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1. In-hospital complications associated with pulmonary vein isolation with adjunctive lesions: the NCDR AFib Ablation Registry

Author

Darden, Douglas, Aldaas, Omar, Du, Chengan, Munir, Muhammad Bilal, Feld, Gregory K, Pothineni, Naga Venkata K, Gopinathannair, Rakesh, Lakkireddy, Dhanunjaya, Curtis, Jeptha P, Freeman, James V, Akar, Joseph G, and Hsu, Jonathan C

Subjects
Clinical Research, Cardiovascular, Heart Disease, Atrial fibrillation, Ablation, Pulmonary vein isolation, Adjunctive lesions, Paroxysmal, Persistent, Outcomes, Registry, Complications, Clinical Sciences, Cardiovascular System & Hematology
Abstract

AimsNo prior study has been adequately powered to evaluate real-world safety outcomes in those receiving adjunctive ablation lesions beyond pulmonary vein isolation (PVI). We sought to evaluate characteristics and in-hospital complications among patients undergoing PVI with and without adjunctive lesions.Methods and resultsPatients in the National Cardiovascular Data Registry AFib Ablation Registry undergoing first-time atrial fibrillation (AF) ablation between 2016 and 2020 were identified and stratified into paroxysmal (PAF) and persistent AF, and separated into PVI only, PVI + cavotricuspid isthmus (CTI) ablation, and PVI + adjunctive (superior vena cava isolation, coronary sinus, vein of Marshall, atypical atrial flutter lines, other). Adjusted odds of adverse events were calculated using multivariable logistic regression. A total of 50 937 patients [PAF: 30 551 (60%), persistent AF: 20 386 (40%)] were included. Among those with PAF, there were no differences in the adjusted odds of complications between PVI + CTI or PVI + adjunctive when compared with PVI only. Among persistent AF, PVI + adjunctive was associated with a higher risk of any complication [3.0 vs. 4.5%, odds ratio (OR) 1.30, 95% confidence interval (CI) 1.07-1.58] and major complication (0.8 vs. 1.4%, OR 1.56, 95% CI 1.10-2.21), while no differences were observed in PVI + CTI compared with PVI only. Overall, there was high heterogeneity in adjunctive lesion type, and those receiving adjunctive lesions had a higher comorbidity burden.ConclusionAdditional CTI ablation was common without an increased risk of complications. Adjunctive lesions other than CTI are commonly performed in those with more comorbidities and were associated with an increased risk of complications in persistent AF, although the current analysis is limited by high heterogeneity in adjunctive lesion set type.

Published
2023

4. Latent Variable Model for Multivariate Data with Measure-specific Sample Weights and Its Application in Hospital Compare

Author

Du, Chengan, Li, Shu-Xia, Lin, Zhenqiu, and Lin, Haiqun

Subjects
Statistics - Methodology
Abstract

We developed a single factor model with measure-specific sample weights for multivariate data with multiple observed indicators clustered within a higher level subject. The factor is therefore a latent variable shared by multiple indicators within a same subject and the sample weights are different across different indicators and different subjects. Even after integrating out the latent variable, the likelihood of the data cannot be written as the sum of weighted likelihood of each subject because a subject has different sample weights respectively for its multiple indicators. In addition, the number of available indicators varies across subjects. We derive a pseudo likelihood for the latent variable model with measure-specific weights. We investigate various statistical properties of the latent variable model with measure-specific sample weights and its connection to the traditional factor analysis. We found that the latent variable model provides consistent estimates for its variances when the measure-specific sample weights are properly re-scaled. Two estimation procedures are developed - EM algorithm for the pseudo likelihood and marginalization of the pseudo likelihood by directly integrating out the latent variable to obtain the parameter estimates. This approach is illustrated by the analysis of publicly reported hospitals with indicators and sample weights. Numerical studies are conducted to investigate the influence of weights and their sample distribution.

