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Anthony MS, Aroda VR, Parlett LE, Djebarri L, Berreghis S, Calingaert B, Beachler DC, Crowe CL, Johannes CB, Juhaeri J, Lanes S, Pan C, Rothman KJ, Saltus CW, Walsh KE. Risk of Anaphylaxis Among New Users of GLP-1 Receptor Agonists: A Cohort Study. Diabetes Care 2024; 47:712-719. [PMID: 38363873 DOI: 10.2337/dc23-1911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/18/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE To assess risk of anaphylaxis among patients with type 2 diabetes mellitus who are initiating therapy with a glucagon-like peptide 1 receptor agonist (GLP-1 RA), with a focus on those starting lixisenatide therapy. RESEARCH DESIGN AND METHODS A cohort study was conducted in three large, U.S. claims databases (2017-2021). Adult (aged ≥18 years) new users of a GLP-1 RA who had type 2 diabetes mellitus and ≥6 months enrollment in the database before GLP-1 RA initiation (start of follow-up) were included. GLP-1 RAs evaluated were lixisenatide, an insulin glargine/lixisenatide fixed-ratio combination (FRC), exenatide, liraglutide or insulin degludec/liraglutide FRC, dulaglutide, and semaglutide (injectable and oral). The first anaphylaxis event during follow-up was identified using a validated algorithm. Incidence rates (IRs) and 95% CIs were calculated within each medication cohort. The unadjusted IR ratio (IRR) comparing anaphylaxis rates in the lixisenatide cohort with all other GLP-1 RAs combined was analyzed post hoc. RESULTS There were 696,089 new users with 456,612 person-years of exposure to GLP-1 RAs. Baseline demographics, comorbidities, and use of other prescription medications in the 6 months before the index date were similar across medication cohorts. IRs (95% CIs) per 10,000 person-years were 1.0 (0.0-5.6) for lixisenatide, 6.0 (3.6-9.4) for exenatide, 5.1 (3.7-7.0) for liraglutide, 3.9 (3.1-4.8) for dulaglutide, and 3.6 (2.6-4.9) for semaglutide. The IRR (95% CI) for the anaphylaxis rate for the lixisenatide cohort compared with the pooled other GLP-1 RA cohort was 0.24 (0.01-1.35). CONCLUSIONS Anaphylaxis is rare with GLP-1 RAs. Lixisenatide is unlikely to confer higher risk of anaphylaxis than other GLP-1 RAs.
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Forrest CB, Chen CP, Perrin EM, Stille CJ, Cooper R, Harris K, Luo Q, Maltenfort MG, Parlett LE. Pediatric Medical Subspecialist Use in Outpatient Settings. JAMA Netw Open 2024; 7:e2350379. [PMID: 38175643 PMCID: PMC10767594 DOI: 10.1001/jamanetworkopen.2023.50379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/16/2023] [Indexed: 01/05/2024] Open
Abstract
Importance A first step toward understanding whether pediatric medical subspecialists are meeting the needs of the nation's children is describing rates of use and trends over time. Objectives To quantify rates of outpatient pediatric medical subspecialty use. Design, Setting, and Participants This repeated cross-sectional study of annual subspecialist use examined 3 complementary data sources: electronic health records from PEDSnet (8 large academic medical centers [January 1, 2010, to December 31, 2021]); administrative data from the Healthcare Integrated Research Database (HIRD) (14 commercial health plans [January 1, 2011, to December 31, 2021]); and administrative data from the Transformed Medicaid Statistical Information System (T-MSIS) (44 state Medicaid programs [January 1, 2016, to December 31, 2019]). Annual denominators included 493 628 to 858 551 patients younger than 21 years with a general pediatric visit in PEDSnet; 5 million beneficiaries younger than 21 years enrolled for at least 6 months in HIRD; and 35 million Medicaid or Children's Health Insurance Program beneficiaries younger than 19 years enrolled for any amount of time in T-MSIS. Exposure Calendar year and type of medical subspecialty. Main Outcomes and Measures Annual number of children with at least 1 completed visit to any pediatric medical subspecialist in an outpatient setting per population. Use rates excluded visits in emergency department or inpatient settings. Results Among the study population, the proportion of girls was 51.0% for PEDSnet, 51.1% for HIRD, and 49.3% for T-MSIS; the proportion of boys was 49.0% for PEDSnet, 48.9% for HIRD, and 50.7% for T-MSIS. The proportion of visits among children younger than 5 years was 37.4% for PEDSnet, 20.9% for HIRD, and 26.2% for T-MSIS; most patients were non-Hispanic Black (29.7% for PEDSnet and 26.1% for T-MSIS) or non-Hispanic White (44.9% for PEDSnet and 43.2% for T-MSIS). Annual rates for PEDSnet ranged from 18.0% to 21.3%, which were higher than rates for HIRD (range, 7.9%-10.4%) and T-MSIS (range, 7.6%-8.6%). Subspecialist use increased in the HIRD commercial health plans (annual relative increase of 2.4% [95% CI, 1.6%-3.1%]), but rates were essentially flat in the other data sources (PEDSnet, -0.2% [95% CI, -1.1% to 0.7%]; T-MSIS, -0.7% [95% CI, -6.5% to 5.5%]). The flat PEDSnet growth reflects a balance between annual use increases among those with commercial insurance (1.2% [95% CI, 0.3%-2.1%]) and decreases in use among those with Medicaid (-0.9% [95% CI, -1.6% to -0.2%]). Conclusions and Relevance The findings of this cross-sectional study suggest that among children, 8.6% of Medicaid beneficiaries, 10.4% of those with commercial insurance, and 21.3% of those whose primary care is received in academic health systems use pediatric medical subspecialty care each year. There was a small increase in rates of subspecialty use among children with commercial but not Medicaid insurance. These data may help launch innovations in the primary-specialty care interface.
