All Publications

  • Associations between pregnancy glucose measurements and risk of preterm birth: a retrospective cohort study of commercially insured women in the United States from 2003-2021. Annals of epidemiology Liang, R., Panelli, D. M., Stevenson, D. K., Rehkopf, D. H., Shaw, G. M. 2023


    To investigate associations between glucose measurements during pregnancy and risk of preterm birth (PTB).Retrospective cohort study of commercially insured women with singleton live births in the United States from 2003-2021 using longitudinal medical claims, socioeconomic data, and eight glucose results from different types of fasting and post-load tests performed between 24-28 weeks of gestation for gestational diabetes screening. Risk ratios of PTB (<37 weeks) were estimated via Poisson regression for z-standardized glucose measures. Non-linear relationships for continuous glucose measures were examined via generalized additive models.Elevations in all eight glucose measures were associated with increased risk (adjusted risk ratio point estimates: 1.05-1.19) of PTB for 196,377 women with non-fasting 50-gram glucose challenge test (one glucose result), 31,522 women with complete 100-gram, 3-hour fasting oral glucose tolerance test (OGTT) results (four glucose results), and 10,978 women with complete 75-gram, 2-hour fasting OGTT results (three glucose results). Associations were consistent after adjusting for and stratifying by sociodemographic and clinical factors. Substantial non-linear relationships (U-, J-, and S-shaped) were observed between several glucose measurements and PTB.Elevations in various glucose measures were linearly and non-linearly associated with increased risk of PTB, even before diagnostic thresholds for gestational diabetes.

    View details for DOI 10.1016/j.annepidem.2023.03.002

    View details for PubMedID 36905977

  • Characteristics and treatment patterns of autism spectrum disorder in China, 2020. Psychiatry research Luo, Y., Zhao, Y., Wang, Y., Liang, R., Hong, C., Yang, Y., Zheng, X. 2022; 317: 114879


    This study aimed to investigate the characteristics of children diagnosed with ASD in China and to estimate ASD treatment patterns in 2020. This study used data from the 2020 Survey on Family Circumstance and Demand Support and Resources among Autistic Children in China. The study sample included 4,557 children diagnosed with ASD aged 2-16 years old. Data were collected through questionnaires completed by parents. Of the 4,557 children with ASD, there was a male-to-female ratio of 5.75:1, and the average age when ASD risk symptoms were first reported was 27.97(SD=10.83) months. Higher proportions of families with highly educated parents (college and above; around 58%) and advanced parental age at childbirth (≥35 years; over 50%) were found among autistic children. Additionally, about 41.05% of autistic children had an immediate family member diagnosed with mental/intellectual disorders. In terms of the treatment patterns for autistic children, 84.82% had received behavioral and developmental treatments and 77.74% had received therapy-based treatments, whereas 3% children had not received any treatment. Higher odds of non-treatment were found among children who were male (OR=1.69, 95% CI: 1.01,3.03) and had ASD diagnosed later on (OR= 1.02, 95% CI:1.01,1.03), as compared to their counterparts. Future studies will need to explore the etiology of the disparities of ASD, and policy efforts are critically needed to understand and address the barriers for children with ASD to receive appropriate treatments.

    View details for DOI 10.1016/j.psychres.2022.114879

    View details for PubMedID 36215776

  • The association between community-level socioeconomic status and depressive symptoms among middle-aged and older adults in China. BMC psychiatry Liu, Y., Liu, Z., Liang, R., Luo, Y. 2022; 22 (1): 297


    BACKGROUND: There was little evidence concerning the association of community socioeconomic status (SES) and the cross-level interaction between community- and individual-level SES with depressive symptoms in China. This study aimed to investigate the association of community-level SES with depressive symptoms among Chinese middle-aged and older people and to examine whether individual-level SES moderates this relationship.METHODS: Using data from the China Health and Retirement Longitudinal 2011-2018 Study, the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) short form was used to measure depressive symptoms in 35,546 Chinese individuals aged 45 years and older. Community SES was calculated as a sum of z scores of the average years of schooling and household income per capita, which were derived by aggregating the individual measures to the community level. Two-level hierarchical linear regression was used.RESULTS: Community SES was negatively related to CES-D-10 scores (coef=-0.438). A 1-SD increase in individual SES was associated with lower CES-D-10 scores (coef=-0.490). The cross-level interaction on individual- and community-level SES was significantly associated with depressive symptoms, indicating that with the increase of individual-level SES, the effect of community-level SES on depression decreases. Stratified analyses observed robust associations of community SES with CES-D scores between urban and rural residents.CONCLUSIONS: This study showed that individuals who live in lower-SES communities had more severe depressive symptoms, particularly individuals with low SES. Additional attention should be given to the community socioeconomic context of middle-aged and older adults with lower SES, which may be helpful to reduce SES inequalities in depressive symptoms in China.

