Faculty Bibliography

PURPOSE/OBJECTIVE:A critical function of public health is to monitor diseases that impede quality of life and burden affected communities. The Diabetes in Children, Adolescents and Young Adults (DiCAYA) Network aims to advance disease monitoring for diabetes using multi-site electronic health record (EHR) data. METHODS:This work involved validating and refining case definitions for accurate identification of type 1 and type 2 diabetes cases to estimate incidence and prevalence of diabetes in children, adolescents, and young adults through age 44 years. RESULTS:In this essay, we describe the challenges experienced by the Network and lessons learned. Challenges included accessing EHR data, harmonizing EHR data from heterogeneous health systems to a common data model, and developing methods to account for bias introduced by the non-representativeness of health care utilization data. Lessons learned included approaches for data quality assessment, bias correction, and scalability. CONCLUSIONS:As the US continues to evolve its public health data systems and its approach to chronic disease monitoring, the DiCAYA Network offers guidance on factors for success as well as pitfalls to avoid.

IMPORTANCE/UNASSIGNED:Emergency departments (EDs) serve patients at high risk for overdose. There is increasing interest in peer-delivered ED interventions for substance use but little rigorous research on their effectiveness. OBJECTIVE/UNASSIGNED:To examine the effectiveness of an initiative (Relay) operated by the New York City Health Department that dispatches trained peer wellness advocates (WAs) to support ED patients after a nonfatal opioid overdose. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This randomized clinical trial compared Relay and site-directed care (SDC) at 4 EDs in New York, New York. Adult patients presenting after opioid-involved overdose were enrolled from October 6, 2020, to June 30, 2022, with 12 months of outcome follow-up. Statistical analysis was performed from November 4, 2024, to May 6, 2025. INTERVENTION/UNASSIGNED:ED workers (generally physicians) called the Relay hotline for patients presenting after a suspected opioid-involved overdose. WAs met patients in the ED to provide peer support and brief overdose risk reduction education. WAs attempted to contact patients for 90 days to provide ongoing support, education, and referrals using a harm reduction framework. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Opioid-related adverse events (any opioid-involved overdose [fatal or nonfatal] or any other substance use-related ED visit) in the 12 months after enrollment were identified using health care administrative data plus self-report. RESULTS/UNASSIGNED:Among a total of 253 participants randomized, 127 were randomized to the Relay arm and 126 to the SDC arm. A total of 247 participants, 125 in the Relay arm and 122 in the SDC arm (190 [76.9%] men; 80 [32.4%] Black, 126 [51.0%] Hispanic or Latinx, 76 [30.8%] White, and 91 other race [36.8%]), were included in the intention-to-treat analyses. No statistically significant differences between arms were observed for the primary outcome (mean [SD] opioid-related adverse events, 3.29 [4.52] in the Relay arm and 4.10 [9.36] in the SDC arm; rate ratio, 1.02; 95% CI, 0.72-1.45; P = .90). By 12 months after enrollment, 24 participants (9.7%) had died (17 [70.8%] due to overdose). Relay participants reported high satisfaction with the ED intervention. CONCLUSIONS AND RELEVANCE/UNASSIGNED:This randomized clinical trial examining the impact of an ED peer navigator intervention on subsequent opioid-related adverse events did not find significant outcome differences for Relay vs SDC participants. These findings highlight the importance of intervening to save lives in this high-risk population and suggest potential refinements to future ED peer intervention research. TRIAL REGISTRATION/UNASSIGNED:ClinicalTrials.gov Identifier: NCT04317053.

INTRODUCTION/BACKGROUND:To help address the continuing epidemic of firearm-related trauma in the United States (US), we conducted a detailed analysis of recent trauma center discharge data and compared firearm-related injuries to mechanisms such as falls, pedestrian injuries, and motor vehicle crashes. METHODS:We combined Trauma Quality Improvement Program (TQIP) data for 2011 to 2022 and analyzed variables for patient demographics, injury mechanisms, disposition, and hospital characteristics over time. Analyses consisted of descriptive statistics, bar plots, time series plots, and comparative tables. RESULTS:There were 3,597,688 US trauma hospital discharges in the TQIP data set for 2011 to 2022 of which 307,062 (8.4%) involved firearms-a higher proportion than those involving pedestrian injuries (3.8%), pedal cycles (2.0%), or motorcycles (6.2%). The case-fatality rate of inpatient hospital deaths for firearm injuries was 8.8%, surpassed only by that of pedestrian injuries (9.9%). Firearms accounted for the youngest patient population over the 12-year study period for the six injury mechanisms analyzed. Over time, firearm-related assaults increased from 75.7% of all firearm injuries in 2011 to 88.6% in 2020. Most, if not all, of this increase appeared to occur in the post-2014 time period. CONCLUSIONS:Better defining national injury trends allows for targeted injury prevention efforts, prioritized research endeavors, and optimized resource allocation.

