Project description:IntroductionThe COVID-19 pandemic reached New York City in early March 2020 resulting in an 11-week lockdown period to mitigate further spread. It has been well documented that cancer care was drastically affected as a result. Given New York City's early involvement, we attempted to identify any stage shift that may have occurred in the diagnoses of non-small cell lung cancer (NSCLC) at our institution as a result of these lockdowns.Patients and methodsWe conducted a retrospective review of a prospective database of lung cancer patients at our institution from July 1, 2019 until March 31, 2021. Patients were grouped by calendar year quarter in which they received care. Basic demographics and clinical staging were compared across quarters.ResultsFive hundred and fifty four patients were identified that underwent treatment during the time period of interest. During the lockdown period, there was a 50% reduction in the mean number of patients seen (15 ± 3 vs. 28 ± 7, P = .004). In the quarter following easing of restrictions, there was a significant trend towards earlier stage (cStage I/II) disease. In comparison to quarters preceding the pandemic lockdown, there was a significant increase in the proportion of patients with Stage IV disease in the quarters following phased reopening (P = .026).ConclusionAfter a transient but significant increase in Stage I/II disease with easing of restrictions there was a significant increase in patients with Stage IV disease. Extended longitudinal studies must be conducted to determine whether COVID-19 lockdowns will lead to further increases in the proportion of patients with advanced NSCLC.
Project description:Building on a unique exposure assessment project in New York, New York, we examined the relationship of particulate matter with aerodynamic diameter less than 2.5 ?m and nitrogen dioxide with birth weight, restricting the population to term births to nonsmokers, along with other restrictions, to isolate the potential impact of air pollution on growth. We included 252,967 births in 2008-2010 identified in vital records, and we assigned exposure at the residential location by using validated models that accounted for spatial and temporal factors. Estimates of association were adjusted for individual and contextual sociodemographic characteristics and season, using linear mixed models to quantify the predicted change in birth weight in grams related to increasing pollution levels. Adjusted estimates for particulate matter with aerodynamic diameter less than 2.5 ?m indicated that for each 10-µg/m(3) increase in exposure, birth weights declined by 18.4, 10.5, 29.7, and 48.4 g for exposures in the first, second, and third trimesters and for the total pregnancy, respectively. Adjusted estimates for nitrogen dioxide indicated that for each 10-ppb increase in exposure, birth weights declined by 14.2, 15.9, 18.0, and 18.0 g for exposures in the first, second, and third trimesters and for the total pregnancy, respectively. These results strongly support the association of urban air pollution exposure with reduced fetal growth.
Project description:IntroductionThis study aims to determine whether subway ridership and built environmental factors, such as population density and points of interests, are linked to the per capita COVID-19 infection rate in New York City ZIP codes, after controlling for racial and socioeconomic characteristics.MethodsSpatial lag models were employed to model the cumulative COVID-19 per capita infection rate in New York City ZIP codes (N=177) as of April 1 and May 25, 2020, accounting for the spatial relationships among observations. Both direct and total effects (through spatial relationships) were reported.ResultsThis study distinguished between density and crowding. Crowding (and not density) was associated with the higher infection rate on April 1. Average household size was another significant crowding-related variable in both models. There was no evidence that subway ridership was related to the COVID-19 infection rate. Racial and socioeconomic compositions were among the most significant predictors of spatial variation in COVID-19 per capita infection rates in New York City, even more so than variables such as point-of-interest rates, density, and nursing home bed rates.ConclusionsPoint-of-interest destinations not only could facilitate the spread of virus to other parts of the city (through indirect effects) but also were significantly associated with the higher infection rate in their immediate neighborhoods during the early stages of the pandemic. Policymakers should pay particularly close attention to neighborhoods with a high proportion of crowded households and these destinations during the early stages of pandemics.
Project description:Extant analyses of the relation between economic conditions and population health were often based on annualized data and were susceptible to confounding by nonlinear time trends. In the present study, the authors used generalized additive models with nonparametric smoothing splines to examine the association between economic conditions, including levels of economic activity in New York State and the degree of volatility in the New York Stock Exchange, and monthly rates of death by suicide in New York City. The rate of suicide declined linearly from 8.1 per 100,000 people in 1990 to 4.8 per 100,000 people in 1999 and then remained stable from 1999 to 2006. In a generalized additive model in which the authors accounted for long-term and seasonal time trends, there was a negative association between monthly levels of economic activity and rates of suicide; the predicted rate of suicide was 0.12 per 100,000 persons lower when economic activity was at its peak compared with when it was at its nadir. The relation between economic activity and suicide differed by race/ethnicity and sex. Stock market volatility was not associated with suicide rates. Further work is needed to elucidate pathways that link economic conditions and suicide.