    View details for DOI 10.1186/s12888-022-03937-9

    View details for PubMedID 35484534

  • The association between community-level socioeconomic status and cognitive function among Chinese middle-aged and older adults: a study based on the China Health and Retirement Longitudinal Study (CHARLS). BMC geriatrics Liu, Y., Liu, Z., Liang, R., Luo, Y. 2022; 22 (1): 239


    BACKGROUND: Although numerous studies focused on the relationship between area socioeconomic status (SES) and health, only a few of them investigated how community-level SES was linked to late-life cognitive function as well as the potential pathways underlying this association, and very few of them focused on the context of China. This study examined how community-level SES was linked to cognitive function and the potential pathways underlying this association among middle-aged and older adults in China.METHODS: Data was drawn from the waves 1-4 of China Health and Retirement Longitudinal Study. We measured cognitive function with the components of the Telephone Interview of Cognitive Status battery. Community-level SES was derived from a sum of z scores of the percentage of the illiterate and the per-capita net income status within communities. We adopted two-level hierarchical linear regression models to explore the associations between community-level SES and cognitive function. A multilevel mediation analysis with structural equation modeling was undertaken to disaggregate the direct and indirect pathways of the associations.RESULTS: Higher community-level SES was associated with better cognitive function (beta=0.562, 95% CI=0.390, 0.734), and this significant association was only present in rural participants, not in urban participants. Furthermore, we discovered the mediating effects of outdoor exercise facilities within communities (beta=0.023, 95% CI=0.000, 0.056) and individual-level SES (beta=0.108, 95% CI=0.057, 0.156) to explain the relationship between community SES and cognitive function.CONCLUSIONS: These findings highlight the importance of community environmental interventions in maintaining individuals' cognitive health in China, especially for older adults. Our results provided solid empirical evidence for reducing mental health inequalities in China, and suggested that developing an aging-friendly environment and properly distributing community resources are important to improve cognitive function of older adults.

    View details for DOI 10.1186/s12877-022-02946-3

    View details for PubMedID 35317733

  • Impact of the COVID-19 Pandemic on Chronic Disease Care in India, China, Hong Kong, Korea, and Vietnam. Asia-Pacific journal of public health Singh, K., Xin, Y., Xiao, Y., Quan, J., Kim, D., Nguyen, T., Kondal, D., Yan, X., Li, G., Ng, C. S., Kang, H., Minh Nam, H., Mohan, S., Yan, L. L., Shi, C., Chen, J., Thi Hong Hanh, H., Mohan, V., Kong, S., Eggleston, K., Research Group on COVID-19 and Chronic disease care in Asia, Prabhakaran, D., Tandon, N., Narayan, K. V., Ali, M. K., Ranjit Mohan, A., Mohan, D., Jagannathan, S., Venkateshmurthy, N. S., Jarhyan, P., Gong, E., Xiong, S., Chen, X., Ostbye, T., Duman, E. K., Cowling, B. J., Ng, T. W., Xiao, J., Leung, G. M., Chang, A., Liang, R. 1800: 10105395211073052


    This study aims to provide evidence on how the COVID-19 pandemic has impacted chronic disease care in diverse settings across Asia. Cross-sectional surveys were conducted to assess the health, social, and economic consequences of the pandemic in India, China, Hong Kong, Korea, and Vietnam using standardized questionnaires. Overall, 5672 participants with chronic conditions were recruited from 5 countries. The mean age of the participants ranged from 55.9 to 69.3 years. A worsened economic status during the COVID-19 pandemic was reported by 19% to 59% of the study participants. Increased difficulty in accessing care was reported by 8% to 24% of participants, except Vietnam: 1.6%. The worsening of diabetes symptoms was reported by 5.6% to 14.6% of participants, except Vietnam: 3%. In multivariable regression analyses, increasing age, female participants, and worsened economic status were suggestive of increased difficulty in access to care, but these associations mostly did not reach statistical significance. In India and China, rural residence, worsened economic status and self-reported hypertension were statistically significantly associated with increased difficulty in access to care or worsening of diabetes symptoms. These findings suggest that the pandemic disproportionately affected marginalized and rural populations in Asia, negatively affecting population health beyond those directly suffering from COVID-19.