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Affiliation(s)
- Christopher B. Forrest
- Applied Clinical Research Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Candice P. Chen
- Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Eliana M. Perrin
- Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Maryland
| | - Christopher J. Stille
- Deparment of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
| | - Ruth Cooper
- Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine, Washington, DC
| | | | - Qian Luo
- Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Mitchell G. Maltenfort
- Applied Clinical Research Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Dawwas GK, Weiss A, Constant BD, Parlett LE, Haynes K, Yang JY, Brensinger C, Wu Q, Pate V, Jonsson Funk M, Schaubel DE, Hurtado-Lorenzo A, David Kappelman M, Lewis JD. Development and Validation of Claims-Based Definitions to Identify Incident and Prevalent Inflammatory Bowel Disease in Administrative Healthcare Databases. Inflamm Bowel Dis 2023; 29:1993-1996. [PMID: 37043675 PMCID: PMC10697409 DOI: 10.1093/ibd/izad053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Indexed: 04/14/2023]
Abstract
BACKGROUND To facilitate inflammatory bowel disease (IBD) research in the United States, we developed and validated claims-based definitions to identify incident and prevalent IBD diagnoses using administrative healthcare claims data among multiple payers. METHODS We used data from Medicare, Medicaid, and the HealthCore Integrated Research Database (Anthem commercial and Medicare Advantage claims). The gold standard for validation was review of medical records. We evaluated 1 incidence and 4 prevalence algorithms based on a combination of International Classification of Diseases codes, National Drug Codes, and Current Procedural Terminology codes. The claims-based incident diagnosis date needed to be within ±90 days of that recorded in the medical record to be valid. RESULTS We reviewed 111 charts of patients with a potentially incident diagnosis. The positive predictive value (PPV) of the claims algorithm was 91% (95% confidence interval [CI], 81%-97%). We reviewed 332 charts to validate prevalent case definition algorithms. The PPV was 94% (95% CI, 86%-98%) for ≥2 IBD diagnoses and presence of prescriptions for IBD medications, 92% (95% CI, 85%-97%) for ≥2 diagnoses without any medications, 78% (95% CI, 67%-87%) for a single diagnosis and presence of an IBD medication, and 35% (95% CI, 25%-46%) for 1 physician diagnosis and no IBD medications. CONCLUSIONS Through a combination of diagnosis, procedural, and medication codes in insurance claims data, we were able to identify incident and prevalent IBD cases with high accuracy. These algorithms can be useful for the ascertainment of IBD cases in future studies.
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Affiliation(s)
- Ghadeer K Dawwas
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alexandra Weiss
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Brad D Constant
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Kevin Haynes
- Janssen Research and Development, LLC, Titusville, NJ, USA
| | - Jeff Yufeng Yang
- Center for Pharmacoepidemiology, Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Colleen Brensinger
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Qufei Wu
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Virginia Pate
- Center for Pharmacoepidemiology, Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michele Jonsson Funk
- Center for Pharmacoepidemiology, Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Douglas E Schaubel
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Michael David Kappelman
- Department of Pediatrics, Division of Pediatric Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James D Lewis
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Lewis JD, Parlett LE, Jonsson Funk ML, Brensinger C, Pate V, Wu Q, Dawwas GK, Weiss A, Constant BD, McCauley M, Haynes K, Yang JY, Schaubel DE, Hurtado-Lorenzo A, Kappelman MD. Incidence, Prevalence, and Racial and Ethnic Distribution of Inflammatory Bowel Disease in the United States. Gastroenterology 2023; 165:1197-1205.e2. [PMID: 37481117 PMCID: PMC10592313 DOI: 10.1053/j.gastro.2023.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/30/2023] [Accepted: 07/07/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND & AIMS We sought to estimate the incidence, prevalence, and racial-ethnic distribution of physician-diagnosed inflammatory bowel disease (IBD) in the United States. METHODS The study used 4 administrative claims data sets: a 20% random sample of national fee-for-service Medicare data (2007 to 2017); Medicaid data from Florida, New York, Pennsylvania, Ohio, and California (1999 to 2012); and commercial health insurance data from Anthem beneficiaries (2006 to 2018) and Optum's deidentified Clinformatics Data Mart (2000 to 2017). We used validated combinations of medical diagnoses, diagnostic procedures, and prescription medications to identify incident and prevalent diagnoses. We computed pooled age-, sex-, and race/ethnicity-specific insurance-weighted estimates and pooled estimates standardized to 2018 United States Census estimates with 95% confidence intervals (CIs). RESULTS The age- and sex-standardized incidence of IBD per 100,000 person-years was 10.9 (95% CI, 10.6-11.2). The incidence of IBD peaked in the third decade of life, decreased to a relatively stable level across the fourth to eighth decades, and declined further. The age-, sex- and insurance-standardized prevalence of IBD was 721 per 100,000 population (95% CI, 717-726). Extrapolated to the 2020 United States Census, an estimated 2.39 million Americans are diagnosed with IBD. The prevalence of IBD per 100,000 population was 812 (95% CI, 802-823) in White, 504 (95% CI, 482-526) in Black, 403 (95% CI, 373-433) in Asian, and 458 (95% CI, 440-476) in Hispanic Americans. CONCLUSIONS IBD is diagnosed in >0.7% of Americans. The incidence peaks in early adulthood and then plateaus at a lower rate. The disease is less commonly diagnosed in Black, Asian, and Hispanic Americans.