Published
2019

5. Measuring health disparities using a continuous social risk factor

Author

Herrin, Jeph, Barthel, Andrea, Goutos, Demetri, Du, Chengan, Zhou, Sheng, Peltz, Alon, Poyer, James, Lin, Zhenqiu, and Bemheim, Susannah

Subjects
Medical research, Medicine, Experimental, Medicare -- Research, Medicaid -- Research, Health care industry -- Research -- Social aspects, Medical care -- Quality management, Health care industry, Business
Abstract

Objective: To propose and evaluate a novel approach for measuring hospital-level disparities according to the effect of a continuous, polysocial risk factor on those outcomes. Study Setting: Our cohort consisted of Medicare Fee-for-Service (FFS) patients 65 years and older admitted to acute care hospitals for one of six common conditions or procedures. Medicare administrative claims data for six hospital readmission measures including hospitalizations from July 2015 to June 2018 were used. Study Design: We adapted existing methodologies that were developed to report hospital-level disparities using dichotomous social risk factors (SRFs). The existing methods report disparities within and across hospitals; we developed and tested modified approaches for both methods using the Agency for Healthcare Research and Quality Socioeconomic Status Index. We applied the adapted methodologies to six 30-day hospital readmission measures included in the Centers for Medicare & Medicaid Services Hospital Readmissions Reduction Program measures. We compared the within- and across-hospital results for each to those obtained from using the original methods and dichotomizing the AHRQ SES Index into 'low' and 'high' scores. Data Collection: We used Medicare FFS administrative claims data linked to U.S. Census data. Principal Findings: For all six readmission measures we find that, when compared with the existing methods, the methods for continuous SRFs provide disparity results for more facilities though across a narrower range of values. Measures of disparity based on this approach are moderately to highly correlated with those based on a dichotomous version of the same risk factor, while reflecting a fuller spectrum of risk. This approach represents an opportunity for detection of provider-level results that more closely align with underlying social risk. Conclusion: We have demonstrated the feasibility and utility of estimating hospital disparities of care using a continuous, polysocial risk factor. This approach expands the potential for reporting hospital-level disparities while better accounting for the multifactorial nature of social risk on hospital outcomes. KEYWORDS determinants of health, patient outcomes, quality of care, social determinants of health What is known on this topic * Prior work on measuring disparities in hospital outcomes has relied on binary classification of patients' social risk factors, an approach that ignores the continuum and multifactorial nature of social risk. * Continuous risk scores, whether individual factors or multidimensional risk scores, have potential to improve the utility of hospital-level disparity measurement and support more robust quality improvement efforts. What this study adds * This report demonstrates the feasibility of measuring hospital-level disparities using a continuous multidimensional social index in a framework that aligns with methods already adopted for measuring disparities using dichotomous factors. * This approach potentially increases the range of measurable social risk by capturing small differences across a spectrum of patient risk. * Measuring disparities using a continuous social risk factor may also identify inequities among patients who are not at high risk., 1 | INTRODUCTION Disparities of care related to social risk have received increasing attention in recent years, especially in the context of measuring hospital performance on quality measures. Pay-for-performance programs [...]

Published
2023
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6. Logistic Regression Augmented Community Detection for Network Data with Application in Identifying Autism-Related Gene Pathways

Author

Zhao, Yunpeng, Pan, Qing, and Du, Chengan

Subjects
Statistics - Machine Learning, Computer Science - Machine Learning, Statistics - Methodology, 62P10
Abstract

When searching for gene pathways leading to specific disease outcomes, additional information on gene characteristics is often available that may facilitate to differentiate genes related to the disease from irrelevant background when connections involving both types of genes are observed and their relationships to the disease are unknown. We propose method to single out irrelevant background genes with the help of auxiliary information through a logistic regression, and cluster relevant genes into cohesive groups using the adjacency matrix. Expectation-maximization algorithm is modified to maximize a joint pseudo-likelihood assuming latent indicators for relevance to the disease and latent group memberships as well as Poisson or multinomial distributed link numbers within and between groups. A robust version allowing arbitrary linkage patterns within the background is further derived. Asymptotic consistency of label assignments under the stochastic blockmodel is proven. Superior performance and robustness in finite samples are observed in simulation studies. The proposed robust method identifies previously missed gene sets underlying autism related neurological diseases using diverse data sources including de novo mutations, gene expressions and protein-protein interactions.

