The Causal Interpretation of “Overall Vaccine Effectiveness” in Test-Negative Studies

2021 ◽  
Author(s):  
Shuo Feng ◽  
Sheena G Sullivan ◽  
Eric J Tchetgen Tchetgen ◽  
Benjamin J Cowling
Keyword(s):  
Disease Burden ◽  
Age Groups ◽  
Weighted Average ◽  
Population Level ◽  
Vaccine Effectiveness ◽  
Individual Risk ◽  
Causal Interpretation ◽  
Entire Sample ◽  
The Us ◽  
Meaningful Measure

Abstract Test-negative studies are commonly used to estimate influenza vaccine effectiveness (VE). In a typical study, an “overall VE” estimate may be reported based on data from the entire sample. However, there may be heterogeneity in VE, particularly by age. We therefore discuss the potential for a weighted average of age-specific VE estimates to provide a more meaningful measure of overall VE. We illustrate this perspective first using simulations to evaluate how overall VE would be biased when certain age groups are over-represented. We found unweighted overall VE estimates tended to be higher than weighted VE when children were over-represented and lower when elderly were over-represented. Then we extracted published estimates from the US Flu VE network, in which children are overrepresented, and some discrepancy between unweighted and weighted overall VE was observed. Differences in weighted versus unweighted overall VE could translate to substantial differences in the interpretation of individual risk reduction in vaccinated persons, and the total averted disease burden at the population level. Weighting overall estimates should be considered in VE studies in future.

scholarly journals Secular trends in testosterone- findings from a large state-mandate care provider

2020 ◽  
Author(s):  
Gabriel Chodick ◽  
Shdema Epstein ◽  
Varda Shalev
Keyword(s):  
Age Groups ◽  
Population Level ◽  
Serum Testosterone ◽  
Secular Trends ◽  
Total Testosterone ◽  
Study Objective ◽  
Testosterone Levels ◽  
State Mandate ◽  
The Us ◽  
Age Independent

Abstract Background Several studies from the US and Europe have shown a population-level decline in serum testosterone in men from 1970's to early 2000's. However, to the best of our knowledge, no study examining population-level decline in testosterone has been published in more recent years. The study objective was therefore to examine secular trends in testosterone levels among Israeli men in the first and second decades of the 21 st century,Methods All incident total testosterone performed between1/2006 and 3/2019 among 102,334 male members of a large health organization.Results A prominent trend of age-independent decline in the testosterone levels for most age groups. The results were highly significant ( Common.EditSubmissionSteps.Transform.EquationText )Conclusions The results show a highly significant age-independent decline in total testosterone that is unlikely to be explained by increasing rates of obesity.

scholarly journals The Population-Level Impacts of Excluding Norovirus-Infected Food Workers From the Workplace: A Mathematical Modeling Study

2018 ◽  
Vol 188 (1) ◽  
pp. 177-187 ◽  
Author(s):  
Wen Yang ◽  
Molly Steele ◽  
Ben Lopman ◽  
Juan S Leon ◽  
Aron J Hall
Keyword(s):  
Mathematical Modeling ◽  
Compartmental Model ◽  
Age Groups ◽  
Population Level ◽  
The United States ◽  
Foodborne Disease ◽  
Current Recommendation ◽  
The Us ◽  
Using Data ◽  
Food Workers

Abstract Norovirus is the leading cause of acute gastroenteritis and foodborne disease in the United States. The Food and Drug Administration recommends that food workers infected with norovirus be excluded from the workplace while symptomatic and for 48 hours after their symptoms subside. Compliance with this recommendation is not ideal, and the population-level impacts of changes in food-worker compliance have yet to be quantified. We aimed to assess the population impacts of varying degrees of compliance with the current recommendation through the use of a compartmental model. We modeled the number and proportion of symptomatic norovirus cases averted annually in the US population (using data from 1983–2014) in specific age groups (children aged <5 years, children aged 5–17 years, adults aged 18–64 years, and adults aged ≥65 years) under various scenarios of food-worker exclusion (i.e., proportion compliant and days of postsymptomatic exclusion) in comparison with a referent scenario which assumed that 66.6¯% of norovirus-symptomatic food workers and 0% of postsymptomatic food workers were excluded from work. Overall, we estimated that 6.0 million cases of norovirus have already been avoided annually under the referent scenario and that 6.7 million (28%) more cases might be avoided through 100% compliance with the current recommendations. Substantial population-level benefits were predicted from improved compliance in exclusion of norovirus-infected food workers from the workplace—benefits that may be realized through policies or programs incentivizing self-exclusion.

scholarly journals A SIMPLE SI MODEL WITH TWO AGE GROUPS AND ITS APPLICATION TO US HIV EPIDEMICS: TO TREAT OR NOT TO TREAT?

