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1.
Am J Epidemiol ; 188(5): 950-959, 2019 05 01.
Article in English | MEDLINE | ID: mdl-30689681

ABSTRACT

The relationship between rainfall, especially extreme rainfall, and increases in waterborne infectious diseases is widely reported in the literature. Most of this research, however, has not formally considered the impact of exposure measurement error contributed by the limited spatiotemporal fidelity of precipitation data. Here, we evaluate bias in effect estimates associated with exposure misclassification due to precipitation data fidelity, using extreme rainfall as an example. We accomplished this via a simulation study, followed by analysis of extreme rainfall and incident diarrheal disease in an epidemiologic study in Ecuador. We found that the limited fidelity typical of spatiotemporal rainfall data sets biases effect estimates towards the null. Use of spatial interpolations of rain-gauge data or satellite data biased estimated health effects due to extreme rainfall (occurrence) and wet conditions (accumulated totals) downwards by 35%-45%. Similar biases were evident in the Ecuadorian case study analysis, where spatial incompatibility between exposed populations and rain gauges resulted in the association between extreme rainfall and diarrheal disease incidence being approximately halved. These findings suggest that investigators should pay greater attention to limitations in using spatially heterogeneous environmental data sets to assign exposures in epidemiologic research.


Subject(s)
Rain , Spatio-Temporal Analysis , Waterborne Diseases/epidemiology , Data Accuracy , Ecuador/epidemiology , Epidemiologic Methods , Humans
2.
J Pediatr ; 159(2): 222-6, 2011 Aug.
Article in English | MEDLINE | ID: mdl-21414631

ABSTRACT

OBJECTIVES: This study assessed racial/ethnic disparities in post-operative mortality after surgery for congenital heart disease (CHD) and explored whether disparities persist after adjusting for access to care. STUDY DESIGN: We used the Pediatric Health Information System database to perform a retrospective cohort study of 44,017 patients with 49,833 CHD surgery encounters in 2004-2008 at 41 children's hospitals. We used χ(2) analysis to compare unadjusted mortality rates by race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic) and constructed Poisson regression models to determine adjusted mortality risk ratios (RRs) and 95% CIs. RESULTS: In-hospital post-operative mortality rate was 3.4%; non-Hispanic whites had the lowest mortality rate (2.8%), followed by non-Hispanic blacks (3.6%) and Hispanics (3.9%) (P < .0001). After adjusting for age, sex, genetic syndrome, and surgery risk category, the RR of death was 1.32 for non-Hispanic blacks (CI, 1.14-1.52) and 1.21 for Hispanics (CI, 1.07-1.37), both compared with non-Hispanic whites. After adjusting for access to care (insurance type and hospital of surgery), these estimates did not appreciably change (non-Hispanic blacks: RR, 1.27; CI, 1.09-1.47; Hispanics: RR, 1.22; CI, 1.05-1.41). CONCLUSIONS: There are notable racial/ethnic disparities in post-operative mortality after CHD surgery that do not appear to be explained by differences in access to care.


Subject(s)
Cardiac Surgical Procedures , Ethnicity , Heart Defects, Congenital/ethnology , Racial Groups , Child, Preschool , Female , Follow-Up Studies , Heart Defects, Congenital/surgery , Humans , Infant , Infant, Newborn , Male , Postoperative Period , Retrospective Studies , Survival Rate/trends , United States/epidemiology
3.
J Pediatr ; 153(6): 807-13, 2008 Dec.
Article in English | MEDLINE | ID: mdl-18657826

ABSTRACT

OBJECTIVE: To determine an accurate estimate of the prevalence of congenital heart defects (CHD) using current standard diagnostic modalities. STUDY DESIGN: We obtained data on infants with CHD delivered during 1998 to 2005 identified by the Metropolitan Atlanta Congenital Defects Program, an active, population-based, birth defects surveillance system. Physiologic shunts in infancy and shunts associated with prematurity were excluded. Selected infant and maternal characteristics of the cases were compared with those of the overall birth cohort. RESULTS: From 1998 to 2005 there were 398 140 births, of which 3240 infants had CHD, for an overall prevalence of 81.4/10 000 births. The most common CHD were muscular ventricular septal defect, perimembranous ventricular septal defect, and secundum atrial septal defect, with prevalence of 27.5, 10.6, and 10.3/10 000 births, respectively. The prevalence of tetralogy of Fallot, the most common cyanotic CHD, was twice that of transposition of the great arteries (4.7 vs 2.3/10 000 births). Many common CHD were associated with older maternal age and multiple-gestation pregnancy; several were found to vary by sex. CONCLUSIONS: This study, using a standardized cardiac nomenclature and classification, provides current prevalence estimates of the various CHD subtypes. These estimates can be used to assess variations in prevalence across populations, time, or space.


Subject(s)
Heart Defects, Congenital/epidemiology , Population Surveillance/methods , Female , Georgia/epidemiology , Heart Defects, Congenital/classification , Humans , Infant, Newborn , Male , Maternal Age , Medical Records , Multicenter Studies as Topic , Prevalence , Urban Population
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