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  1. Article ; Online: The Accuracy of Nonstandardized MELD/PELD Score Exceptions in the Pediatric Liver Allocation System.

    Ahn, Daniel J / Zeng, Sharon / Pelzer, Kenley M / Barth, Rolf N / Gallo, Amy / Parker, William F

    Transplantation

    2023  Volume 107, Issue 10, Page(s) e247–e256

    Abstract: Background: In the United States, over half of pediatric candidates receive exceptions and status upgrades that increase their allocation model of end-stage liver disease/pediatric end-stage liver disease (MELD/PELD) score above their laboratory MELD/ ... ...

    Abstract Background: In the United States, over half of pediatric candidates receive exceptions and status upgrades that increase their allocation model of end-stage liver disease/pediatric end-stage liver disease (MELD/PELD) score above their laboratory MELD/PELD score. We determined whether these "nonstandardized" MELD/PELD exceptions accurately depict true pretransplant mortality risk.
    Methods: Using data from the Scientific Registry of Transplant Recipients, we identified pediatric candidates (<18 y of age) with chronic liver failure added to the waitlist between June 2016 and September 2021 and estimated all-cause pretransplant mortality with mixed-effects Cox proportional hazards models that treated allocation MELD/PELD and exception status as time-dependent covariates. We also estimated concordance statistics comparing the performance of laboratory MELD/PELD with allocation MELD/PELD. We then compared the proportion of candidates with exceptions before and after the establishment of the National Liver Review Board.
    Results: Out of 2026 pediatric candidates listed during our study period, 403 (19.9%) received an exception within a week of listing and 1182 (58.3%) received an exception before delisting. Candidates prioritized by their laboratory MELD/PELD scores had an almost 9 times greater risk of pretransplant mortality compared with candidates who received the same allocation score from an exception (hazard ratio 8.69; 95% confidence interval, 4.71-16.03; P < 0.001). The laboratory MELD/PELD score without exceptions was more accurate than the allocation MELD/PELD score with exceptions (Harrell's c-index 0.843 versus 0.763). The proportion of patients with an active exception at the time of transplant decreased significantly after the National Liver Review Board was implemented (67.4% versus 43.4%, P < 0.001).
    Conclusions: Nonstandardized exceptions undermine the rank ordering of pediatric candidates with chronic liver failure.
    MeSH term(s) Child ; Humans ; United States/epidemiology ; End Stage Liver Disease/diagnosis ; End Stage Liver Disease/surgery ; Liver Transplantation ; Severity of Illness Index ; Waiting Lists ; Registries
    Language English
    Publishing date 2023-07-06
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 208424-7
    ISSN 1534-6080 ; 0041-1337
    ISSN (online) 1534-6080
    ISSN 0041-1337
    DOI 10.1097/TP.0000000000004720
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  2. Article ; Online: Association of Zip Code Vaccination Rate With COVID-19 Mortality in Chicago, Illinois.

    Zeng, Sharon / Pelzer, Kenley M / Gibbons, Robert D / Peek, Monica E / Parker, William F

    JAMA network open

    2022  Volume 5, Issue 5, Page(s) e2214753

    Abstract: Importance: There has been large geographic inequity in vaccination coverage across Chicago, Illinois, with higher vaccination rates in zip codes with residents who predominantly have high incomes and are White.: Objective: To determine the ... ...