An important goal of environmental health research is to assess risks posed by mixtures of environmental exposures. Studies in different fields often group exposures based on their shared biological features. However, such grouping information has not been widely utilized in population-based environmental mixtures analyses due to the lack of appropriate statistical tools. Inspired by data from the National Health and Nutrition Examination Survey (NHANES), we propose a semiparametric multiple-index interaction model (MIIM) to explore the impact of three groups of persistent organic pollutants (POPs) on leukocyte telomere length (LTL). MIIM effectively addresses the challenge of high dimensionality by summarizing exposures into group-level indices, while allowing for nonlinear effects and interactions among exposures through these group indices. This formulation provides interpretable insights into both overall group effects and between-group interactions on the outcome, and allows for identification of key contributors within each group. MIIM can be applied to different types of health outcomes, including continuous, binary, and survival outcomes. We conducted Monte Carlo simulation studies to evaluate the performance of MIIM under various scenarios with high-dimensional and correlated exposure mixtures and illustrated its application to the NHANES data. By bridging biological insights with population-based epidemiological data, MIIM serves as a translational tool to explore the effects of environmental mixtures on health outcomes.

OBJECTIVE:Health systems have finite capacity. During crises, policymakers may explicitly reallocate health system resources, or capacity limitations may necessitate implicit resource reallocation. This study modelled timing and intensity of pre-vaccination health system resource reallocation policies to predict excess mortality during the COVID-19 pandemic. METHODS:This longitudinal panel analysis included 85 countries (752 country-months, January 2020-January 2021). The predictor was resource reallocation scope, scale (summarized as intensity, 0-100), and timing. The outcome was all-cause excess mortality (percentage deaths greater than historical average/month). Covariates included COVID-19 incidence and health system parameters. RESULTS:= -0.58, 95%CI -0.93-0.23: e.g., 42,010 fewer deaths per unit increased resource reallocation, March 2020, all study countries). Effects were magnified in older populations. Health system capacity and preparedness were associated with lower mortality. CONCLUSIONS:In the pre-vaccination COVID-19 pandemic, preemptive health system resource reallocation was associated with lower mortality, whereas simultaneous resource reallocation was associated with greater mortality. This longitudinal multinational study indicates that readiness, capacity building, and proactive resource reallocation improve crisis response.

BACKGROUND:Chinese immigrants face numerous social determinants of health (SDOH) challenges that limit access to evidence-based diabetes self-management education and support programs (DSMES). To address these challenges, our team developed the LINK-IT intervention. This manuscript presents the study protocol for the LINK-IT trial. METHODS:The LINK-IT trial is a 12-month, 3-arm randomized controlled trial aiming to enroll 405 Chinese immigrants with T2D (HbA1c≥7%) from multiple community and clinical settings in New York City. A total of 405 participants will be randomly allocated to one of three groups (n = 135 per group): (1) video-based DSMES plus community health worker (CHW) support (VIDEO+CHW), (2) video-based DSMES only (VIDEO), or (3) wait-list control (CONTROL). The VIDEO+CHW group will receive 24 culturally and linguistically tailored DSMES videos (one per week for 24 weeks) delivered via text message links, along with biweekly (every other week) phone calls from trained CHWs to review video content, support goal setting, and address SDOH barriers. The VIDEO group will receive the same video intervention without CHW support. The CONTROL group will receive usual care and will be offered access to the videos upon study completion. The primary outcome is the change in HbA1c at 6 months. Secondary outcomes include changes in HbA1c at 12 months, self-efficacy for diabetes, dietary intake, physical activity, medication adherence and emotional support at 6 and 12 months. Data will be analyzed using an intention-to-treat approach with linear mixed-effects models. ETHICS AND DISSEMINATION/BACKGROUND:This study protocol has been approved by the Institutional Review Board of the NYU Grossman School of Medicine (S23-01274). All study procedures will adhere to the ethical principles outlined in the Declaration of Helsinki. Written or verbal informed consent will be obtained from all participants. Study results will be disseminated through peer-reviewed publications, presentations at scientific conferences, and community events. TRIAL REGISTRATION/BACKGROUND:The LINK-IT trial was registered on March 20, 2024, on ClinicalTrials.gov under the identifier NCT06319716; https://clinicaltrials.gov/study/NCT06319716.