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Affiliation(s)
- James D Lewis
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | | | - Michele L Jonsson Funk
- Center for Pharmacoepidemiology, Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Colleen Brensinger
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Virginia Pate
- Center for Pharmacoepidemiology, Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Qufei Wu
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ghadeer K Dawwas
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexandra Weiss
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brad D Constant
- Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Maureen McCauley
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kevin Haynes
- Janssen Research and Development, LLC, Titusville, New Jersey
| | - Jeff Yufeng Yang
- Center for Pharmacoepidemiology, Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Douglas E Schaubel
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Michael David Kappelman
- Department of Pediatrics, Division of Pediatric Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Kappelman MD, Long MD, Zhang X, Lin FC, Weisbein L, Chen W, Burris J, Dorand JE, Parlett LE, Fehlmann T, Brensinger CM, Haynes K, Nair V, Kaul AF, Dobes A, Lewis JD. Comparing Patient-Reported Outcomes Among Anti-TNF Experienced Patients With Ulcerative Colitis Initiating Vedolizumab Versus Tofacitinib. Crohns Colitis 360 2023; 5:otad031. [PMID: 37350775 PMCID: PMC10284045 DOI: 10.1093/crocol/otad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Indexed: 06/24/2023] Open
Abstract
Background Primary and secondary nonresponse to anti-tumor necrosis factor (TNF) therapy is common in patients with ulcerative colitis (UC), yet limited research has compared the effectiveness of subsequent biological therapy. Objective We sought to compare the effectiveness of vedolizumab and tofacitinib in anti-TNF experienced patients with UC, focusing on patient-prioritized patient-reported outcomes (PROs). Methods We conducted a prospective cohort study nested within the Crohn's & Colitis Foundation's IBD Partners and SPARC IBD initiatives. We identified anti-TNF experienced patients with UC initiating vedolizumab or tofacitinib and analyzed PROs reported approximately 6 months later (minimum 4 months, maximum 10 months). Co-primary outcomes were Patient Reported Outcome Measurement Information System (PROMIS) domains of Fatigue and Pain Interference. Secondary outcomes included PRO2, treatment persistence, and need for colectomy. Results We compared 72 vedolizumab initiators and 33 tofacitinib initiators. At follow-up, Pain Interference (P = .04), but not Fatigue (P = .53) was lower among tofacitinib initiators. A trend toward higher Social Role Satisfaction was not significant. The remainder of secondary outcomes (PRO2, treatment persistence, colectomy) did not differ between treatment groups. Conclusions Among anti-TNF experienced patients with UC, Pain Interference 4-10 months after treatment initiation was lower among tofacitinib users as compared with vedolizumab users. Many, but not all, secondary endpoints and subanalyses also favored tofacitinib. Future studies with larger sample sizes are needed to further evaluate these findings.