2007 ◽  
Vol 15 (02) ◽  
pp. 169-184
Author(s):  
ROXANA LÓPEZ ◽  
YANG KUANG ◽  
ABDESSAMAD TRIDANE
Keyword(s):  
Age Groups ◽  
Population Level ◽  
The United States ◽  
Global Dynamics ◽  
Hiv Dynamics ◽  
The Us ◽  
The Usa ◽  
Si Model ◽  
Two Age Groups

The objective of this paper is to study the global dynamics of a simple SI model with two explicit age groups and apply the findings to the HIV dynamics in the United States. Specifically, we would like to explore the long term HIV dynamics to answer questions such as what will happen to human population level if all the demographical and epidemiological parameters stay constant. We also wonder if treatment alone will actually slow the spread of HIV or not. We divide the population into juvenile and adult groups. Only adults are assumed to be sexually active and we implicitly assume that the sex ratio is constant. We also assume that infected adults may produce both susceptible newborns and infected newborns. The model is fit with parameters from the HIV epidemic in the US. It produces an optimistic outcome: if nothing changes, the USA infected population may be halved in about 20 years. However, if treatment is found to extend the life expectance of infected individuals to 30 years or more, then the number of infected adults may actually increase in the next 20 years or so. This creates a dilemma: to treat or not to treat?

scholarly journals Differential Effect of Vaccine Effectiveness and Safety on COVID-19 Vaccine Acceptance across Socioeconomic Groups in an International Sample

Vaccines ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. 1010
Author(s):  
Stefania Kerekes ◽  
Mengdi Ji ◽  
Shu-Fang Shih ◽  
Hao-Yuan Chang ◽  
Harapan Harapan ◽  
...  
Keyword(s):  
Age Groups ◽  
Mainland China ◽  
Vaccine Safety ◽  
Vaccine Effectiveness ◽  
Effective Vaccine ◽  
Lower Income ◽  
Cross Sectional ◽  
Vaccine Acceptance ◽  
The Us ◽  
Over Time

Controlling the spread of SARS-CoV-2 will require high vaccination coverage, but acceptance of the vaccine could be impacted by perceptions of vaccine safety and effectiveness. The aim of this study was to characterize how vaccine safety and effectiveness impact acceptance of a vaccine, and whether this impact varied over time or across socioeconomic and demographic groups. Repeated cross-sectional surveys of an opt-in internet sample were conducted in 2020 in the US, mainland China, Taiwan, Malaysia, Indonesia, and India. Individuals were randomized into receiving information about a hypothetical COVID-19 vaccine with different safety and effectiveness profiles (risk of fever 5% vs. 20% and vaccine effectiveness 50% vs. 95%). We examined the effect of the vaccine profile on vaccine acceptance in a logistic regression model, and included interaction terms between vaccine profile and socioeconomic/demographic variables to examine the differences in sensitivity to the vaccine profile. In total, 12,915 participants were enrolled in the six-country study, including the US (4054), China (2797), Taiwan (1278), Malaysia (1497), Indonesia (1527), and India (1762). Across time and countries, respondents had stronger preferences for a safer and more effective vaccine. For example, in the US in November 2020, acceptance was 3.10 times higher for a 95% effective vaccine with a 5% risk of fever, vs a vaccine 50% effective, with a 20% risk of fever (95% CI: 2.07, 4.63). Across all countries, there was an increase in the effect of the vaccine profile over time (p < 0.0001), with stronger preferences for a more effective and safer vaccine in November 2020 compared to August 2020. Sensitivity to the vaccine profile was also stronger in August compared to November 2020, in younger age groups, among those with lower income; and in those that are vaccine hesitant. Uptake of COVID-19 vaccines could vary in a country based upon effectiveness and availability. Effective communication tools will need to be developed for certain sensitive groups, including young adults, those with lower income, and those more vaccine hesitant.

scholarly journals Secular trends in testosterone- findings from a large state-mandate care provider

2020 ◽  
Author(s):  
Gabriel Chodick ◽  
Shdema Epstein ◽  
Varda Shalev
Keyword(s):  
Age Groups ◽  
Population Level ◽  
Serum Testosterone ◽  
Secular Trends ◽  
Total Testosterone ◽  
Study Objective ◽  
Testosterone Levels ◽  
The Us ◽  
Health Organization ◽  
Age Independent

