Janine Yunfan Yang

All Publications

• Influence of Sex and Race or Ethnicity on Major Adverse Cardiovascular Outcomes Following Coronary Artery Bypass Surgery in a Large Integrated Health Care System. Journal of the American Heart Association Yang, J. Y., Stram, D., Doan, J., Fairman, A. P., Merchant, M., Triplett, C., Sheikh, A. Y., Ha, R. V., Pursnani, S. K. 2025; 14 (19): e042071

  Abstract

  We aimed to evaluate the influence of sex and race or ethnicity on major adverse cardiovascular events (MACEs) following coronary artery bypass grafting (CABG).This was a retrospective study of Kaiser Permanente Northern California members who underwent CABG from 2008 to 2019, evaluating odds of MACEs (myocardial infarction, stroke, serial percutaneous intervention, repeat CABG, death) at 30 days, 1 year, and up to 12 years follow-up using multivariable logistic and proportional hazards regression analyses. We adjusted for demographic, clinical/surgical, and socioeconomic characteristics.Cohort included n=7405 with mean age 65.2 years. There were n=6082 men and n=1323 women with 2179 (35.8%) and 639 (48.3%) MACEs, respectively. Older age, higher glycated hemoglobin, diabetes, end-stage renal disease, lower hemoglobin, higher creatinine, smoking, lack of cardiopulmonary bypass, and use of nonarterial graft were significant predictors of long-term MACEs. Female sex was associated with an increased odds of MACE at 30 days (odds ratio, 1.62 [95% CI, 1.19-2.21]) and 1 year (hazard ratio, 1.24 [95% CI, 1.02-1.51]).Female, Black, and Other (Native American, multiethnic or missing) race or ethnicity groups had the greatest incidence of MACEs at up to 12 years follow-up post CABG, with differences largely driven by increased risk factor burden. Black and Other race or ethnicity were not significantly associated with long-term CABG risk in multivariable modeling. Further understanding is required to improve upstream preventive efforts.

  View details for DOI 10.1161/JAHA.125.042071

  View details for PubMedID 40970524

  View details for PubMedCentralID PMC12684509

• Long-Term Clinical Course and Treatment Outcomes in Occult and Overt Acute Zonal Outer Retinopathy. Ocular immunology and inflammation Yang, J., Meng, D., Apivatthakakul, A., Mallery, R., Millay, R. H., Rizzo, J. F., Sobrin, L. 2025; 33 (7): 1159-1167

  Abstract

  To report the longitudinal outcomes for AZOOR patients including treatment response, imaging evolution, and overlap with multiple evanescent white dot syndrome (MEWDS).Visual acuity (VA) and visual field (VF) outcomes of occult and overt AZOOR patients were retrospectively compared between the first and final visits as well as between the two AZOOR subtypes. For treated patients, rates of VA change and fundus lesion area were compared before and after treatment. Analyses were performed using STATA 17.Seventeen eyes from 11 occult AZOOR patients and 45 eyes from 29 overt AZOOR patients were included. In a composite VA/VF primary outcome, clinical improvement was noted in five occult AZOOR and three overt AZOOR patients. The decline of logarithm of the Minimal Angle of Resolution (logMAR) VA was minimal in both groups: 0.00016 units/month in occult AZOOR patients and 0.009 units/month in overt AZOOR patients (p = 0.94). Occult AZOOR patients were more likely to have improved or stable VF than overt AZOOR patients (p = 0.04). One occult AZOOR and two overt AZOOR patients developed MEWDS at subsequent visits. Treatment with steroids or immunomodulatory therapy (IMT) was initiated in one occult AZOOR patient and nine overt AZOOR patients. Treated patients had overall VA stability. Fundus lesion area in treated patients changed by a mean of 0.2831 mm2/month, with 40% of patients showing decreased lesion area.AZOOR patients generally maintained their VA. Overt AZOOR patients were more likely to receive steroids or IMT; treatment was associated with stabilization of VA.

  View details for DOI 10.1080/09273948.2024.2358100

  View details for PubMedID 38843492

• Development of electronic health record based algorithms to identify individuals with diabetic retinopathy. Journal of the American Medical Informatics Association : JAMIA Breeyear, J. H., Mitchell, S. L., Nealon, C. L., Hellwege, J. N., Charest, B., Khakharia, A., Halladay, C. W., Yang, J., Garriga, G. A., Wilson, O. D., Basnet, T. B., Hung, A. M., Reaven, P. D., Meigs, J. B., Rhee, M. K., Sun, Y., Lynch, M. G., Sobrin, L., Brantley, M. A., Sun, Y. V., Wilson, P. W., Iyengar, S. K., Peachey, N. S., Phillips, L. S., Edwards, T. L., Giri, A. 2024