    Abstract Importance: There has been large geographic inequity in vaccination coverage across Chicago, Illinois, with higher vaccination rates in zip codes with residents who predominantly have high incomes and are White.
    Objective: To determine the association between inequitable zip code-level vaccination coverage and COVID-19 mortality in Chicago.
    Design, setting, and participants: This retrospective cohort study used Chicago Department of Public Health vaccination and mortality data and Cook County Medical Examiner mortality data from March 1, 2020, through November 6, 2021, to assess the association of COVID-19 mortality with zip code-level vaccination rates. Data were analyzed from June 1, 2021, to April 13, 2022.
    Exposures: Zip code-level first-dose vaccination rates before the Alpha and Delta waves of COVID-19.
    Main outcomes and measures: The primary outcome was deaths from COVID-19 during the Alpha and Delta waves. The association of a marginal increase in zip code-level vaccination rate with weekly mortality rates was estimated with a mixed-effects Poisson regression model, and the total number of preventable deaths in the least vaccinated quartile of zip codes was estimated with a linear difference-in-difference design.
    Results: The study population was 2 686 355 Chicago residents in 52 zip codes (median [IQR] age 34 [32-38] years; 1 378 658 [51%] women; 773 938 Hispanic residents [29%]; 783 916 non-Hispanic Black residents [29%]; 894 555 non-Hispanic White residents [33%]). Among residents in the least vaccinated quartile, 80% were non-Hispanic Black, compared with 8% of residents identifying as non-Hispanic Black in the most vaccinated quartile (P < .001). After controlling for age distribution and recovery from COVID-19, a 10-percentage point increase in zip code-level vaccination 6 weeks before the peak of the Alpha wave was associated with a 39% lower relative risk of death from COVID-19 (incidence rate ratio [IRR], 0.61 [95% CI, 0.52-0.72]). A 10-percentage point increase in zip code vaccination rate 6 weeks before the peak of the Delta wave was associated with a 24% lower relative risk of death (IRR, 0.76 [95% CI, 0.66-0.87]). The difference-in-difference estimate was that 119 Alpha wave deaths (72% [95% CI, 63%-81%]) and 108 Delta wave deaths (75% [95% CI, 66%-84%]) might have been prevented in the least vaccinated quartile of zip codes if it had had the vaccination coverage of the most vaccinated quartile.
    Conclusions and relevance: These findings suggest that low zip code-level vaccination rates in Chicago were associated with more deaths during the Alpha and Delta waves of COVID-19 and that inequitable vaccination coverage exacerbated existing racial and ethnic disparities in COVID-19 deaths.
    MeSH term(s) Adult ; COVID-19/prevention & control ; Chicago/epidemiology ; Female ; Humans ; Illinois/epidemiology ; Infant ; Male ; Retrospective Studies ; Vaccination
    Language English
    Publishing date 2022-05-02
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ISSN 2574-3805
    ISSN (online) 2574-3805
    DOI 10.1001/jamanetworkopen.2022.14753
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  3. Article ; Online: Association of high-priority exceptions with waitlist mortality among heart transplant candidates.

    Johnson, Daniel Y / Ahn, Daniel / Lazenby, Kevin / Zeng, Sharon / Zhang, Kevin / Narang, Nikhil / Khush, Kiran / Parker, William F

    The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation

    2023  Volume 42, Issue 9, Page(s) 1175–1182

    Abstract: Background: The US heart allocation system ranks candidates using six categorical status levels. Transplant programs can request exceptions to increase a candidate's status level if they believe their candidate has the same medical urgency as candidates ...