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Affiliation(s)
- Michael D Kappelman
- Address correspondence to: Michael D. Kappelman, MD, MPH, University of North Carolina at Chapel Hill, Campus Box 7229, Bioinformatics Building, 130 Mason Farm Rd., Chapel Hill, NC 27599-7555, USA ()
| | - Millie D Long
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Xian Zhang
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Feng-Chang Lin
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Laura Weisbein
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Wenli Chen
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | | | - Tara Fehlmann
- Crohn’s & Colitis Foundation, New York, New York, USA
| | - Colleen M Brensinger
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kevin Haynes
- Janssen Research & Development, Titusville, New Jersey, USA
| | | | - Alan F Kaul
- Medical Outcomes Management and the Practice Research Network (PRACnet), Sharon, Massachusetts, USA
| | - Angela Dobes
- Crohn’s & Colitis Foundation, New York, New York, USA
| | - James D Lewis
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Kappelman MD, Lewis JD, Zhang X, Lin FC, Weisbein L, Chen W, Burris J, Dorand JE, Parlett LE, Haynes K, Nair V, Kaul AF, Dobes A, Long MD. Comparing Patient-Reported Outcomes Among Anti-TNF-Experienced Patients with Crohn's Disease Initiating Vedolizumab Versus Ustekinumab. Dig Dis Sci 2023:10.1007/s10620-023-07942-0. [PMID: 37115362 DOI: 10.1007/s10620-023-07942-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/30/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Primary and secondary non-response to anti-tumor necrosis factor (TNF) therapy is common in patients with Crohn's disease (CD), yet limited research has compared the effectiveness of subsequent biological therapy. OBJECTIVE We sought to compare the effectiveness of vedolizumab and ustekinumab in anti-TNF-experienced patients with CD, focusing on patient-prioritized patient-reported outcomes (PROs). METHODS We conducted a prospective, internet-based cohort study nested within IBD Partners. We identified anti-TNF-experienced patients initiating with CD vedolizumab or ustekinumab and analyzed PROs reported approximately 6 months later (minimum 4 months, maximum 10 months). Co-primary outcomes were Patient-Reported Outcome Measurement Information System (PROMIS) domains of Fatigue and Pain Interference. Secondary outcomes included patient-reported short Crohn's disease activity index (sCDAI), treatment persistence, and corticosteroid use. Inverse probability of treatment weighting (IPTW) was used to control for a number of potential confounders and incorporated into linear and logistic regression models for continuous and categorical outcomes, respectively. RESULTS Overall, 141 vedolizumab and 219 ustekinumab initiators were included in our analysis. After adjustment, we found no differences between treatment groups in our primary outcomes of Pain Interference or Fatigue or the secondary outcome of sCDAI. However, vedolizumab was associated with lower treatment persistence (OR 0.4, 95% CI 0.2-0.6) and higher corticosteroid use at follow-up assessment (OR 1.7, 95% CI 1.1-2.6). DISCUSSION Among anti-TNF experienced patients with CD, Pain Interference or Fatigue was not significantly different 4-10 months after starting ustekinumab or vedolizumab. However, reduced steroid use and increased persistence suggest superiority of ustekinumab for non-PRO outcomes.
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Affiliation(s)
- Michael D Kappelman
- University of North Carolina at Chapel Hill, Bioinformatics Building, 130 Mason Farm Rd., Campus Box 7229, Chapel Hill, NC, 27599-7555, USA.
| | - J D Lewis
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - X Zhang
- University of North Carolina at Chapel Hill, Bioinformatics Building, 130 Mason Farm Rd., Campus Box 7229, Chapel Hill, NC, 27599-7555, USA
| | - F C Lin
- University of North Carolina at Chapel Hill, Bioinformatics Building, 130 Mason Farm Rd., Campus Box 7229, Chapel Hill, NC, 27599-7555, USA
| | - L Weisbein
- University of North Carolina at Chapel Hill, Bioinformatics Building, 130 Mason Farm Rd., Campus Box 7229, Chapel Hill, NC, 27599-7555, USA
| | - W Chen
- University of North Carolina at Chapel Hill, Bioinformatics Building, 130 Mason Farm Rd., Campus Box 7229, Chapel Hill, NC, 27599-7555, USA
| | - J Burris
- Yale School of Medicine, New Haven, CT, USA
| | - J E Dorand
- Crohn's & Colitis Foundation, New York, NY, USA
| | | | | | - V Nair
- Medical Outcomes Management and the Practice Research Network (PRACNET), Sharon, MA, USA
| | - A F Kaul
- Medical Outcomes Management and the Practice Research Network (PRACNET), Sharon, MA, USA
| | - A Dobes
- Crohn's & Colitis Foundation, New York, NY, USA
| | - M D Long
- University of North Carolina at Chapel Hill, Bioinformatics Building, 130 Mason Farm Rd., Campus Box 7229, Chapel Hill, NC, 27599-7555, USA
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Horton DB, Neikirk AL, Yang Y, Huang C, Panettieri RA, Crystal S, Strom BL, Parlett LE. Childhood asthma diagnoses declined during the COVID-19 pandemic in the United States. Respir Res 2023; 24:72. [PMID: 36899362 PMCID: PMC9999066 DOI: 10.1186/s12931-023-02377-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/28/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Prior studies have documented declines in pediatric asthma exacerbations and asthma-related health care utilization during the COVID-19 pandemic, but less is known about the incidence of asthma during the pandemic. METHODS We conducted a retrospective cohort study of children under age 18 without a prior diagnosis of asthma within a large US commercial claims database. Incident asthma was defined using a combination of diagnosis codes, location of services, and medication dispensing. Crude quarterly rates of asthma diagnosis per 1000 children were calculated, and the incidence rate ratio and 95% confidence interval were estimated for newly diagnosed asthma during versus before the pandemic using negative binomial regression, adjusted for age, sex, region, and season. RESULTS Compared with 3 years prior to the pandemic, crude incident diagnosis rates of asthma decreased by 52% across the first four quarters of the US pandemic. The covariate-adjusted pandemic-associated incidence rate ratio was 0.47 (95% confidence interval 0.43, 0.51). CONCLUSIONS New diagnoses of childhood asthma in the US declined by half during the first year of the pandemic. These findings raise important questions whether pandemic-related changes in infectious or other triggers truly altered the incidence of childhood asthma beyond the well-described disruptions in healthcare access.