Published
2018

9. On Consistency of Graph-based Semi-supervised Learning

Author

Du, Chengan, Zhao, Yunpeng, and Wang, Feng

Subjects
Statistics - Machine Learning
Abstract

Graph-based semi-supervised learning is one of the most popular methods in machine learning. Some of its theoretical properties such as bounds for the generalization error and the convergence of the graph Laplacian regularizer have been studied in computer science and statistics literatures. However, a fundamental statistical property, the consistency of the estimator from this method has not been proved. In this article, we study the consistency problem under a non-parametric framework. We prove the consistency of graph-based learning in the case that the estimated scores are enforced to be equal to the observed responses for the labeled data. The sample sizes of both labeled and unlabeled data are allowed to grow in this result. When the estimated scores are not required to be equal to the observed responses, a tuning parameter is used to balance the loss function and the graph Laplacian regularizer. We give a counterexample demonstrating that the estimator for this case can be inconsistent. The theoretical findings are supported by numerical studies., Comment: This paper is accepted by 2019 IEEE 39th International Conference on Distributed Computing Systems (ICDCS)

Published
2017

11. Age-Specific All-Cause Mortality Disparities by Race and Ethnicity During the COVID-19 Pandemic

Author

Faust, Jeremy Samuel, primary, Renton, Benjamin, additional, Bongiovanni, Tasce, additional, Chen, Alexander Junxiang, additional, Sheares, Karen Dorsey, additional, Du, Chengan, additional, Essien, Utibe R., additional, Fuentes-Afflick, Elena, additional, Haywood, Trent, additional, Khera, Rohan, additional, King, Terris, additional, Li, Shu-Xia, additional, Lin, Zhenqiu, additional, Lu, Yuan, additional, Marshall, Andrew D.A., additional, Ndumele, Chima D., additional, Opara, Ijeoma, additional, Loarte-Rodriguez, Tina, additional, Sawano, Mitsuaki, additional, Taparra, Kekoa, additional, Taylor, Herman A., additional, Watson, Karol E., additional, Yancy, Clyde W., additional, and Krumholz, Harlan M., additional

Published
2024
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13. Suicide trends in the early months of the COVID-19 pandemic: an interrupted time-series analysis of preliminary data from 21 countries

Author

Pirkis, Jane, John, Ann, Shin, Sangsoo, DelPozo-Banos, Marcos, Arya, Vikas, Analuisa-Aguilar, Pablo, Appleby, Louis, Arensman, Ella, Bantjes, Jason, Baran, Anna, Bertolote, Jose M, Borges, Guilherme, Brečić, Petrana, Caine, Eric, Castelpietra, Giulio, Chang, Shu-Sen, Colchester, David, Crompton, David, Curkovic, Marko, Deisenhammer, Eberhard A, Du, Chengan, Dwyer, Jeremy, Erlangsen, Annette, Faust, Jeremy S, Fortune, Sarah, Garrett, Andrew, George, Devin, Gerstner, Rebekka, Gilissen, Renske, Gould, Madelyn, Hawton, Keith, Kanter, Joseph, Kapur, Navneet, Khan, Murad, Kirtley, Olivia J, Knipe, Duleeka, Kolves, Kairi, Leske, Stuart, Marahatta, Kedar, Mittendorfer-Rutz, Ellenor, Neznanov, Nikolay, Niederkrotenthaler, Thomas, Nielsen, Emma, Nordentoft, Merete, Oberlerchner, Herwig, O’Connor, Rory C, Pearson, Melissa, Phillips, Michael R, Platt, Steve, Plener, Paul L, Psota, Georg, Qin, Ping, Radeloff, Daniel, Rados, Christa, Reif, Andreas, Reif-Leonhard, Christine, Rozanov, Vsevolod, Schlang, Christiane, Schneider, Barbara, Semenova, Natalia, Sinyor, Mark, Townsend, Ellen, Ueda, Michiko, Vijayakumar, Lakshmi, Webb, Roger T, Weerasinghe, Manjula, Zalsman, Gil, Gunnell, David, and Spittal, Matthew J

Published
2021
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15. Thermosensitive Nanomedicine