    Abstract Background: The US heart allocation system ranks candidates using six categorical status levels. Transplant programs can request exceptions to increase a candidate's status level if they believe their candidate has the same medical urgency as candidates who meet the standard criteria for that level. We aimed to determine if exception candidates have the same medical urgency as standard candidates.
    Methods: Using the Scientific Registry of Transplant Recipients, we constructed a longitudinal waitlist history dataset of adult heart-only transplant candidates listed between October 18, 2018 and December 1, 2021. We estimated the association between exceptions and waitlist mortality with a mixed-effects Cox proportional hazards model that treated status and exceptions as time-dependent covariates.
    Results: Out of 12,458 candidates listed during the study period, 2273 (18.2%) received an exception at listing and 1957 (15.7%) received an exception after listing. After controlling for status, exception candidates had approximately half the risk of waitlist mortality as standard candidates (hazard ratio [HR] 0.55, 95% confidence interval [CI] [0.41, 0.73], p < .001). Exceptions were associated with a 51% lower risk of waitlist mortality among Status 1 candidates (HR 0.49, 95% CI [0.27, 0.91], p = .023) and a 61% lower risk among Status 2 candidates (HR 0.39, 95% CI [0.24, 0.62], p < .001).
    Conclusions: Under the new heart allocation policy, exception candidates had significantly lower waitlist mortality than standard candidates, including exceptions for the highest priority statuses. These results suggest that candidates with exceptions, on average, have a lower level of medical urgency than candidates who meet standard criteria.
    MeSH term(s) Adult ; Humans ; Heart Transplantation ; Liver Transplantation ; Proportional Hazards Models ; Waiting Lists ; Transplant Recipients
    Language English
    Publishing date 2023-05-22
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 1062522-7
    ISSN 1557-3117 ; 1053-2498
    ISSN (online) 1557-3117
    ISSN 1053-2498
    DOI 10.1016/j.healun.2023.05.009
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  4. Article ; Online: The social vulnerability metric (SVM) as a new tool for public health.

    Saulsberry, Loren / Bhargava, Ankur / Zeng, Sharon / Gibbons, Jason B / Brannan, Cody / Lauderdale, Diane S / Gibbons, Robert D

    Health services research

    2022  Volume 58, Issue 4, Page(s) 873–881

    Abstract: Objective: To derive and validate a new ecological measure of the social determinants of health (SDoH), calculable at the zip code or county level.: Data sources and study setting: The most recent releases of secondary, publicly available data were ... ...

    Abstract Objective: To derive and validate a new ecological measure of the social determinants of health (SDoH), calculable at the zip code or county level.
    Data sources and study setting: The most recent releases of secondary, publicly available data were collected from national U.S. health agencies as well as state and city public health departments.
    Study design: The Social Vulnerability Metric (SVM) was constructed from U.S. zip-code level measures (2018) from survey data using multidimensional Item Response Theory and validated using outcomes including all-cause mortality (2016), COVID-19 vaccination (2021), and emergency department visits for asthma (2018). The SVM was also compared with the existing Centers for Disease Control and Prevention's Social Vulnerability Index (SVI) to determine convergent validity and differential predictive validity.
    Data collection/extraction methods: The data were collected directly from published files available to the public online from national U.S. health agencies as well as state and city public health departments.
    Principal findings: The correlation between SVM scores and national age-adjusted county all-cause mortality was r = 0.68. This correlation demonstrated the SVM's robust validity and outperformed the SVI with an almost four-fold increase in explained variance (46% vs. 12%). The SVM was also highly correlated (r ≥ 0.60) to zip-code level health outcomes for the state of California and city of Chicago.
    Conclusions: The SVM offers a measurement tool improving upon the performance of existing SDoH composite measures and has broad applicability to public health that may help in directing future policies and interventions. The SVM provides a single measure of SDoH that better quantifies associations with health outcomes.
    MeSH term(s) Humans ; Social Vulnerability ; Public Health ; COVID-19 Vaccines ; Support Vector Machine ; COVID-19/epidemiology ; COVID-19/prevention & control
    Chemical Substances COVID-19 Vaccines
    Language English
    Publishing date 2022-11-29
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 410435-3
    ISSN 1475-6773 ; 0017-9124
    ISSN (online) 1475-6773
    ISSN 0017-9124
    DOI 10.1111/1475-6773.14102
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  5. Article ; Online: Consequences of COVID-19 vaccine allocation inequity in Chicago

    Zeng, Sharon / Pelzer, Kenley M / Gibbons, Robert D / Peek, Monica E / Parker, William Fiske

    medRxiv

    Abstract: During Chicago9s initial COVID-19 vaccine rollout, the city disproportionately allocated vaccines to zip codes with high incomes and predominantly White populations. However, the impact of this inequitable distribution on COVID-19 outcomes is unknown. ... ...