INTRODUCTION/BACKGROUND:Hazardous working conditions fuel inequities in accidental-poisoning, suicide, and chronic-liver-disease mortality. Relational theories suggest such hazards flow from power imbalances between workers, managers, and employers - social classes demarcated by power over property and labor. However, to our knowledge, no US studies using relational measures have analyzed class inequities in the cause-specific mortality. METHODS:We used the Mortality Disparities in American Communities dataset, which links the 2008 American Community Survey to the National Death Index through December 31, 2019. We classified respondents as incorporated business owners, unincorporated business owners, managers, workers, or not in the labor force based on their employment, occupational, and business-ownership status. Then, using an inverse-probability-weighted Aalen-Johansen estimator, we estimated risk differences in the cause-specific mortality across classes at the end of follow-up, including by sex, race/ethnicity, and education. RESULTS:Our sample included 2,304,500 respondents and 10,870 accidental-poisoning, suicide, and chronic-liver-disease deaths. Compared to incorporated business owners, those not in the labor force, workers, and unincorporated business owners had, respectively, 8.9 (95 % CI: 8.0, 9.7), 0.9 (95 % CI: 0.4, 1.5), and 1.1 (95 % CI: 0.3, 1.9) greater 12-year age- and sex-adjusted risks of the cause-specific mortality per 1000. Managers' risks resembled incorporated business owners'. Inequities largely persisted after thorough sociodemographic adjustment. Among workers, risks were elevated among the unemployed and those with blue-collar or service occupations. Finally, inequities were greater among men and less-educated respondents than among women and more-educated respondents. DISCUSSION/CONCLUSIONS:We estimated considerable class inequities in the cause-specific mortality, adding to research connecting class relations to mortality inequities and worsening population health.

Environmental exposures are contributors to morbidity and mortality, yet the potential protective role of health insurance in mitigating these effects remains underexplored. We used data from the 1999-2000 and 2001-2002 cycles of the National Health and Nutrition Examination Survey (NHANES) to examine whether health insurance status is associated with the chemical exposome and whether being insured modifies relationships of environmental exposures with epigenetic aging biomarkers of morbidity and mortality (GrimAge2 and DunedinPoAm). Among 2315 adults aged 50 - 84 years, we evaluated 64 chemical exposures. In covariate, socioeconomic status-adjusted models, being insured compared to being uninsured was marginally associated with 0.21-SD lower blood lead levels (95% CI: -0.39, -0.04, P = 0.03) and 0.29-SD higher PCB180 levels (95% CI: 0.003, 0.57, P = 0.048). In leukocyte- and covariate-adjusted models, insurance attenuated the relationship of lead with GrimAge2 (Insured: β = 0.08-years, 95% CI: -0.08, 0.24; Uninsured β = 0.65-years, 95% CI: 0.11, 1.20; P _interaction = 0.04) and DunedinPoAm (Insured: β = 0.001, 95% CI: -0.002, 0.003; Uninsured β = 0.01, 95% CI 0.0001, 0.02; P _interaction = 0.047). Similar trends were also observed for cadmium, cotinine, and PCB180 but not statistically different between insurance categories. These findings suggest that health insurance may serve as a protective factor against the biological aging impacts of certain environmental exposures, possibly through improved access to exposure monitoring and preventive/therapeutic care. While not a substitute for environmental policy or exposure remediation, insurance may represent a small, complementary, and more immediately actionable tool to help reduce harm. However, given the small magnitude of model estimates, results should be interpreted with caution regarding their practical significance.

Pediatric hypertension is increasing in prevalence and is associated with cardiovascular and kidney outcomes in adulthood. Beyond traditional contributors such as obesity and kidney disease, a growing body of evidence implicates environmental exposures in the early disruption of blood pressure regulation. This review aims to evaluate and synthesize current evidence on key exposure routes, including airborne pollutants, heavy metals, and endocrine-disrupting chemicals, and their impact on pediatric blood pressure regulation through biological pathways involving vascular integrity, kidney sodium handling, neurohormonal signaling, and epigenetic programming. Mechanistic studies support roles for oxidative stress, endothelial dysfunction, hormonal dysregulation, and persistent transcriptional changes in mediating exposure-related blood pressure elevations. Although pediatric data remain limited and often are derived from observational studies, the plausibility of these pathways and the developmental sensitivity of the cardiovascular system underscore the urgency for longitudinal research. Clinical and public health strategies should incorporate environmental risk assessment to better identify modifiable exposures contributing to hypertension in children.