2022 in Review: Our Most Engaging Research
In 2022, Institute faculty published 100’s of papers, many of them first- or senior-author publications, in a variety of medical journals, ranging from New England Journal of Medicine to JAMA to highly specialized journals like The Journal of Cachexia, Sarcopenia and Muscle, and Vaccine.
Here are the ten publications that received the most attention on social media, in the press, and in page views and downloads. True to the Institute’s mission, this work aims to improve health care delivery and population health through research and education, in partnership with health plans, delivery systems, and public health agencies.
Measured by Altmetric, we present to you a 2022 year in review: our most engaging research.
10 | Physician engagement in the political process
A study senior-authored by Xiaojuan Li investigated changes in physicians’ voting behavior in modern day elections using nationally representative data. The team utilized data from U.S. Census Bureau Current Population Survey Voting and Registration Supplement, a biennial, nationally representative household survey, and examined U.S. physicians who participated in the survey between 2000 and 2020. The study provides a needed update on recent changes in physician voting behavior on a national level and across time. According to the study, voter turnout among U.S. physicians has grown over the past two decades: physicians were just as likely to vote as the general population in the recent midterm (2018) and more likely to vote in the latest presidential (2020) election. What’s more, physicians in states that allowed no-excuse mail-in voting had higher turnout than in those states that did not.
Institute Investigator(s): Xiaojuan Li | Journal: JAMA Network Open
9 | A study in antibiotic stewardship: identifying candidates for early antibiotic discontinuation in cases of suspected pneumonia
Suspected pneumonia is the most common indication for antibiotics in hospitalized patients – however, it is frequently over diagnosed. A team led by Michael Klompas with Tom Chen, Chanu Rhee, and Jessica Young explored whether normal oxygenation could be used as an indicator to support early discontinuation of antibiotics. Prompted by clinical observations, the team decided to assess if there was indeed a pattern. They retrospectively identified patients started on antibiotics for pneumonia in four hospitals who had oxygen saturations of 95% or more on ambient air between May 2017 and February 2021. One-quarter of hospitalized patients treated for pneumonia had oxygenation saturations ≥95% on ambient air. Outcomes were similar with 1–2 vs 5–8 days of antibiotics. Normal oxygenation levels may help identify candidates for early antibiotic discontinuation. They suggest that prospective trials are warranted.
Institute Investigator(s): Tom Chen, Michael Klompas, Chanu Rhee, Jessica Young | Journal: Clinical Infectious Diseases
8 | Hospital-based study shows that the increase in hospital-acquired COVID cases mirror increases in community case numbers during the Omicron surge
The SARS-CoV-2 Omicron variant is more contagious than prior variants, leading to large increases in community cases. However, little is known about the incidence of hospital-acquired Omicron infections versus prior variants. A team of researchers led by Michael Klompas, including Meghan Baker and senior author Chanu Rhee conducted a retrospective hospital-based study to examine all nosocomial infections during the Omicron surge vs an earlier wave when wild-type variants predominated. Infection control policies were similar across periods and included universal masking, daily employee health attestations, testing on admission and 72 hours after admission, visitor restrictions, contact tracing, and free on-demand testing for employees. The team reported an increase in hospital-onset infections during the Omicron wave, which mirrored similar increases in community and health care worker case numbers. They note that the increase in hospital-onset infections associated with the Omicron variant despite consistent infection control policies and mandated employee vaccinations underscores the risk of nosocomial transmission, especially when community incidence rates are high, and the need for enhanced infection control strategies.
Institute Investigator(s): Michael Klompas, Meghan Baker, Chanu Rhee | Journal/Publication: JAMA
The increase in hospital-onset infections associated with the Omicron variant despite consistent infection control policies and mandated employee vaccinations underscores the risk of nosocomial transmission, especially when community incidence rates are high, and the need for enhanced infection control strategies.
- Klompas M, Pandolfi MC, Nisar AB, Baker MA, Rhee C. Association of Omicron vs Wild-type SARS-CoV-2 Variants With Hospital-Onset SARS-CoV-2 Infections in a US Regional Hospital System. JAMA. 2022;328(3):296–298.
7 | Study finds unionized health care workers earned better pay and benefits; unionization rates remain low
Unionized health care workers earned better pay and received better non-cash benefits, with little difference in their work hours when compared to non-unionized workers, according to a study senior-authored by Xiaojuan Li. The study team examined the prevalence of labor unionization among health care workers and its associations with employee pay, non-cash benefits, and work hours across the health care workforce in the United States. The researchers found that labor unionization rates were low, at an overall prevalence of 13.2%, with no significant change from 2009 through 2021. Labor unionization was associated with better pay and better benefits for health care workers. Unionized workers reported earning $123 more per week than nonunionized workers, receiving better health insurance from their employer (both in terms of employer’s contribution and the kind of insurance plan), and higher chance of having a pension or other retirement benefits at work. However, compared with nonunionized, unionized workers reported slightly more weekly work hours.
Institute Investigator(s): Xiaojuan Li | Journal/Publication: JAMA
This study is the first to systemically investigate the landscape of labor unionization among the US health care workforce and its associated economic effects.