    Abstract During Chicago9s initial COVID-19 vaccine rollout, the city disproportionately allocated vaccines to zip codes with high incomes and predominantly White populations. However, the impact of this inequitable distribution on COVID-19 outcomes is unknown. This observational study determined the association between zip-code level vaccination rate and COVID-19 mortality in residents of 52 Chicago zip codes. After controlling for age distribution and recovery from infection, a 10% higher vaccination rate by March 28, 2021, was associated with a 39% lower relative risk of death during the peak of the spring wave of COVID-19. Using a difference-in-difference analysis, Chicago could have prevented an estimated 72% of deaths in the least vaccinated quartile of the city (vaccination rates of 17.8 - 26.9%) if it had had the same vaccination rate as the most vaccinated quartile (39.9 - 49.3%). Inequitable vaccine allocation in Chicago likely exacerbated existing racial disparities in COVID-19 mortality.
    Keywords covid19
    Language English
    Publishing date 2021-09-23
    Publisher Cold Spring Harbor Laboratory Press
    Document type Article ; Online
    DOI 10.1101/2021.09.22.21263984
    Database COVID19

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  6. Article ; Online: The endogenous repertoire harbors self-reactive CD4

    Lee, Victoria / Rodriguez, Donald M / Ganci, Nicole K / Zeng, Sharon / Ai, Junting / Chao, Jaime L / Walker, Matthew T / Miller, Christine H / Klawon, David E J / Schoenbach, Mary H / Kennedy, Domenick E / Maienschein-Cline, Mark / Socci, Nicholas D / Clark, Marcus R / Savage, Peter A

    Nature immunology

    2023  Volume 24, Issue 3, Page(s) 487–500

    Abstract: The T cell repertoire of healthy mice and humans harbors self-reactive ... ...

    Abstract The T cell repertoire of healthy mice and humans harbors self-reactive CD4
    MeSH term(s) Animals ; Humans ; Mice ; Autoimmunity ; Cell Differentiation ; Clone Cells ; Phenotype ; T Follicular Helper Cells ; T-Lymphocytes, Helper-Inducer ; T-Lymphocytes, Regulatory ; CD4-Positive T-Lymphocytes/immunology
    Language English
    Publishing date 2023-02-09
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 2016987-5
    ISSN 1529-2916 ; 1529-2908
    ISSN (online) 1529-2916
    ISSN 1529-2908
    DOI 10.1038/s41590-023-01425-0
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  7. Article ; Online: Eomes identifies thymic precursors of self-specific memory-phenotype CD8

    Miller, Christine H / Klawon, David E J / Zeng, Sharon / Lee, Victoria / Socci, Nicholas D / Savage, Peter A

    Nature immunology

    2020  Volume 21, Issue 5, Page(s) 567–577

    Abstract: Unprimed mice harbor a substantial population of 'memory-phenotype' ... ...

    Abstract Unprimed mice harbor a substantial population of 'memory-phenotype' CD8
    MeSH term(s) Animals ; Autoantigens/immunology ; CD8-Positive T-Lymphocytes/immunology ; Cell Differentiation ; Clonal Selection, Antigen-Mediated ; Clone Cells ; Immunologic Memory ; Male ; Mice ; Mice, Inbred C57BL ; Mice, Knockout ; Mice, Transgenic ; Programmed Cell Death 1 Receptor/metabolism ; Prostatic Neoplasms/immunology ; Receptors, Antigen, T-Cell/genetics ; T-Box Domain Proteins/genetics ; T-Box Domain Proteins/metabolism ; Thymus Gland/physiology ; Up-Regulation
    Chemical Substances Autoantigens ; Eomes protein, mouse ; Pdcd1 protein, mouse ; Programmed Cell Death 1 Receptor ; Receptors, Antigen, T-Cell ; T-Box Domain Proteins
    Language English
    Publishing date 2020-04-13
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2016987-5
    ISSN 1529-2916 ; 1529-2908
    ISSN (online) 1529-2916
    ISSN 1529-2908
    DOI 10.1038/s41590-020-0653-1
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