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Affiliation(s)
- Daniel B Horton
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA. .,Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers University, Piscataway, NJ, USA. .,Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, 112 Paterson Street, New Brunswick, NJ, 08901, USA.
| | | | | | - Cecilia Huang
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, 112 Paterson Street, New Brunswick, NJ, 08901, USA
| | - Reynold A Panettieri
- Rutgers Institute for Translational Medicine and Science, New Brunswick, NJ, USA.,Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Stephen Crystal
- Rutgers Center for Health Services Research, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, USA.,School of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - Brian L Strom
- Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers University, 112 Paterson Street, New Brunswick, NJ, 08901, USA.,Rutgers Biomedical and Health Sciences, Newark, NJ, USA
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Lo Re V, Carbonari DM, Jacob J, Short WR, Leonard CE, Lyons JG, Kennedy A, Damon J, Haug N, Zhou EH, Graham DJ, McMahill-Walraven CN, Parlett LE, Nair V, Selvan M, Zhou Y, Pocobelli G, Maro JC, Nguyen MD. Validity of ICD-10-CM diagnoses to identify hospitalizations for serious infections among patients treated with biologic therapies. Pharmacoepidemiol Drug Saf 2021; 30:899-909. [PMID: 33885214 DOI: 10.1002/pds.5253] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/11/2021] [Indexed: 11/10/2022]
Abstract
PURPOSE Identifying hospitalizations for serious infections among patients dispensed biologic therapies within healthcare databases is important for post-marketing surveillance of these drugs. We determined the positive predictive value (PPV) of an ICD-10-CM-based diagnostic coding algorithm to identify hospitalization for serious infection among patients dispensed biologic therapy within the FDA's Sentinel Distributed Database. METHODS We identified health plan members who met the following algorithm criteria: (1) hospital ICD-10-CM discharge diagnosis of serious infection between July 1, 2016 and August 31, 2018; (2) either outpatient/emergency department infection diagnosis or outpatient antimicrobial treatment within 7 days prior to hospitalization; (3) inflammatory bowel disease, psoriasis, or rheumatological diagnosis within 1 year prior to hospitalization, and (4) were dispensed outpatient biologic therapy within 90 days prior to admission. Medical records were reviewed by infectious disease clinicians to adjudicate hospitalizations for serious infection. The PPV (95% confidence interval [CI]) for confirmed events was determined after further weighting by the prevalence of the type of serious infection in the database. RESULTS Among 223 selected health plan members who met the algorithm, 209 (93.7% [95% CI, 90.1%-96.9%]) were confirmed to have a hospitalization for serious infection. After weighting by the prevalence of the type of serious infection, the PPV of the ICD-10-CM algorithm identifying a hospitalization for serious infection was 80.2% (95% CI, 75.3%-84.7%). CONCLUSIONS The ICD-10-CM-based algorithm for hospitalization for serious infection among patients dispensed biologic therapies within the Sentinel Distributed Database had 80% PPV for confirmed events and could be considered for use within pharmacoepidemiologic studies.
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Affiliation(s)
- Vincent Lo Re
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Dena M Carbonari
- Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jerry Jacob
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - William R Short
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Charles E Leonard
- Center for Clinical Epidemiology and Biostatistics, Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer G Lyons
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
| | - Adee Kennedy
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
| | - Jolene Damon
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
| | - Nicole Haug
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
| | - Esther H Zhou
- United States Food and Drug Administration, Silver Spring, Maryland, USA
| | - David J Graham
- United States Food and Drug Administration, Silver Spring, Maryland, USA
| | | | | | - Vinit Nair
- Competitive Health Analytics, Humana Healthcare Research, Inc., Louisville, Kentucky, USA
| | - Mano Selvan
- Competitive Health Analytics, Humana Healthcare Research, Inc., Louisville, Kentucky, USA
| | - Yunping Zhou
- Competitive Health Analytics, Humana Healthcare Research, Inc., Louisville, Kentucky, USA
| | - Gaia Pocobelli
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Judith C Maro
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
| | - Michael D Nguyen
- United States Food and Drug Administration, Silver Spring, Maryland, USA
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Cook MB, Beachler DC, Parlett LE, Cochetti PT, Finkle WD, Lanes S, Hoover RN. Testosterone Therapy in Relation to Prostate Cancer in a U.S. Commercial Insurance Claims Database. Cancer Epidemiol Biomarkers Prev 2019; 29:236-245. [PMID: 31641011 DOI: 10.1158/1055-9965.epi-19-0619] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/26/2019] [Accepted: 10/07/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We conducted a study to assess whether testosterone therapy (TT) alters prostate cancer risk using a large U.S. commercial insurance research database. METHODS From the HealthCore Integrated Research Database (HIRD), we selected men ages 30 years or greater who were new users of TT during 2007 to 2015. We selected two comparison groups: (i) unexposed (matched 10:1) and (ii) new users of phosphodiesterase type 5 inhibitor (PDE5i). Incident prostate cancer was defined as diagnosis of prostate cancer within 4 weeks following prostate biopsy. Propensity scores and inverse probability of treatment weights were used in Poisson regression models to estimate adjusted incidence rates, incidence rate ratios (IRR), and 95% confidence intervals (CI). Subgroup analyses included stratification by prostate cancer screening, hypogonadism, and follow-up time. RESULTS The adjusted prostate cancer IRR was 0.77 (95% CI, 0.68-0.86) when comparing TT with the unexposed group and 0.85 (95% CI, 0.79-0.91) in comparison with the PDE5i group. Inverse associations between TT and prostate cancer were observed in a majority of subgroup analyses, although in both comparisons estimates generally attenuated with increasing time following initial exposure. Among TT users, duration of exposure was not associated with prostate cancer. CONCLUSIONS Men who received TT did not have a higher rate of prostate cancer compared with the unexposed or PDE5i comparison groups. The inverse association between TT and prostate cancer could be the result of residual confounding, contraindication bias, or undefined biological effect. IMPACT This study suggests that limited TT exposure does not increase risk of prostate cancer in the short term.