    View details for DOI 10.1177/10105395211073052

    View details for PubMedID 35067078

  • The effects of indoor air pollution from solid fuel use on cognitive function among middle-aged and older population in China. The Science of the total environment Luo, Y. n., Zhong, Y. n., Pang, L. n., Zhao, Y. n., Liang, R. n., Zheng, X. n. 2021; 754: 142460


    Growing evidence has linked outdoor air pollution exposure with higher risk of cognitive impairments. However, the role of indoor air pollution in cognitive decline is not well elaborated. By using nationally representative longitudinal data, this study aimed to explore the effects of indoor air pollution from solid fuel use on cognitive function among middle-aged and older individuals in China.Data were obtained from 2011 to 2015 waves of CHARLS (China Health and Retirement Longitudinal Study). Scores from the Telephone Interview of Cognitive Status and figure drawing/word recall tests were used to measure cognitive function in 39,482 individuals. Exposure to indoor air pollution was measured as use of solid fuel for cooking. Solid fuel was defined as coal, biomass charcoal, wood, and straw; clean fuel was defined as liquefied gas, natural gas, and electricity. Linear mixed effect models were applied to examine the effect of indoor air pollution from solid fuel use on cognitive function.Participants had an average global cognitive function of 9.67 (SD = 4.13). Solid fuel users made up 49.71% of participants, but this proportion was much greater among those living in rural areas (64.22%). Compared with clean fuel users, solid fuel users had worse cognitive function. On average, solid fuel users had a 0.81 (95%CI: -0.89, -0.73) lower global cognition score, 0.63 (95%CI: -0.69, -0.57) lower mental health score, and 0.16 (95%CI: -0.22, -0.14) lower episodic memory score. These effects were stronger among participants who are female, aged 65 years old and above, have education level of primary school and below, or have cardiovascular diseases.These results provide evidence for the role of indoor air pollution in neurobehavioral disorders in China. Promotion of practices like expanded use of clean fuel and improved stoves in households may be crucial to significantly reduce indoor air pollution and protect mental health.

    View details for DOI 10.1016/j.scitotenv.2020.142460

    View details for PubMedID 33254849

  • Low Prenatal Vitamin D Metabolite Ratio and Subsequent Postpartum Depression Risk. Journal of women's health (2002) Accortt, E. E., Arora, C., Mirocha, J., Jackman, S., Liang, R., Karumanchi, S. A., Berg, A. H., Hobel, C. J. 2020


    Background: Depression is a common complication of pregnancy and vitamin D deficiency is one biological risk factor for postpartum depression (PPD). Methods: We evaluated the ratio of 24,25(OH)2D and 25(OH)D serum concentrations referred to as the Vitamin D Metabolite Ratio (VMR), a new candidate biomarker during pregnancyand its relationship with PPD. Women were enrolled in the first trimester of pregnancy and followed through four timepoints. Results: A total of 89 women had complete depression, biomarker and demographic data and 34% were at risk for PPD (CES-D≥16). Stepwise multiple logistic regression models for PPD risk were carried out with eight predictors. Results showed that only lower VMR, OR = 1.43, 95% CI 1.10-1.86, p = 0.007, and Hispanic/Latina identification, OR = 3.83, 95% CI 1.44-10.92, p = 0.007 were significantly associated with higher PPD risk. Conclusion: Routine prenatal screening for vitamin D metabolites, particularly in Hispanic/Latina women, may identify women at risk for PPD.

    View details for DOI 10.1089/jwh.2019.8209

    View details for PubMedID 33021442

  • Schizophrenia and education in Chinese metropolises: a population-based study SOCIAL PSYCHIATRY AND PSYCHIATRIC EPIDEMIOLOGY Luo, Y., He, P., Zhang, L., Pang, L., Guo, C., Liang, R., Zheng, X. 2020


    Schizophrenia is a public concern in metropolises. Increases in city size may strengthen the correlation between prevalence of schizophrenia and indices of socioeconomic status, such as education. This study used population-based data of adults to investigate the association between education and schizophrenia in Chinese metropolises and its differences between inner city areas and outer suburbs.Data was obtained from the Second China National Sample Survey on Disability in 2006, and analysis was restricted to 189,143 participants aged 18 years or older in all counties (districts) of Beijing, Shanghai, and Tianjin. Schizophrenia diagnoses were ascertained according to the International Statistical Classification of Diseases, 10th Revision. Logistic regression models were fitted to examine the association between education and schizophrenia.An inverse U-shaped pattern between education and schizophrenia was found in inner city areas of Chinese metropolises. Compared with the primary school or below group, the odds ratios of junior high school group and senior high school or above group was 2.79 (95% CI 1.96, 3.96) and 1.45(95% CI 0.99, 2.13), respectively. In outer suburbs, junior high school (OR = 0.87, 95% CI 0.63, 1.19) and senior high school or above groups (0.58, 95% CI 0.38, 0.87) were less likely to develop schizophrenia than the primary school or below group.This study showed an association between education and schizophrenia in Chinese metropolises. In inner city areas, the association was an inverse U-shaped pattern between education and schizophrenia, whereas in suburban areas, the association was a negative linear pattern. Our findings can help identify high-risk populations of schizophrenia in Chinese metropolises. Programs for prevention and early intervention of schizophrenia will need to consider the socioeconomic disparities between inner city and outer suburban areas. Public policies can help improve mental health by developing social security for migrants in inner city areas and promoting regional equality.

