Research Recap: October 24 - November 4

Research Recap: October 24 - November 4

December 27, 2022

A biweekly overview of recent studies published by Institute investigators and their collaborators spans a wide variety of topics, including:

Patient and clinician perceptions of cardiac care; Lyme disease; COVID-19 health disparities; postoperative and ventilator-associated pneumonia; developing new analytic tools; squamous cell carcinoma; privacy across distributed data networks; and more

For all faculty publications, see our Publications page. For up-to-date media coverage and research findings, visit In the Media, and follow us on Twitter. To search for a subject matter expert, visit our Investigator Directory.

dnaPatient and Clinician Perceptions of Precision Cardiology Care: Findings From the HeartCare Study
Routine genome-wide screening for cardiovascular disease risk may inform clinical decision-making. However, little is known about whether clinicians and patients would find such testing useful or acceptable within the context of a genomics-enabled learning health system. Led by Hadley Stevens Smith, a team conducted surveys with patients and their clinicians who were participating in the HeartCare Study, a precision cardiology care project that returned results from a next-generation sequencing panel of 158 genes associated with cardiovascular disease risk. Results, published in Circulation: Genomic and Precision Medicine, show that both patients and clinicians thought the HeartCare panel screen for cardiovascular disease risk provided information that was useful in terms of personal or health benefits to the patient and that informed clinical care without causing patients to be confused or overwhelmed. The team suggests that further research can assess perceptions of genome-wide screening among the US cardiology clinic population.

Institute Investigator(s): Hadley Stevens Smith

Do any algorithms tick all the boxes? Evaluating systems for reporting Lyme disease
Lyme disease (LD) is the fifth most commonly reported notifiable infectious disease in the U.S. with approximately 35,000 cases reported in 2019 via public health surveillance. However, healthcare claims-based studies estimate that the number of LD cases is >10 times larger than reported through surveillance. To assess the burden of LD using healthcare claims data and the effectiveness of interventions for LD prevention and treatment, it is important to use validated well-performing LD case-finding algorithms (“LD algorithms”). A team led by former fellow Young Hee Nam and including Aaron Mendelsohn and Jeffrey Brown conducted a systematic literature review to identify LD algorithms used with U.S. healthcare claims data and their validation status. The review, published in PLoS One, points out that US claims-based LD case-finding algorithms have used diverse strategies. Only one algorithm was validated, and its performance was poor. The team suggests further studies are warranted to assess performance for different algorithm designs and inform efforts to better assess the true burden of LD.

Institute Investigator(s): Aaron Mendelsohn

COVIDRacial and Ethnic Disparities in Outpatient Treatment of COVID-19 ― United States, January–July 2022
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 new
CDC Morbidity and Mortality Weekly Report (MMWR) senior-authored by 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

PCORnet and privacy-preserving electronic health record linkage
Can a secure, privacy-preserving record linkage (PPRL) methodology be implemented in a scalable manner for use in a large national clinical research network? With patients across the US care from different unaffiliated health systems, individual sites do not always have complete capture of the necessary variables or outcomes of interest for many types of studies. This gap can be bridged by linking overlapping records across Network Partners in a privacy-preserving manner. To address this, a PCORnet team including Darren Toh assembled a multi-disciplinary team to advise on how to establish a standardized and scalable PPRL infrastructure for the entire network. Results, published in BMC Research Notes, shows that the PPRL solution successfully links patients across data sources using distributed queries without directly accessing patient PII. The overlap queries and analysis performed in this pilot is being replicated across the full network to provide additional insight into patient linkages among a distributed research network.

Institute Investigator(s): Darren Toh

Temporal trends in postoperative and ventilator-associated pneumonia in the United States
A group including Michael Klompas sought to determine the change in rate, if any, of postoperative pneumonia and ventilator-associated pneumonia among patients hospitalized in the U.S. during 2009 – 2019. They conducted a retrospective review of data from the Medicare Patient Safety Monitoring System, a chart-abstraction-derived database including 21 adverse-event measures among patients hospitalized in the U.S. Results, published in Infection Control & Hospital Epidemiology show a significant statistical and clinical decrease in the rate of postoperative pneumonia among patients hospitalized for major surgical procedures, but no change in the rates of ventilator-associated pneumonia among those hospitalized for major surgical procedures, acute myocardial infarction, heart failure, and pneumonia.

Institute Investigator(s): Michael Klompas

elderly in the coldEffects of long-term average temperature on cardiovascular disease hospitalizations in an American elderly population
Short-term exposure to high or low temperatures is associated with increased mortality and morbidity. However, less is known about effects of long-term exposure to high or low temperatures. Prolonged exposure to high or low temperatures might contribute to pathophysiological mechanisms, thereby influencing the development of diseases. A team including Peter James evaluated associations of long-term temperature exposure with cardiovascular disease (CVD) hospitalizations. Results, published in Environmental Research, suggest that living in areas with high summer average temperatures or low winter average temperatures could increase the risk of CVD hospitalizations. The magnitude of the associations of summer and winter average temperatures differs by demographics and relative humidity levels.

Institute Investigator(s):  Peter James

A new analytic tool for assessing the impact of the US Food and Drug Administration regulatory actions
Interrupted Time Series (ITS) has long proved itself to be among the most robust quasi-analytic methods. A team led by Christine Lu sought to use its power to assess the impact of Food and Drug Administration (FDA) regulatory actions on drug use. The team developed a flexible, reusable analytic tool using ITS with databases formatted to the Sentinel Common Data Model. They tested the tool through an assessment of the impact of a prior FDA safety communication (intervention), selecting a previously studied case example to compare results against the findings of published analyses. The study, published in Pharmacoepidemiology & Drug Safety, confirms that the tool was successfully tested and demonstrated expected findings in the test case: FDA's 2010 communications on LABA safety in adults with asthma. The reusable, parameterized nature of the tool allows for analyses of the multiple types of FDA actions and can be applied to real-world databases formatted to the Sentinel Common Data Model.

Institute Investigator(s): Ting-Ying (Jane) Huang, Christine Lu, Fang Zhang

Genetically Predicted Serum Vitamin C Levels and Cutaneous Squamous Cell Carcinoma Risk
In vitro and in vivo studies have shown that vitamin C prevents oxidative damage to keratinocytes, which could help prevent the formation of cutaneous squamous cell carcinoma (cSCC). Epidemiologic studies, however, have shown conflicting effects of vitamin C exposure on cSCC risk. A team led by Yuhree Kim with senior author Maryam Asgari performed two-sample Mendelian randomization (MR) analyses to investigate the causal association between vitamin C exposure and cSCC risk. Published as a Letter to the Editor in Journal of Investigative Dermatology, results of the study suggest that genetically predicted serum vitamin C level is not associated with cSCC risk.

Institute Investigator(s): Maryam Asgari, Yuhree Kim