Environmental epidemiologic studies routinely utilize aggregate health outcomes to estimate effects of short-term (e.g., daily) exposures that are available at increasingly fine spatial resolutions. However, areal averages are typically used to derive population-level exposure, which cannot capture the spatial variation and individual heterogeneity in exposures that may occur within the spatial and temporal unit of interest (e.g., within day or ZIP code). We propose a general modeling approach to incorporate within-unit exposure heterogeneity in health analyses via exposure quantile functions. Furthermore, by viewing the exposure quantile function as a functional covariate, our approach provides additional flexibility in characterizing associations at different quantile levels. We apply the proposed approach to an analysis of air pollution and emergency department (ED) visits in Atlanta over four years. The analysis utilizes daily ZIP code-level distributions of personal exposures to four traffic-related ambient air pollutants simulated from the Stochastic Human Exposure and Dose Simulator. Our analyses find that effects of carbon monoxide on respiratory and cardiovascular disease ED visits are more pronounced with changes in lower quantiles of the population-level exposure. Software for implement is provided in the R package nbRegQF.
The exposome recognizes that individuals are exposed simultaneously to a multitude of different environmental factors and takes a holistic approach to the discovery of etiological factors for disease. However, challenges arise when trying to quantify the health effects of complex exposure mixtures. Analytical challenges include dealing with high dimensionality, studying the combined effects of these exposures and their interactions, integrating causal pathways, and integrating omics layers. To tackle these challenges, ISGlobal Exposome Hub held a data challenge event open to researchers from a…
Statistical techniques play a large role in the structural health monitoring of instrumented infrastructure, such as a railway bridge constructed with an integrated network of fibre optic sensors. One possible way to reason about the structural health of such a railway bridge, is to model the time it takes to recover to a no-load (baseline) state after a train passes over. Inherently, this recovery time is random and should be modelled statistically. This paper uses a non-parametric model, based on empirical quantile approximations, to construct a space-memory efficient baseline distribution f…
Exposure to green space seems to be beneficial for self-reported mental health. In this study we used an objective health indicator, namely antidepressant prescription rates. Current studies rely exclusively upon mean regression models assuming linear associations. It is, however, plausible that the presence of green space is non-linearly related with different quantiles of the outcome antidepressant prescription rates. These restrictions may contribute to inconsistent findings. Our aim was to assess antidepressant prescription rates in relation to green space, and to analyze how the relations…
Analyses of environmental phenomena often are concerned with understanding unlikely events such as floods, heatwaves, droughts or high concentrations of pollutants. Yet the majority of the causal inference literature has focused on modelling means, rather than (possibly high) quantiles. We define a general estimator of the population quantile treatment (or exposure) effects (QTE) -- the weighted QTE (WQTE) -- of which the population QTE is a special case, along with a general class of balancing weights incorporating the propensity score. Asymptotic properties of the proposed WQTE estimators ar…
The analysis of data arising from environmental health studies which collect a large number of measures of exposure can benefit from using latent variable models to summarize exposure information. However, difficulties with estimation of model parameters may arise since existing fitting procedures for linear latent variable models require correctly specified residual variance structures for unbiased estimation of regression parameters quantifying the association between (latent) exposure and health outcomes. We propose an estimating equations approach for latent exposure models with longitudin…
This paper presents an approach to estimating the health effects of an environmental hazard. The approach is general in nature, but is applied here to the case of air pollution. It uses a computer model involving ambient pollution and temperature inputs, to simulate the exposures experienced by individuals in an urban area, whilst incorporating the mechanisms that determine exposures. The output from the model comprises a set of daily exposures for a sample of individuals from the population of interest. These daily exposures are approximated by parametric distributions, so that the predictive…
Long-term behavioral and health risk factors constitute a primary focus of research on the etiology of chronic diseases. Yet, identifying critical time-windows during which risk factors have the strongest impact on disease risk is challenging. To assess the trajectory of association of an exposure history with an outcome, the weighted cumulative exposure index (WCIE) has been proposed, with weights reflecting the relative importance of exposures at different times. However, WCIE is restricted to a complete observed error-free exposure whereas exposures are often measured with intermittent miss…