Author

Cooper, Stefan M., primary, Ha, Duc, additional, Snow-Davis, Candace, additional, Watson, Novia, additional, Samuel, Raymond E., additional, Ghebreyessus, Kesete, additional, Du, Chengan, additional, Huang, Yongzhuo, additional, and Li, Feng, additional

Published
2021
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21. Initial Findings From the National Cardiovascular Data Registry of Atrial Fibrillation Ablation Procedures

Author

Hsu, Jonathan C., primary, Darden, Douglas, additional, Du, Chengan, additional, Marine, Joseph E., additional, Nichols, Sheila, additional, Marcus, Gregory M., additional, Natale, Andrea, additional, Noseworthy, Peter A., additional, Selzman, Kimberly A., additional, Varosy, Paul, additional, Masoudi, Frederick, additional, Freeman, James, additional, Curtis, Jeptha, additional, Akar, Joseph, additional, and Kowey, Peter R., additional

Published
2023
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22. PROCEDURE VOLUME AND OUTCOMES WITH WATCHMAN LEFT ATRIAL APPENDAGE CLOSURE: A REPORT FROM THE NCDR LAAO REGISTRY

Author

Friedman, Daniel J., primary, Du, Chengan, additional, Lin, Zhenqiu, additional, Vemulapalli, Sreekanth, additional, Kosinski, Andrzej, additional, Piccini, Jonathan P., additional, Pereira, Lucy, additional, Minges, Karl E., additional, Masoudi, Frederick A., additional, Faridi, Kamil, additional, Curtis, Jeptha P., additional, and Freeman, James V., additional

Published
2023
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29. Disparities in Excess Mortality Associated with COVID-19--United States, 2020

Author

Rossen, Lauren M., Ahmad, Farida B., Anderson, Robert N., Branum, Amy M., Du, Chengan, Krumholz, Harlan M., Li, Shu-Xia, Lin, Zhenqiu, Marshall, Andrew, Sutton, Paul D., and Faust, Jeremy S.

Subjects
Mortality, Native Americans -- Health aspects, Health
Abstract

The COVID-19 pandemic has disproportionately affected Hispanic or Latino, non-Hispanic Black (Black), non-Hispanic American Indian or Alaska Native (AI/AN), and non-Hispanic Native Hawaiian or Other Pacific Islander (NH/PI) populations in [...]

Published
2021

30. Two years of COVID-19: Excess mortality by age, region, gender, and race/ethnicity in the United States during the COVID-19 pandemic, March 1, 2020, through February 28, 2022

Author

Faust, Jeremy Samuel, primary, Du, Chengan, additional, Renton, Benjamin, additional, Liang, Chenxue, additional, Chen, Alexander Junxiang, additional, Li, Shu-Xia, additional, Lin, Zhenqiu, additional, Nunez-Smith, Marcella, additional, and Krumholz, Harlan M., additional

Published
2022
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31. Indications for Left Atrial Appendage Occlusion in the United States and Associated In-Hospital Outcomes: Results From the NCDR LAAO Registry

Author

Daimee, Usama A., primary, Wang, Yongfei, additional, Masoudi, Frederick A., additional, Varosy, Paul D., additional, Friedman, Daniel J., additional, Du, Chengan, additional, Koutras, Cristina, additional, Reddy, Vivek Y., additional, Saw, Jacqueline, additional, Price, Matthew J., additional, Kusumoto, Fred M., additional, Curtis, Jeptha P., additional, and Freeman, James V., additional

Published
2022
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34. Sex-based differences in atrial fibrillation ablation adverse events.