Project description:Epidemiological studies investigating associations between early life factors and adult health are often limited to studying exposures that can be reliably recalled in adulthood or obtained from existing medical records. There are few US studies with detailed data on the pre- and postnatal environment whose study populations are now in adulthood; one exception is the Collaborative Perinatal Project (CPP). We contacted former female participants of the New York site of the CPP who were born from 1959 to 1963 and were prospectively followed for 7 years to examine whether the pre- and postnatal environment is associated with adult health in women 40 years after birth. The New York CPP cohort is particularly diverse; at enrolment, the race/ethnicity distribution of mothers was approximately 30% White, 40% Black and 30% Puerto Rican. Of the 841 eligible women, we successfully traced 375 women (45%) and enrolled 262 women (70% of those traced). Baseline data were available for all eligible women, and we compared those who participated with the remaining cohort (n = 579). Higher family socio-economic status at age 7, availability of maternal social security number, and White race/ethnicity were statistically significantly associated with a higher probability of tracing. Of those traced, race/ethnicity was associated with participation, with Blacks and Puerto Ricans less likely to participate than Whites (OR = 0.5, 95% CI 0.3, 0.8, and OR = 0.5, 95% CI 0.3, 1.0, respectively). In addition, higher weight at 7 years was associated with lower participation (OR = 0.95, 95% CI 0.92, 0.99), but this association was observed only among the non-White participants. None of the other maternal characteristics, infant or early childhood growth measures was associated with participation or with tracing, either overall or within each racial/ethnic subgroup. Daughters' recall of early life factors such as pre-eclampsia (sensitivity = 24%) and birthweight were generally poor, with the latter varying by category of birthweight with the highest sensitivity for the largest babies (81%) and the lowest sensitivity for the smallest babies (54%). These data reinforce the need to rejuvenate existing birth cohorts with prospective data for life course studies of adult health. Understanding the factors that are associated with tracing and participation in these existing cohorts will help in interpreting the validity and generalisability of the findings from these invaluable cohorts.
Project description:A surveillance system that uses census tract resolution and the SaTScan prospective space-time scan statistic detected clusters of increasing severe acute respiratory syndrome coronavirus 2 test percent positivity in New York City, NY, USA. Clusters included one in which patients attended the same social gathering and another that led to targeted testing and outreach.
Project description:OBJECTIVES:We assessed whether New York City's gun-related homicide rates in the 1990s were associated with a range of social determinants of homicide rates. METHODS:We used cross-sectional time-series data for 74 New York City police precincts from 1990 through 1999, and we estimated Bayesian hierarchical models with a spatial error term. Homicide rates were estimated separately for victims aged 15-24 years (youths), 25-34 years (young adults), and 35 years or older (adults). RESULTS:Decreased cocaine consumption was associated with declining homicide rates in youths (posterior median [PM] = 0.25; 95% Bayesian confidence interval [BCI] = 0.07, 0.45) and adults (PM = 0.07; 95% BCI = 0.02, 0.12), and declining alcohol consumption was associated with fewer homicides in young adults (PM = 0.14; 95% BCI = 0.02, 0.25). Receipt of public assistance was associated with fewer homicides for young adults (PM = -104.20; 95% BCI = -182.0, -26.14) and adults (PM = -28.76; 95% BCI = -52.65, -5.01). Misdemeanor policing was associated with fewer homicides in adults (PM = -0.01; 95% BCI = -0.02, -0.001). CONCLUSIONS:Substance use prevention policies and expansion of the social safety net may be able to cause major reductions in homicide among age groups that drive city homicide trends.
Project description:Disease caused by Powassan virus (POWV), a tick-borne flavivirus, ranges from asymptomatic to severe neurologic compromise and death. Two cases of POWV meningoencephalitis in New York, USA, highlight diagnostic techniques, neurologic outcomes, and the effect of POWV on communities to which it is endemic.
Project description:We assessed the geographic variation in socio-demographics, mobility, and built environmental factors in relation to COVID-19 testing, case, and death rates in New York City (NYC). COVID-19 rates (as of June 10, 2020), relevant socio-demographic information, and built environment characteristics were aggregated by ZIP Code Tabulation Area (ZCTA). Spatially adjusted multivariable regression models were fitted to account for spatial autocorrelation. The results show that different sets of neighborhood characteristics were independently associated with COVID-19 testing, case, and death rates. For example, the proportions of Blacks and Hispanics in a ZCTA were positively associated with COVID-19 case rate. Contrary to the conventional hypothesis, neighborhoods with low-density housing experienced higher COVID-19 case rates. In addition, demographic changes (e.g. out-migration) during the pandemic may bias the estimates of COVID-19 rates. Future research should further investigate these neighborhood-level factors and their interactions over time to better understand the mechanisms by which they affect COVID-19.
Project description:This paper proposes an ensemble predictor for the weekly increase in the number of confirmed COVID-19 cases in the city of New York at zip code level. Within a Bayesian model averaging framework, the baseline is a Poisson regression for count data. The set of covariates includes autoregressive terms, spatial effects, and demographic and socioeconomic variables. Our results for the second wave of the coronavirus pandemic show that these regressors are more significant to predict the number of new confirmed cases as the pandemic unfolds. Both pointwise and interval forecasts exhibit strong predictive ability in-sample and out-of-sample.