Statistical methods for identifying harmful chemicals in a correlated mixture often assume linearity in exposure-response relationships. Non-monotonic relationships are increasingly recognised (e.g., for endocrine-disrupting chemicals); however, the impact of non-monotonicity on exposure selection has not been evaluated. In a simulation study, we assessed the performance of Bayesian kernel machine regression (BKMR), Bayesian additive regression trees (BART), Bayesian structured additive regression with spike-slab priors (BSTARSS), and lasso penalised regression. We used data on exposure to 12 …
While human mobility plays a crucial role in determining air pollution exposures and health risks, research to-date has assessed risks based solely on residential location. Here we leveraged a database of ~ 130 million workers in the US and published PM2.5 data between 2011-2018 to explore how incorporating information on both workplace and residential location changes our understanding of disparities in air pollution exposure. In general, we observed higher workplace exposures (W) relative to home exposures (H), as well as increasing exposures for non-white and less educated workers relative …
Air pollution is a pernicious but increasingly rampant health problem in human populations across the globe. Varying duration of exposure to airborne pollutants can result in a plethora of health conditions, ranging from short-term bronchitis to prolonged cardiovascular diseases and lung cancers. Under chronic exposure to pollution, medical treatment for pollutant-caused health conditions can be quite costly. The most immediate and effective way to combat the health detriments of pollution is air purifiers, which take in ambient air and filter out the harmful pollutants before releasing it bac…
Distributed lag models are useful in environmental epidemiology as they allow the user to investigate critical windows of exposure, defined as the time period during which exposure to a pollutant adversely affects health outcomes. Recent studies have focused on estimating the health effects of a large number of environmental exposures, or an environmental mixture, on health outcomes. In such settings, it is important to understand which environmental exposures affect a particular outcome, while acknowledging the possibility that different exposures have different critical windows. Further, in …
There is increasing focus on whether air pollution originating from different sources has different health implications. In particular, recent evidence suggests that fine particulate matter (PM2.5) with chemical tracers suggesting coal combustion origins is especially harmful. Augmenting this knowledge with estimates from causal inference methods to identify the health impacts of PM2.5 derived from specific point sources of coal combustion would be an important step towards informing specific, targeted interventions. We investigated the effect of high-exposure to coal combustion emissions from…
This article is motivated by the problem of studying the joint effect of different chemical exposures on human health outcomes. This is essentially a nonparametric regression problem, with interest being focused not on a black box for prediction but instead on selection of main effects and interactions. For interpretability, we decompose the expected health outcome into a linear main effect, pairwise interactions, and a non-linear deviation. Our interest is in model selection for these different components, accounting for uncertainty and addressing non-identifability between the linear and non…
Exposures to environmental chemicals during gestation can alter health status later in life. Most studies of maternal exposure to chemicals during pregnancy have focused on a single chemical exposure observed at high temporal resolution. Recent research has turned to focus on exposure to mixtures of multiple chemicals, generally observed at a single time point. We consider statistical methods for analyzing data on chemical mixtures that are observed at a high temporal resolution. As motivation, we analyze the association between exposure to four ambient air pollutants observed weekly throughou…
The population-attributable fraction (PAF) quantifies the public health impact of a harmful exposure. Despite being a measure of significant importance an estimand accommodating complicated time-to-event data is not clearly defined. We discuss current estimands of the PAF used to quantify the public health impact of an internal time-dependent exposure for data subject to competing outcomes. To overcome some limitations, we proposed a novel estimand which is based on dynamic prediction by landmarking. In a profound simulation study, we discuss interpretation and performance of the various estim…
The health effects of environmental exposures have been studied for decades, typically using standard regression models to assess exposure-outcome associations found in observational non-experimental data. We propose and illustrate a different approach to examine causal effects of environmental exposures on health outcomes from observational data. Our strategy attempts to structure the observational data to approximate data from a hypothetical, but realistic, randomized experiment. This approach, based on insights from classical experimental design, involves four stages, and relies on modern c…