  Abstract

  To develop, validate, and implement algorithms to identify diabetic retinopathy (DR) cases and controls from electronic health care records (EHRs).We developed and validated electronic health record (EHR)-based algorithms to identify DR cases and individuals with type I or II diabetes without DR (controls) in 3 independent EHR systems: Vanderbilt University Medical Center Synthetic Derivative (VUMC), the VA Northeast Ohio Healthcare System (VANEOHS), and Massachusetts General Brigham (MGB). Cases were required to meet 1 of the following 3 criteria: (1) 2 or more dates with any DR ICD-9/10 code documented in the EHR, (2) at least one affirmative health-factor or EPIC code for DR along with an ICD9/10 code for DR on a different day, or (3) at least one ICD-9/10 code for any DR occurring within 24 hours of an ophthalmology examination. Criteria for controls included affirmative evidence for diabetes as well as an ophthalmology examination.The algorithms, developed and evaluated in VUMC through manual chart review, resulted in a positive predictive value (PPV) of 0.93 for cases and negative predictive value (NPV) of 0.91 for controls. Implementation of algorithms yielded similar metrics in VANEOHS (PPV = 0.94; NPV = 0.86) and lower in MGB (PPV = 0.84; NPV = 0.76). In comparison, the algorithm for DR implemented in Phenome-wide association study (PheWAS) in VUMC yielded similar PPV (0.92) but substantially reduced NPV (0.48). Implementation of the algorithms to the Million Veteran Program identified over 62 000 DR cases with genetic data including 14 549 African Americans and 6209 Hispanics with DR.We demonstrate the robustness of the algorithms at 3 separate healthcare centers, with a minimum PPV of 0.84 and substantially improved NPV than existing automated methods. We strongly encourage independent validation and incorporation of features unique to each EHR to enhance algorithm performance for DR cases and controls.

  View details for DOI 10.1093/jamia/ocae213

  View details for PubMedID 39158361

• Circular Perivascular Autofluorescence Pattern in Patients With Autoimmune Retinopathy JOURNAL OF VITREORETINAL DISEASES Yang, J., Liu, R., Apivatthakakul, A., Sobrin, L. 2024; 8 (3): 299-306

  View details for DOI 10.1177/24741264241237023

  View details for Web of Science ID 001226268800010

• Interleukin-6 and Macular Edema: A Review of Outcomes with Inhibition. International journal of molecular sciences Yang, J. Y., Goldberg, D., Sobrin, L. 2023; 24 (5)

  Abstract

  This paper describes the current literature on the molecular pathophysiology of interleukin-6 (IL-6) in the genesis of macular edema and on the outcomes with IL-6 inhibitors in the treatment of non-infectious macular edema. The role of IL-6 in the development of macular edema has been well elucidated. IL-6 is produced by multiple cells of the innate immune system and leads to a higher likelihood of developing autoimmune inflammatory diseases, such as non-infectious uveitis, through a variety of mechanisms. These include increasing the helper T-cell population over the regulatory T-cell population and leading to the increased expression of inflammatory cytokines, such as tumor necrosis factor-alpha. In addition to being key in the generation of uveitis and subsequent macular edema through these inflammatory pathways, IL-6 also can lead to the development of macular edema through other pathways. IL-6 induces the production of vascular endothelial growth factor (VEGF) and facilitates vascular leakage by downregulating tight junction proteins in retinal endothelial cells. Clinically, the use of IL-6 inhibitors has been found to be efficacious primarily in the context of treatment-resistant non-infectious uveitis and secondary macular edema. IL-6 is a key cytokine in retinal inflammation and macular edema. It is thus not surprising that the use of IL-6 inhibitors in treatment-resistant macular edema in the setting of non-infectious uveitis has been well documented as an effective treatment option. The use of IL-6 inhibitors in macular edema secondary to non-uveitic processes has only begun to be explored.

  View details for DOI 10.3390/ijms24054676

  View details for PubMedID 36902105

  View details for PubMedCentralID PMC10003386

• Recommendations From the Twitter Hashtag #DoctorsAreDickheads: Qualitative Analysis (vol 22, e17595, 2020) JOURNAL OF MEDICAL INTERNET RESEARCH Sharma, A., Mann, Z., Cherian, R., Del Rosario, J., Yang, J., Sarkar, U. 2020; 22 (11)

  View details for DOI 10.2196/25511

  View details for Web of Science ID 000589259900005

• What Safety Events Are Reported For Ambulatory Care? Analysis of Incident Reports from a Patient Safety Organization. Joint Commission journal on quality and patient safety Sharma, A. E., Yang, J., Del Rosario, J. B., Hoskote, M., Rivadeneira, N. A., , Sarkar, U. 2020

  Abstract

  Health care staff document patient safety events using incident reporting systems, which are compiled within Patient Safety Organization databases. Researchers sought to describe the patterns and characteristics of incident reporting behaviors for ambulatory care from in-situ reporting systems from the United States.The team analyzed safety reports in ambulatory settings collected from a Patient Safety Organization comprising 400 hospital members in 10 states, from May 2012 to October 2018. All events involving moderate harm, severe harm, and death were included, as well as subsamples of events with missing harm, no harm, and mild harm. The team deductively coded incident types and if patient or caregiver challenges were involved. A multivariate logistic regression was conducted to identify predictors of higher harm (severe harm and death) among safety events reported.Of 2,701 events, there were 51 deaths, 159 severe harm events, 1,180 moderate harm, 926 mild harm, 384 no harm, and 1 unknown. Most were from outpatient subspecialty care, while 5.2% were from home/community, and 2.1% were from primary care. Medication-related events were most common (45.3%). In multivariate analysis, diagnostic errors (adjusted odds ratio [aOR] 11.5), patient/caregiver challenges (aOR 2.2), and events in the home/community (aOR 2.0) and in psychiatric settings (aOR 5.0) were associated with higher harm.Outpatient reporting systems are limited for primary care and home/community settings, but ambulatory care systems report more harmful events related to diagnosis and patient and caregiver challenges. Improved standardization of reporting, focus on diagnosis, and novel approaches of safety reporting that engage patients will be necessary to improve capture of preventable events affecting patients and to develop system-level solutions.

  View details for DOI 10.1016/j.jcjq.2020.08.010

  View details for PubMedID 32980254

  View details for PubMedCentralID PMC7938864