Author

Mszar, Reed, Friedman, Daniel J., Ong, Emily, Chengan Du, Yongfei Wang, Zeitler, Emily P., Cunningham, Shayna D., Akar, Joseph, Curtis, Jeptha P., Freeman, James V., Du, Chengan, and Wang, Yongfei

Subjects
ATRIAL fibrillation, SEX factors in disease, ARTERIAL catheterization, CRYOSURGERY, ATRIAL arrhythmias, LOW-molecular-weight heparin, TRANSIENT ischemic attack
Abstract

Objective: Older, relatively small studies identified female sex as a risk factor for adverse events after catheter ablation for atrial fibrillation (AF). We aimed to assess contemporary sex-based differences in baseline and procedural characteristics, adverse events, and quality of life among adults undergoing catheter ablation for AF.Methods: In this observational cohort study, we evaluated those enrolled in the National Cardiovascular Data Registry AFib Ablation Registry between January 2016 and September 2020. Using logistic regression, we analysed the association between patient sex and in-hospital adverse events.Results: Among 58 960 adults (34.6% women) from 150 centres undergoing AF ablation by 706 physicians, women were older (68 vs 64 years, p<0.001), had more comorbidities, and had lower AF-related quality of life at the time of ablation (mean Atrial Fibrillation Effect on QualiTy-of-life Questionnaire) score: 51.8 vs 62.2, p<0.001). Women had a higher risk of hospitalisation >1 day (adjusted OR (aOR) 1.41 (95% CI 1.33 to 1.49)), major adverse event (aOR 1.60 (95% CI 1.33 to 1.92)) and any adverse event (aOR 1.57 (95% CI 1.41 to 1.75)). Women had a higher risk of bradycardia requiring pacemaker, phrenic nerve damage, pericardial effusion, bleeding and vascular injury, but had no differences in death or acute pulmonary vein isolation.Conclusions: Among almost 60 000 patients in the largest prospective registry of AF ablation procedures, female sex was independently associated with a higher risk of hospitalisation >1 day, adverse events, and reduced quality of life, although there were no differences in death or acute pulmonary vein isolation. [ABSTRACT FROM AUTHOR]

Published
2023
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36. Clinical Outcomes at 1 Year Following Transcatheter Left Atrial Appendage Occlusion in the United States

Author

Price, Matthew J., primary, Slotwiner, David, additional, Du, Chengan, additional, Freeman, James V., additional, Turi, Zoltan, additional, Rammohan, Chidambaram, additional, Kusumoto, Fred M., additional, Kavinsky, Clifford, additional, Akar, Joseph, additional, Varosy, Paul D., additional, Koutras, Christina, additional, Curtis, Jeptha P., additional, and Masoudi, Frederick A., additional

Published
2022
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38. Racial and Ethnic Disparities in Age-Specific All-Cause Mortality During the COVID-19 Pandemic.

Author

Faust, Jeremy Samuel, Renton, Benjamin, Bongiovanni, Tasce, Chen, Alexander Junxiang, Sheares, Karen Dorsey, Du, Chengan, Essien, Utibe R., Fuentes-Afflick, Elena, Haywood, Trent, Khera, Rohan, King, Terris, Li, Shu-Xia, Lin, Zhenqiu, Lu, Yuan, Marshall, Andrew D. A., Ndumele, Chima D., Opara, Ijeoma, Loarte-Rodriguez, Tina, Sawano, Mitsuaki, and Taparra, Kekoa

Published
2024
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39. Suicide trends in the early months of the COVID-19 pandemic: interrupted time series analysis of preliminary data from 21 countries

Author

Pirkis, Jane, John, Ann, Shin, Sangsoo, DelPozo-Banos, Marcos, Arya, Vikas, Aguilar, Pablo Analuisa, Appleby, Louis, Arensman, Ella, Bantjes, Jason, Baran, Anna, Bertolote, Jose M., Borges, Guilherme, Brečić, Petrana, Caine, Eric, Castelpietra, Giulio, Chang, Shu-Sen, Colchester, David, Crompton, David, Curkovic, Marko, Deisenhammer, Eberhard A., Du, Chengan, Dwyer, Jeremy, Erlangsen, Annette, Faust, Jeremy S., Fortune, Sarah, Garrett, Andrew, George, Devin, Gerstner, Rebekka, Gilissen, Renske, Gould, Madelyn, Hawton, Keith, Kanter, Joseph, Kapur, Navneet, Khan, Murad, Kirtley, Olivia J., Knipe, Duleeka, Kolves, Kairi, Leske, Stuart, Marahatta, Kedar, Mittendorfer-Rutz, Ellenor, Neznanov, Nikolay, Niederkrotenthaler, Thomas, Nielsen, Emma, Nordentoft, Merete, Oberlerchner, Herwig, O'Connor, Rory C., Pearson, Melissa, Phillips, Michael R., Platt, Steve, Plener, Paul L., Psota, Georg, Qin, Ping, Radeloff, Daniel, Rados, Christa, Reif, Andreas, Reif-Leonhard, Christine, Rozanov, Vsevolod, Schlang, Christiane, Schneider, Barbara, Semenova, Natalia, Sinyor, Mark, Townsend, Ellen, Ueda, Michiko, Vijayakumar, Lakshmi, Webb, Roger T., Weerasinghe, Manjula, Zalsman, Gil, Gunnell, David, and Spittal, Matthew J.