Abstract Background: Several studies from the US and Europe have shown a population-level decline in serum testosterone in men from 1970's to early 2000's. However, to the best of our knowledge, no study examining population-level decline in testosterone has been published in more recent years. The study objective was therefore to examine secular trends in testosterone levels among Israeli men in the first and second decades of the 21st century, Methods: All incident total testosterone performed between1/2006 and 3/2019 among 102,334 male members of a large health organization. Results: A significant (p<0.001) and prominent trend of age-independent decline in the testosterone levels was recorded during the study period for most age groups. Conclusions: There was a highly significant age-independent decline in total testosterone in the first and second decades of the 21st century. The decline was unlikely to be explained by increasing rates of obesity.

scholarly journals The health effects in the US of quarantine policies based on predicted individual risk of severe COVID-19 outcomes

2021 ◽  
Author(s):  
Samuel Edmund Lovick ◽  
Gillian S Dite ◽  
Richard Allman
Keyword(s):  
At Risk ◽  
Genetic Test ◽  
Age Groups ◽  
Transmission Model ◽  
Individual Risk ◽  
Nucleotide Polymorphisms ◽  
Infection Rates ◽  
Social Distancing ◽  
Genetic Test Results ◽  
The Us

Background: Social distancing, testing and public health measures are the principal protections against COVID-19 in the US. Social distancing based on an accurate assessment of the individual risk of severe outcomes could reduce harm even as infection rates accelerate. Methods: An SEIR dynamic transmission model of COVID-19 was created to simulate the disease in the US after October 2020. The model comprised 8 age groups with US-specific contact rates and low- and high-risk sub-groups defined in terms of the risk of a severe outcome determined by relevant comorbidities and a genetic test. Monte Carlo analysis was used to compare quarantine measures applied to at risk persons identified with and without the genetic test. Results: Under the piecemeal social distancing measures currently in place, absent a vaccine the US can expect 114 million symptomatic infections, 4.8 million hospitalisations and 262,000 COVID-19 related deaths. Social distancing based solely on comorbidities with 80% compliance reduces symptomatic infections by between 1.2 and 2.2 million, hospitalisations by between 1.2 and 1.3 million, and deaths by between 71,800 and 80,900. Refining the definition of at risk using a test of single-nucleotide polymorphisms further reduces symptomatic infections by 1.0 to 1.2 million, hospitalisations by 0.4 million and deaths by between 20,500 and 24,100. Conclusions: Models are now available that can accurately predict the likelihood of severe COVID-19 outcomes based on age, sex, comorbidities and polygenetic testing. Quarantine based on risk of severe outcomes could substantially reduce pandemic harm, even when infection rates outside of quarantine are high.  

scholarly journals Adult E-Cigarettes Use Associated with a Self-Reported Diagnosis of COPD

2019 ◽  
Vol 16 (20) ◽  
pp. 3938 ◽  
Author(s):  
Mario F. Perez ◽  
Nkiruka C. Atuegwu ◽  
Erin L. Mead ◽  
Cheryl Oncken ◽  
Eric M. Mortensen
Keyword(s):  
Survey Design ◽  
Electronic Cigarettes ◽  
Age Groups ◽  
Chronic Obstructive ◽  
Cigarette Use ◽  
Matched Sample ◽  
Long Term Effects ◽  
Entire Sample ◽  
Obstructive Pulmonary Disease ◽  
The Us

The use of electronic cigarettes (e-cigarettes) has increased in the US, but little is known about the effects of these products on lung health. The main purpose of this study was to examine the association between e-cigarette use and a participant’s report of being diagnosed with chronic obstructive pulmonary disease (COPD) in a nationally representative sample of adults. Methods: The first wave of the Population Assessment of Tobacco and Health (PATH) survey adult data was used (N = 32,320). Potential confounders between e-cigarette users and non-users were balanced using propensity score matching. Odds ratios (OR) were calculated to examine the association between e-cigarette use and COPD in the propensity-matched sample, the entire sample, different age groups, and in nonsmokers. Replicate weights and balanced repeated replication methods were utilized to account for the complex survey design. Results: Of the 3642 participants who met the criteria for e-cigarette use, 2727 were propensity matched with 2727 non e-cigarette users. In the propensity-matched sample, e-cigarette users were more likely to report being diagnosed with COPD (OR 1.43, 95% confidence interval [CI] 1.12–1.85) than non-e-cigarette users after adjusting for confounders. The result was similar in the entire sample and in the different age subgroups. Among nonsmokers, the odds of reporting a COPD diagnosis were even greater among e-cigarette users (OR 2.94, 95% CI 1.73–4.99) compared to non-e-cigarette users. Conclusion: Our findings demonstrate that e-cigarette use was associated with a reported diagnosis of COPD among adults in the US. Further research is necessary to characterize the nature of this association and on the long-term effects of using e-cigarettes.