    View details for DOI 10.1007/s00127-020-01898-6

    View details for Web of Science ID 000550652400001

    View details for PubMedID 32691081

  • Association between urbanicity and dementia in China: a population-based study. The journals of gerontology. Series B, Psychological sciences and social sciences Luo, Y., Zhao, Y., Pang, L., Guo, C., Liang, R., Zheng, X. 2020


    OBJECTIVES: This study investigated the relationship between urbanicity and dementia, and predicted its non-linear pattern among Chinese adults aged 50 years old and above.METHODS: This study used data from the Second National Sample Survey on Disability, which was implemented from 1 April to 31 May 2006 across China. Dementia status was determined by a two-stage process: the combination of self-reports or family members' reports and an on-site medical diagnosis by experienced specialists based on the International Statistical Classification of Diseases and Related Health Problems 10th Revision Symptom Checklist for Mental Disorders. Logistic regression models were used to examine the relationship between urbanicity and dementia, and restricted polynomial spline regression models were plotted to examine the non-linear exposure-response relationship of urbanicity and dementia.RESULTS: Logistic regression results showed that an increase of 10% in the degree of urbanization was associated with a 73% decrease in the odds of dementia after adjusting for covariates, particularly area-level socioeconomic variables. This observed association was stronger in the younger age group, and this age group difference was only present in females. Spline regression findings suggested a non-linear exposure-response relationship between urbanicity and the odds of dementia. Areas with very high levels of urbanization were associated with increased odds of dementia.CONCLUSIONS: These findings highlight the necessity to properly examinethenuanced relationship betweenurbanicityandmental health, especially for females in the younger age group. Notably, there were increased odds of dementia at very high levels of urbanicity.

    View details for DOI 10.1093/geronb/gbaa090

    View details for PubMedID 32644163

  • Use of the Bedside-Placed Angel Catheter IVC Filter for Venous Thromboembolic Disease in Critically Ill Medical Patients JOURNAL OF INTENSIVE CARE MEDICINE Matusov, Y., Weinberg, A. S., Liang, R., Meza, J., Friedman, O., Tapson, V. F. 2019
  • Extubation to high-flow nasal cannula in critically ill surgical patients. The Journal of surgical research Dhillon, N. K., Smith, E. J., Ko, A., Harada, M. Y., Polevoi, D., Liang, R., Barmparas, G., Ley, E. J. 2017; 217: 258-264


    High-flow nasal cannula (HFNC) is increasingly used to reduce reintubations in patients with respiratory failure. Benefits include providing positive end expiratory pressure, reducing anatomical dead space, and decreasing work of breathing. We sought to compare outcomes of critically ill surgical patients extubated to HFNC versus conventional therapy.A retrospective review was conducted in the surgical intensive care unit of an academic center during August 2015 to February 2016. Data including demographics, ventilator days, oxygen therapy after extubation, reintubation rates, surgical intensive care unit and hospital length of stay, and mortality were collected. Self and palliative extubations were excluded. Characteristics and outcomes, with the primary outcome being reintubation, were compared between those extubated to HFNC versus cool mist/nasal cannula (CM/NC).Of the 184 patients analyzed, 46 were extubated to HFNC and 138 to CM/NC. Mean age and days on ventilation before extubation were 57.8 years and 4.3 days, respectively. Both cohorts were similar in age, sex, and had a similar prevalence of cardiopulmonary diagnoses at admission. Although prior to extubation HFNC had lengthier ventilation requirements (7.1 versus 3.4 days, P < 0.01) and ICU stays (7.8 versus 4.1 days, P < 0.01), the rate of reintubation was similar to CM/NC (6.5% versus 13.8%, P = 0.19). Multivariable analysis demonstrated HFNC to be associated with a lower risk of reintubation (adjusted odds ratio = 0.15, P = 0.02). Mortality rates were similar.Ventilated patients at risk for recurrent respiratory failure have reduced reintubation rates when extubated to HFNC. Patients with prolonged intubation or those with high-risk comorbidities may benefit from extubation to HFNC.

    View details for DOI 10.1016/j.jss.2017.06.026

    View details for PubMedID 28711371