 to 2017. Fatal injury rates were highest among Hispanic workers, who experienced 2.75 times the fatal injury rate of non-Hispanic White workers (95% CI 2.42 to 3.11) and self-employed workers, who experienced 1.44 times the fatal injury rate of private workers (95% CI 1.29 to 1.60). We also observed that fatal injury rates increased with age group and were higher among male relative to female workers even after adjustment for differential distributions across occupations. Conclusions: The decline in unintentional fatal occupational injury rates over this period is encouraging, but the increase in injury rate after 2009 and the large disparities between occupations, industries and demographic groups highlight the need for additional targeted safety interventions.
MeSH term(s)	Humans ; Male ; Female ; North Carolina/epidemiology ; Occupational Injuries/epidemiology ; Retrospective Studies ; Accidents, Occupational ; Industry ; Accidental Injuries ; Wounds and Injuries
Language	English
Publishing date	2023-11-23
Publishing country	England
Document type	Journal Article
ZDB-ID	1180733-7
ISSN	1470-7926 ; 1351-0711
ISSN (online)	1470-7926
ISSN	1351-0711
DOI	10.1136/oemed-2023-109050
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Article ; Online: Forty-year trends in fatal occupational injuries in North Carolina.

Richardson, David B / Martin, Amelia T / McClure, Elizabeth S / Nocera, Maryalice / Cantrell, John / Ranapurwala, Shabbar I / Marshall, Stephen

American journal of industrial medicine

2023 Volume 67, Issue 2, Page(s) 87–98

Abstract: Background: We describe progress in the control of deaths on-the-job due to fatal occupational injury in North Carolina over the period 1978-2017.: Methods: Forty years of information on fatal occupational injuries in North Carolina has been ... ...

Abstract	Background: We describe progress in the control of deaths on-the-job due to fatal occupational injury in North Carolina over the period 1978-2017. Methods: Forty years of information on fatal occupational injuries in North Carolina has been assembled from medical examiners' reports and death certificates, supplemented by newspaper and police reports. Cases were defined as unintentional fatal occupational injuries among adults. Annual estimates of the population at risk were derived from US Census data, and rates were quantified using Poisson regression methods. Results: There were 4434 eligible deaths. The unintentional fatal occupational injury rate at the beginning of the study period was more than threefold the rate at the end of the study. The fatal occupational injury rate among men declined from 9.6 per 100,000 worker-years in the period 1978-1982 to 3.1 per 100,000 worker-years in the period 2013-2017. The fatal occupational injury rate among women declined from 0.3 per 100,000 worker-years in the period 1978-1981 to 0.1 per 100,000 worker-years in the period 2013-2017. Declines in rates were observed for young adults as well as older workers and were observed across all major industry categories. Average annual declines in rates were greatest in those industries and occupations that had the highest fatal injury rates at the start of the study period. Conclusions: The substantial decline in fatal injury rates underscores the importance of injury prevention and demonstrates the ability to make meaningful reductions in unintentional fatal injury.
MeSH term(s)	Male ; Young Adult ; Humans ; Female ; United States ; North Carolina/epidemiology ; Occupational Injuries/epidemiology ; Accidents, Occupational ; Industry ; Occupations ; Wounds and Injuries
Language	English
Publishing date	2023-11-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	604538-8
ISSN	1097-0274 ; 0271-3586
ISSN (online)	1097-0274
ISSN	0271-3586
DOI	10.1002/ajim.23549
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Article ; Online: Matching study design to prescribing intention: The prevalent new-user design for studying abuse-deterrent formulations of opioids.

DiPrete, Bethany L / Oh, GYeon / Moga, Daniela C / Dasgupta, Nabarun / Slavova, Svetla / Slade, Emily / Delcher, Chris / Pence, Brian W / Ranapurwala, Shabbar I

Pharmacoepidemiology and drug safety

2024 Volume 33, Issue 5, Page(s) e5805

Abstract: Purpose: In drug studies, research designs requiring no prior exposure to certain drug classes may restrict important populations. Since abuse-deterrent formulations (ADF) of opioids are routinely prescribed after other opioids, choice of study design, ... ...

Abstract	Purpose: In drug studies, research designs requiring no prior exposure to certain drug classes may restrict important populations. Since abuse-deterrent formulations (ADF) of opioids are routinely prescribed after other opioids, choice of study design, identification of appropriate comparators, and addressing confounding by "indication" are important considerations in ADF post-marketing studies. Methods: In a retrospective cohort study using claims data (2006-2018) from a North Carolina private insurer [NC claims] and Merative MarketScan [MarketScan], we identified patients (18-64 years old) initiating ADF or non-ADF extended-release/long-acting (ER/LA) opioids. We compared patient characteristics and described opioid treatment history between treatment groups, classifying patients as traditional (no opioid claims during prior six-month washout period) or prevalent new users. Results: We identified 8415 (NC claims) and 147 978 (MarketScan) ADF, and 10 114 (NC claims) and 232 028 (MarketScan) non-ADF ER/LA opioid initiators. Most had prior opioid exposure (ranging 64%-74%), and key clinical differences included higher prevalence of recent acute or chronic pain and surgery among patients initiating ADFs compared to non-ADF ER/LA initiators. Concurrent immediate-release opioid prescriptions at initiation were more common in prevalent new users than traditional new users. Conclusions: Careful consideration of the study design, comparator choice, and confounding by "indication" is crucial when examining ADF opioid use-related outcomes.
MeSH term(s)	Humans ; Analgesics, Opioid/administration & dosage ; Retrospective Studies ; Middle Aged ; Male ; Female ; Adult ; Opioid-Related Disorders/prevention & control ; Opioid-Related Disorders/epidemiology ; Practice Patterns, Physicians'/statistics & numerical data ; Practice Patterns, Physicians'/standards ; Abuse-Deterrent Formulations ; Young Adult ; Adolescent ; Research Design ; North Carolina/epidemiology ; Delayed-Action Preparations ; Cohort Studies ; Drug Prescriptions/statistics & numerical data
Chemical Substances	Analgesics, Opioid ; Abuse-Deterrent Formulations ; Delayed-Action Preparations
Language	English
Publishing date	2024-05-08
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1099748-9
ISSN	1099-1557 ; 1053-8569
ISSN (online)	1099-1557
ISSN	1053-8569
DOI	10.1002/pds.5805
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