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Affiliation(s)
- Michael B Cook
- Division of Cancer Epidemiology and Genetics, NCI, NIH, Department of Health and Human Services, Bethesda, Maryland.
| | | | - Lauren E Parlett
- Translational Research and Quality, HealthCore Inc., Alexandria, Virginia
| | - Philip T Cochetti
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | | | - Stephan Lanes
- Safety and Epidemiology, HealthCore Inc., Wilmington, Delaware
| | - Robert N Hoover
- Division of Cancer Epidemiology and Genetics, NCI, NIH, Department of Health and Human Services, Bethesda, Maryland
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Barrett ES, Parlett LE, Sathyanarayana S, Redmon JB, Nguyen RHN, Swan SH. Prenatal Stress as a Modifier of Associations between Phthalate Exposure and Reproductive Development: results from a Multicentre Pregnancy Cohort Study. Paediatr Perinat Epidemiol 2016; 30:105-14. [PMID: 26576028 PMCID: PMC4749428 DOI: 10.1111/ppe.12264] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prenatal phthalate exposure is associated with altered male reproductive tract development, and in particular, shorter anogenital distance (AGD). AGD, a sexually dimorphic index of prenatal androgen exposure, may also be altered by prenatal stress. How these exposures interact to impact AGD is unknown. Here, we examine the extent to which associations between prenatal phthalate exposure and infant AGD are modified by prenatal exposure to stressful life events (SLEs). METHODS Phthalate metabolites [including those of diethylhexyl phthalate (DEHP) and their molar sum (ΣDEHP)] were measured in first trimester urine from 738 pregnant women participating in The Infant Development and the Environment Study (TIDES). Women completed questionnaires on SLEs, and permitted infant AGD measurements at birth. Subjects were classified as 'lower' and 'higher' stress (0 first trimester SLEs vs. 1+).We estimated relationships between phthalate concentrations and AGD (by infant sex and stress group) using adjusted multiple regression interaction models. RESULTS In the lower stress group, first trimester ΣDEHP was inversely associated with two measures of male AGD: anoscrotal distance (AGD-AS; β = -1.78; 95% CI -2.97, -0.59) and anopenile distance (AGD-AP; β = -1.61; 95% CI -3.01, -0.22). By contrast, associations in the higher stress group were mostly positive and non-significant in male infants. No associations were observed in girls. CONCLUSIONS Associations between prenatal phthalate exposure and altered genital development were only apparent in sons of mothers who reported no SLEs during pregnancy. Prenatal stress and phthalates may interact to shape fetal development in ways that have not been previously explored.
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Affiliation(s)
- Emily S. Barrett
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Lauren E. Parlett
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21215, USA
| | - Sheela Sathyanarayana
- Departments of Pediatrics and Environmental and Occupational Health Sciences, University of Washington, Seattle, WA; Seattle Children’s Research Institute, Seattle, WA
| | - J. Bruce Redmon
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Ruby H. N. Nguyen
- Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Shanna H. Swan
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Barrett ES, Parlett LE, Wang C, Drobnis EZ, Redmon JB, Swan SH. Environmental exposure to di-2-ethylhexyl phthalate is associated with low interest in sexual activity in premenopausal women. Horm Behav 2014; 66:787-92. [PMID: 25448532 PMCID: PMC5035677 DOI: 10.1016/j.yhbeh.2014.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 09/09/2014] [Accepted: 10/31/2014] [Indexed: 02/05/2023]
Abstract
Phthalates, a ubiquitous class of environmental chemicals, may interfere with typical reproductive hormone production both in utero and in adulthood. Although they are best known as anti-androgens, increasingly, evidence suggests that phthalates, particularly di-2-ethylhexyl phthalate (DEHP), may also suppress estrogen production. Given that both androgens and estrogens are essential for sexual function, particularly sexual interest, it is plausible that adult exposure to phthalates alters sexual function. To this end, we used data from 360 women participating in a pregnancy cohort study (the Study for Future Families) to examine whether urinary phthalate metabolite concentrations were associated with two dimensions of self-reported sexual dysfunction in the months prior to conception: lack of sexual interest and vaginal dryness. Women in the highest quartile of urinary concentrations of mono-2-ethyl-5-hydroxyhexyl phthalate, a DEHP metabolite, had 2.58 (95% CI 1.33, 5.00) times the adjusted odds of reporting that they almost always or often lacked interest in sexual activity, and results were similar for mono-2-ethyl-5-oxohexyl phthalate (aOR: 2.56, 95% CI 1.32, 4.95), another DEHP metabolite. Self-reported vaginal dryness was not associated with any phthalate metabolite concentration. This study is novel in its focus on sexual function in relation to environmentally relevant (rather than occupational) exposure to phthalates in adult women and these preliminary findings merit replication in a large, prospective study. Better understanding how adult exposure to phthalates may affect reproductive health, including sexual function, is of public health interest given that virtually all Westerners are exposed to phthalates.