Motivated by analyzing a national data base of annual air pollution and cardiovascular disease mortality rate for 3100 counties in the U.S. (areal data), we develop a novel statistical framework to automatically detect spatially varying region-wise associations between air pollution exposures and health outcomes. The automatic region-wise spatially varying coefficient model consists three parts: we first compute the similarity matrix between the exposure-health outcome associations of all spatial units, then segment the whole map into a set of disjoint regions based on the adjacency matrix wit…
A wealth of epidemiological data suggests an association between mortality/morbidity from pulmonary and cardiovascular adverse events and air pollution, but uncertainty remains as to the extent implied by those associations although the abundance of the data. In this paper we describe an SSA (Singular Spectrum Analysis) based approach in order to decompose the time-series of particulate matter concentration into a set of exposure variables, each one representing a different timescale. We implement our methodology to investigate both acute and long-term effects of $PM_{10}$ exposure on morbidit…
The identification of factors associated with mental and behavioral disorders in early childhood is critical both for psychopathology research and the support of primary health care practices. Motivated by the Millennium Cohort Study, in this paper we study the effect of a comprehensive set of covariates on children's emotional and behavioural trajectories in England. To this end, we develop a Quantile Mixed Hidden Markov Model for joint estimation of multiple quantiles in a linear regression setting for multivariate longitudinal data. The novelty of the proposed approach is based on the Multi…
Cardiometabolic diseases have substantially increased in China in the past 20 years and blood pressure is a primary modifiable risk factor. Using data from the China Health and Nutrition Survey, we examine blood pressure trends in China from 1991 to 2009, with a concentration on age cohorts and urbanicity. Very large values of blood pressure are of interest, so we model the conditional quantile functions of systolic and diastolic blood pressure. This allows the covariate effects in the middle of the distribution to vary from those in the upper tail, the focal point of our analysis. We join the…
We propose the spatial-temporal aggregated predictor (STAP) modeling framework to address measurement and estimation issues that arise when assessing the relationship between built environment features (BEF) and health outcomes. Many BEFs can be mapped as point locations and thus traditional exposure metrics are based on the number of features within a pre-specified spatial unit. The size of the spatial unit--or spatial scale--that is most appropriate for a particular health outcome is unknown and its choice inextricably impacts the estimated health effect. A related issue is the lack of knowl…
Built environment features (BEFs) refer to aspects of the human constructed environment, which may in turn support or restrict health related behaviors and thus impact health. In this paper we are interested in understanding whether the spatial distribution and quantity of fast food restaurants (FFRs) influence the risk of obesity in schoolchildren. To achieve this goal, we propose a two-stage Bayesian hierarchical modeling framework. In the first stage, examining the position of FFRs relative to that of some reference locations - in our case, schools - we model the distances of FFRs from thes…
A key goal of environmental health research is to assess the risk posed by mixtures of pollutants. As epidemiologic studies of mixtures can be expensive to conduct, it behooves researchers to incorporate prior knowledge about mixtures into their analyses. This work extends the Bayesian multiple index model (BMIM), which assumes the exposure-response function is a non-parametric function of a set of linear combinations of pollutants formed with a set of exposure-specific weights. The framework is attractive because it combines the flexibility of response-surface methods with the interpretabilit…
A new statistical approach for joint modeling of longitudinal outcomes measured in electronic health records with clinically informative presence and observation processes
Considering parallel tempering and comparing post-treatment procedures in Bayesian Profile Regression Models for a survival outcome and correlated exposures
Environmental health researchers often aim to identify sources/behaviors that give rise to potentially harmful exposures. We adapted principal component pursuit (PCP)-a robust technique for dimensionality reduction in computer vision and signal processing-to identify patterns in environmental mixtures. PCP decomposes the exposure mixture into a low-rank matrix containing consistent exposure patterns across pollutants and a sparse matrix isolating unique exposure events. We adapted PCP to accommodate non-negative and missing data, and values below a given limit of detection (LOD). We simulated …