Abstract

Background:\ud The COVID-19 pandemic is having profound mental health consequences for many people. Concerns have been expressed that, at their most extreme, these consequences could manifest as increased suicide rates. We aimed to assess the early effect of the COVID-19 pandemic on suicide rates around the world.\ud \ud Methods:\ud We sourced real-time suicide data from countries or areas within countries through a systematic internet search and recourse to our networks and the published literature. Between Sept 1 and Nov 1, 2020, we searched the official websites of these countries’ ministries of health, police agencies, and government-run statistics agencies or equivalents, using the translated search terms “suicide” and “cause of death”, before broadening the search in an attempt to identify data through other public sources. Data were included from a given country or area if they came from an official government source and were available at a monthly level from at least Jan 1, 2019, to July 31, 2020. Our internet searches were restricted to countries with more than 3 million residents for pragmatic reasons, but we relaxed this rule for countries identified through the literature and our networks. Areas within countries could also be included with populations of less than 3 million. We used an interrupted time-series analysis to model the trend in monthly suicides before COVID-19 (from at least Jan 1, 2019, to March 31, 2020) in each country or area within a country, comparing the expected number of suicides derived from the model with the observed number of suicides in the early months of the pandemic (from April 1 to July 31, 2020, in the primary analysis).\ud \ud Findings:\ud We sourced data from 21 countries (16 high-income and five upper-middle-income countries), including whole-country data in ten countries and data for various areas in 11 countries). Rate ratios (RRs) and 95% CIs based on the observed versus expected numbers of suicides showed no evidence of a significant increase in risk of suicide since the pandemic began in any country or area. There was statistical evidence of a decrease in suicide compared with the expected number in 12 countries or areas: New South Wales, Australia (RR 0·81 [95% CI 0·72–0·91]); Alberta, Canada (0·80 [0·68–0·93]); British Columbia, Canada (0·76 [0·66–0·87]); Chile (0·85 [0·78–0·94]); Leipzig, Germany (0·49 [0·32–0·74]); Japan (0·94 [0·91–0·96]); New Zealand (0·79 [0·68–0·91]); South Korea (0·94 [0·92–0·97]); California, USA (0·90 [0·85–0·95]); Illinois (Cook County), USA (0·79 [0·67–0·93]); Texas (four counties), USA (0·82 [0·68–0·98]); and Ecuador (0·74 [0·67–0·82]).\ud \ud Interpretation:\ud This is the first study to examine suicides occurring in the context of the COVID-19 pandemic in multiple countries. In high-income and upper-middle-income countries, suicide numbers have remained largely unchanged or declined in the early months of the pandemic compared with the expected levels based on the pre-pandemic period. We need to remain vigilant and be poised to respond if the situation changes as the longer-term mental health and economic effects of the pandemic unfold.

Published
2021

40. Sex Differences in Procedural Outcomes Among Patients Undergoing Left Atrial Appendage Occlusion

Author

Darden, Douglas, primary, Duong, Thao, additional, Du, Chengan, additional, Munir, Muhammad Bilal, additional, Han, Frederick T., additional, Reeves, Ryan, additional, Saw, Jacqueline, additional, Zeitler, Emily P., additional, Al-Khatib, Sana M., additional, Russo, Andrea M., additional, Minges, Karl E., additional, Curtis, Jeptha P., additional, Freeman, James V., additional, and Hsu, Jonathan C., additional

Published
2021
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