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Affiliation(s)
- Emily S Barrett
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
| | - Lauren E Parlett
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21215, USA.
| | - Christina Wang
- UCLA Clinical and Translational Science Institute Los Angeles Biomedical Research Institute and Harbor-UCLA Medical Center; Professor of Medicine, David Geffen School of Medicine at UCLA Division of Endocrinology, Department of Medicine Harbor-UCLA Medical Center.
| | - Erma Z Drobnis
- Department of Obstetrics, Gynecology and Women's Health, University of Missouri, Columbia, MO, USA.
| | - J Bruce Redmon
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Department of Urologic Surgery, University of Minnesota, Minneapolis, MN, USA.
| | - Shanna H Swan
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
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Barrett ES, Parlett LE, Windham GC, Swan SH. Differences in ovarian hormones in relation to parity and time since last birth. Fertil Steril 2014; 101:1773-80.e1. [PMID: 24684956 DOI: 10.1016/j.fertnstert.2014.02.047] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 02/25/2014] [Accepted: 02/25/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To examine ovarian function in relation to parity and time since last birth. DESIGN Cross-sectional study. SETTING Health-care program in California. PATIENT(S) 346 naturally cycling women, aged 18 to 39 years. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Mean follicular urinary estradiol metabolite concentration (E1C) (cycle days -8 to -1), mean luteal progesterone metabolite concentration (PdG) (days 0 to +10), and cycle phase lengths in ovulatory cycles. RESULT(S) After the women had collected daily urine samples for up to eight menstrual cycles, we measured the E1C and PdG using enzyme-linked immunoassay. The cycle phase lengths were calculated from the hormone profiles and daily diaries. Women who had given birth within the previous 3 years had lower E1C than the nulliparous women and women who last given birth >3 years earlier. Among the parous women, E1C was positively associated with the time since last birth. Women who last gave birth >3 years earlier had longer follicular phases than the nulliparous women. There were no associations between parity and PdG or luteal phase length. CONCLUSION(S) Our cross-sectional data suggest that ovarian function differs in nulliparous and parous women and is positively associated with the time since last birth. Longitudinal research is needed to explore within-woman changes in ovarian function prepartum and postpartum.
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Affiliation(s)
- Emily S Barrett
- Department of Obstetrics and Gynecology, School of Medicine and Dentistry, University of Rochester, Rochester, New York.
| | - Lauren E Parlett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Gayle C Windham
- Division of Environmental and Occupational Disease Control, California Department of Public Health, Richmond, California
| | - Shanna H Swan
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Barrett ES, Parlett LE, Redmon JB, Swan SH. Evidence for sexually dimorphic associations between maternal characteristics and anogenital distance, a marker of reproductive development. Am J Epidemiol 2014; 179:57-66. [PMID: 24124194 DOI: 10.1093/aje/kwt220] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Data from animal models, historical cohorts, and modern epidemiologic studies have suggested that maternal characteristics can affect reproductive health of offspring; however, distinguishing between prenatal and postnatal contributions is difficult. Anogenital distance (AGD), the distance from the anus to the genitals, is believed to be a biomarker of prenatal androgen exposure in many species, and in humans it has been associated with several adult reproductive health outcomes. We used data from a pregnancy cohort study conducted in 4 US cities from 1999-2005 to examine whether AGD measurements in infants were associated with maternal self-reported age at conception, age at menarche, age at first birth, parity, and gravidity. AGD was measured in 289 infants (140 male, 149 female) born to study participants. After adjustment for relevant covariates, in linear regression models stratified by infant sex, maternal age was positively associated with AGD in male infants (AGD, anus to penis: β = 0.50, P = 0.002; AGD, anus to scrotum: β = 0.29, P = 0.02) but not female infants. Parity was inversely associated with AGD (anus to scrotum; β = -1.68, P = 0.03) in male infants. No other maternal characteristic predicted AGD in either sex. The mechanism underlying the unexpected relationship between maternal characteristics and AGD is unknown; however, we suggest several possibilities for future study.