- Xiaojuan Li, PhD
6 | The Understudied Potential Benefit of State Mandated Paid Sick Leave
Paid sick leave provides job-protected, paid time off to address short-term illnesses for the employee and their family members, but it is not widely offered. If it was, what impact could it make? A team led by Yanlei Ma and including Hefei Wen and Hao Yu studied the impact of mandatory paid sick leave at the state level on emergency department (ED) visit rates, using all-payer, longitudinal ED data from the Healthcare Cost and Utilization Project for the period 2011-19. Results showed that state implementation of paid sick leave mandates was associated with a 5.6 percent reduction in the total ED visit rate relative to the baseline, equivalent to 23 fewer visits per 1,000 population per year, concentrated in Medicaid patients. The authors suggest that mandatory paid sick leave may be an effective policy lever to reduce excess ED use and costs.
Institute Investigator(s): Yanlei Ma, Hefei Wen, Hao Yu | Journal/Publication: Health Affairs
5 | Three measures to reduce COVID-19 transmission in hospitals
The increase in hospital-onset Omicron infections demonstrates the discounted frequency of hospital-based COVID transmissions throughout the pandemic. Michael Klompas and colleague point to hospitals’ limited testing procedures to explain the unappreciated frequency of hospital-acquired infections. The article outlines three additional measures hospitals can implement to reduce the risk of transmission and better protect patients and staff, recommending mandatory vaccine boosters, more frequent testing, and universal use of N95 respirators.
Institute Investigator(s): Michael Klompas | Journal/Publication: JAMA
Stressors earlier in life may ripple through the lifecourse, with adverse effects on health. A Project Viva study examined the possible association of psychosocial stressors in early pregnancy with menopausal symptoms and well-being of women in midlife in a longitudinal cohort. Led by former fellow Sabrina Faleschini with Marie-France Hivert and senior author Emily Oken, a study team observed that a history of physical or sexual abuse, or the experience of financial instability, were associated with worse menopausal symptoms and with poorer well-being almost two decades after exposure assessment.
Institute Investigator(s): Marie-France Hivert, Emily Oken | Journal/Publication: Menopause
3 | Prevalence of Select New Symptoms and Conditions Among Persons Aged Younger Than 20 Years and 20 Years or Older at 31 to 150 Days After Testing Positive or Negative for SARS-CoV-2
Are select new symptoms and conditions more common among persons aged younger than 20 years and 20 years or older who tested positive for SARS-CoV-2 compared with those who tested negative? A study senior authored by Jason Block compared the prevalence of new diagnoses of select symptoms and conditions between 31 and 150 days after testing among persons who tested positive vs negative for SARS-CoV-2. In a cohort study of 338,024 persons younger than 20 years and 1,790,886 persons 20 years or older who were tested for SARS-CoV-2, new diagnoses of shortness of breath, nonspecific heart rate abnormalities, and type 2 diabetes were more common among those hospitalized after positive compared with negative test results; fatigue was more common among those aged 20 years or older. The team suggests that, given these findings, health care professionals should be aware of new symptoms and conditions that may develop after SARS-CoV-2 infection, particularly among those hospitalized.
Institute Investigator(s): Jason Block | Journal/Publication: JAMA Network Open
2 | The correlation between neighborhood conditions and consequences for lifelong health
Residence in neighborhoods with higher opportunity or lower vulnerability in early life, especially at birth, may be associated with lower mean BMI trajectory and lower risk of obesity through adolescence. A study team led by Izzuddin Aris addressed these research gaps by examining novel neighborhood indices and using a geographically diverse cohort of over 20,000 children from 54 birth cohorts across the US participating in the Environmental influences on Child Health Outcomes (ECHO) program. They found that, at every life stage, children who resided in areas with higher Child Opportunity Index scores had lower mean BMI trajectories and lower risk of obesity from childhood to adolescence, independent of family sociodemographics and prenatal characteristics. The team observed similar patterns of findings for children who resided in areas with lower Social Vulnerability Index scores. These associations were strongest for children residing in neighborhoods with highest opportunity or lowest vulnerability. Importantly, these associations were strongest for exposure to neighborhoods at birth compared with exposure at later life stages, indicating that pregnancy is an important window for exposure.
Institute Investigator(s): Izzuddin Aris, Peter James, Emily Oken | Journal/Publication: JAMA Network Open
This study bolsters the need for a focus on investments that address the structures that consistently compromise the health of marginalized communities.”
- Izzuddin Aris, PhD
1 | Investigating racial and ethnic disparities in outpatient COVID-19 treatment
Outpatient medications are effective at preventing severe COVID-19 and are important to pandemic mitigation. Paxlovid is the most commonly prescribed medication and the preferred outpatient therapeutic for eligible patients. A team including senior author Jason Block investigated the racial and ethnic disparities in outpatient COVID-19 treatment that persisted through July 2022. The report found that during April–July 2022, the percentage of COVID-19 patients aged ≥20 years treated with Paxlovid was 36% and 30% lower among Black and Hispanic patients than among White and non-Hispanic patients, respectively. These disparities existed among all age groups and patients with immunocompromise. The team suggests that expanding programs to increase awareness of and access to available outpatient COVID-19 treatments can help protect persons at high risk for severe illness and facilitate equitable health outcomes.
Institute Investigator(s): Jason Block | Journal/Publication: CDC Morbidity and Mortality Weekly Report (MMWR)
Expansion of programs to increase awareness of and access to available outpatient COVID-19 treatments can help protect persons at high risk for severe illness and facilitate equitable health outcomes.
- Boehmer TK, Koumans EH, Skillen EL, et al. Racial and Ethnic Disparities in Outpatient Treatment of COVID-19 ― United States, January–July 2022. MMWR Morb Mortal Wkly Rep 2022;71:1359–1365.