scholarly journals Patterns of dental antibiotic prescribing in 2017: Australia, England, United States, and British Columbia (Canada)

2021 ◽  
pp. 1-8
Author(s):  
Wendy Thompson ◽  
Leanne Teoh ◽  
Colin C. Hubbard ◽  
Fawziah Marra ◽  
David M. Patrick ◽  
...  
Keyword(s):  
United States ◽  
British Columbia ◽  
Broad Spectrum ◽  
Antibiotic Prescription ◽  
Population Level ◽  
The United States ◽  
Antibiotic Prescribing ◽  
Prescribing Behavior ◽  
The Us ◽  
Amoxicillin Clavulanic Acid

Abstract Objective: Our objective was to compare patterns of dental antibiotic prescribing in Australia, England, and North America (United States and British Columbia, Canada). Design: Population-level analysis of antibiotic prescription. Setting: Outpatient prescribing by dentists in 2017. Participants: Patients receiving an antibiotic dispensed by an outpatient pharmacy. Methods: Prescription-based rates adjusted by population were compared overall and by antibiotic class. Contingency tables assessed differences in the proportion of antibiotic class by country. Results: In 2017, dentists in the United States had the highest antibiotic prescribing rate per 1,000 population and Australia had the lowest rate. The penicillin class, particularly amoxicillin, was the most frequently prescribed for all countries. The second most common agents prescribed were clindamycin in the United States and British Columbia (Canada) and metronidazole in Australia and England. Broad-spectrum agents, amoxicillin-clavulanic acid, and azithromycin were the highest in Australia and the United States, respectively. Conclusion: Extreme differences exist in antibiotics prescribed by dentists in Australia, England, the United States, and British Columbia. The United States had twice the antibiotic prescription rate of Australia and the most frequently prescribed antibiotic in the US was clindamycin. Significant opportunities exist for the global dental community to update their prescribing behavior relating to second-line agents for penicillin allergic patients and to contribute to international efforts addressing antibiotic resistance. Patient safety improvements will result from optimizing dental antibiotic prescribing, especially for antibiotics associated with resistance (broad-spectrum agents) or C. difficile (clindamycin). Dental antibiotic stewardship programs are urgently needed worldwide.

scholarly journals Influenza-associated disease burden in mainland China: a systematic review and meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jing Li ◽  
Yinzi Chen ◽  
Xiling Wang ◽  
Hongjie Yu
Keyword(s):  
Systematic Review ◽  
Publication Bias ◽  
Fixed Effects ◽  
Disease Burden ◽  
Outpatient Visit ◽  
Meta Analysis ◽  
Age Groups ◽  
Mainland China ◽  
Mortality And Morbidity ◽  
All Cause Mortality

AbstractInfluenza causes substantial morbidity and mortality. Many original studies have been carried out to estimate disease burden of influenza in mainland China, while the full disease burden has not yet been systematically reviewed. We did a systematic review and meta-analysis to assess the burden of influenza-associated mortality, hospitalization, and outpatient visit in mainland China. We searched 3 English and 4 Chinese databases with studies published from 2005 to 2019. Studies reporting population-based rates of mortality, hospitalization, or outpatient visit attributed to seasonal influenza were included in the analysis. Fixed-effects or random-effects model was used to calculate pooled estimates of influenza-associated mortality depending on the degree of heterogeneity. Meta-regression was applied to explore the sources of heterogeneity. Publication bias was assessed by funnel plots and Egger’s test. We identified 30 studies eligible for inclusion with 17, 8, 5 studies reporting mortality, hospitalization, and outpatient visit associated with influenza, respectively. The pooled influenza-associated all-cause mortality rates were 14.33 and 122.79 per 100,000 persons for all ages and ≥ 65 years age groups, respectively. Studies were highly heterogeneous in aspects of age group, cause of death, statistical model, geographic location, and study period, and these factors could explain 60.14% of the heterogeneity in influenza-associated mortality. No significant publication bias existed in estimates of influenza-associated all-cause mortality. Children aged < 5 years were observed with the highest rates of influenza-associated hospitalizations and ILI outpatient visits. People aged ≥ 65 years and < 5 years contribute mostly to mortality and morbidity burden due to influenza, which calls for targeted vaccination policy for older adults and younger children in mainland China.

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