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Barrett ES, Parlett LE, Sathyanarayana S, Liu F, Redmon JB, Wang C, Swan SH. Prenatal exposure to stressful life events is associated with masculinized anogenital distance (AGD) in female infants. Physiol Behav 2013; 114-115:14-20. [PMID: 23499769 DOI: 10.1016/j.physbeh.2013.03.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 03/01/2013] [Accepted: 03/04/2013] [Indexed: 12/11/2022]
Abstract
In animal models, prenatal stress programs reproductive development in the resulting offspring, however little is known about effects in humans. Anogenital distance (AGD) is a commonly used, sexually dimorphic biomarker of prenatal androgen exposure in many species. In rodents, prenatally stressed males have shorter AGD than controls (suggesting lower prenatal androgen exposure), whereas prenatally stressed females have longer AGD than controls (suggesting greater prenatal androgen exposure). Our objective was to investigate the relationship between stressful life events in pregnancy and infant AGD. In a prospective cohort study, pregnant women and their partners reported exposure to stressful life events during pregnancy. Pregnancies in which the couple reported 4+ life events were considered highly stressed. After birth (average 16.5 months), trained examiners measured AGD in the infants (137 males, 136 females). After adjusting for age, body size and other covariates, females born to couples reporting high stress had significantly longer (i.e. more masculine) AGD than females born to couples reporting low stress (p=0.015). Among males, high stress was weakly, but not significantly, associated with shorter AGD. Our results suggest prenatal stress may masculinize some aspects of female reproductive development in humans. More sensitive measures of prenatal stress and additional measures of reproductive development are needed to better understand these relationships and clarify mechanisms.
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Affiliation(s)
- Emily S Barrett
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
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Parlett LE, Calafat AM, Swan SH. Women's exposure to phthalates in relation to use of personal care products. J Expo Sci Environ Epidemiol 2013; 23:197-206. [PMID: 23168567 PMCID: PMC4097177 DOI: 10.1038/jes.2012.105] [Citation(s) in RCA: 150] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 06/15/2012] [Accepted: 10/01/2012] [Indexed: 05/18/2023]
Abstract
Several phthalates, particularly diethyl phthalate (DEP) and di-n-butyl phthalate, can be used in personal care products (PCPs) to fix fragrance and hold color. We investigated associations between women's reported use of PCPs within the 24 h before urine collection and concentrations of several urinary phthalate metabolites. Between 2002 and 2005, 337 women provided spot urine samples and answered questions regarding their use of 13 PCPs at a follow-up visit 3-36 months after pregnancy. We examined associations between urinary concentrations of several phthalate metabolites and use of PCPs using linear regression. Use of individual PCPs ranged from 7% (nail polish) to 91% (deodorant). After adjusting for age, education, and urinary creatinine, women reporting use of perfume had 2.92 times higher (95% CI: 2.20-3.89) concentration of monoethyl phthalate (MEP; the primary metabolite of DEP) than other women. Other PCPs that were significantly associated with MEP concentrations included: hair spray, nail polish, and deodorant. MEP concentrations increased with the number of PCPs used. PCP use was widespread in this group of recently pregnant women. Women's use of PCPs, particularly of perfumes and fragranced products, was positively associated with urinary concentration of multiple phthalate metabolites.
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Affiliation(s)
- Lauren E Parlett
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
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Kobrosly RW, Parlett LE, Stahlhut RW, Barrett ES, Swan SH. Socioeconomic factors and phthalate metabolite concentrations among United States women of reproductive age. Environ Res 2012; 115:11-7. [PMID: 22472009 DOI: 10.1016/j.envres.2012.03.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 03/12/2012] [Accepted: 03/14/2012] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Relatively little is known about the socioeconomic correlates of phthalate metabolite urine concentrations among the general population, exposures of increasing public health concern, particularly for women of reproductive age. METHODS We pooled data from the 2001-2008 cycles of the National Health and Nutrition Examination Survey to examine the associations between phthalate metabolite concentrations (including the molar sum of four di-2-ethylhexyl phthalate (DEHP) metabolites, the molar sum of two dibutyl phthalate (DBP) metabolites, and metabolites of benzylbutyl phthalate (BzBP) and diethyl phthalate (DEP)) with socioeconomic indicators (including ethnicity, education, income, and food security status) among women 20 to 39 years age. We also derived a socioeconomic status summary measure using factor analysis and investigated its associations with metabolite concentrations. RESULTS In fully adjusted models, the lowest quartile of overall socioeconomic status was associated with 1.83 (95% CI=1.54-2.17) times the concentrations of mono-benzyl phthalate (MBzP), and 0.72 (95% CI=0.54-0.98) times the concentrations of (molar sum) DEHP metabolites compared with the highest quartile of overall socioeconomic status. This latter association was driven primarily by educational attainment. All Non-White ethnicities combined had 1.24 (95% CI=1.09-1.40) times the concentrations of (molar sum) DBP metabolites, 1.32 (95% CI=1.12-1.56) times the mono-ethyl phthalate (MEP) concentrations, and 0.82 (95% CI=0.71-0.96) the concentrations of MBzP of Non-Hispanic Whites. CONCLUSIONS Biomarkers of phthalate exposure vary with socioeconomic factors in women of reproductive age in the United States. Given the public health concern surrounding phthalate exposure, more research is needed to elucidate the reasons for these differences.
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Affiliation(s)
- Roni W Kobrosly
- Center for Reproductive Epidemiology, University of Rochester Medical Center, Rochester, NY 14642, USA.
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