Hong Xian

Saint Louis University | SLU · Department of Epidemiology & Biostatistics

Childhood attention-deficit/hyperactivity disorder (ADHD) is common and is associated with lifelong adverse outcomes. Little is known about factors associated with mental health service use (MHSU) among children with ADHD from adolescence to early adulthood. This retrospective cohort study aims to investigate factors associated with MHSU among chil...

INTRODUCTION Despite their increased application, the heritability of Alzheimer's disease (AD)–related blood‐based biomarkers remains unexplored. METHODS Plasma amyloid beta 40 (Aβ40), Aβ42, the Aβ42/40 ratio, total tau (t‐tau), and neurofilament light (NfL) data came from 1035 men 60 to 73 years of age (μ = 67.0, SD = 2.6). Twin models were used...

Background: Randomised clinical trials showed that compared with placebo, SGLT2 inhibitors and GLP-1 receptor agonists reduced risk of adverse cardiovascular events. The evidence base for the older antihyperglycaemic drug classes (DPP-4 inhibitors and sulfonylureas) is generally less well developed. Because most randomised trials evaluated one ant...

Objective Investigate how hypertension during pregnancy (HDP) and depression during pregnancy (DDP) independently and jointly affect infant birth outcomes. Methods This population-based, retrospective cohort study included a sample of 68,052 women who participated in PRAMS 2016–2018 survey. Poisson regression was used for adjusted relative risks (...

Objective: In animal models, inflammation due to experimental acute pancreatitis (AP) promotes pancreatic carcinogenesis that is preventable by suppressing inflammation. Recent studies noted higher long-term risk of the pancreatic ductal adenocarcinoma (PDAC) following AP. In this study, we evaluated if the long-term PDAC risk following AP was inf...

Objective Depression is a prevalent (24–30%) and significant comorbidity in patients with systemic lupus erythematosus (SLE). In the present study, we leveraged the longitudinal SLE cohort at the Washington University Lupus Clinic to address 1) what is the longitudinal course of depressed affect among outpatients with SLE and 2) what is the longitu...

Objective To measure the effect of maternal family history of hypertension on preterm birth (PTB) and to identify factors that modified this association. Methods A case-control study was nested in a prospective cohort of the entire pregnant population in Wuhan, China, from 2011 to 2013. Home-visit interviews were scheduled for all PTBs and their c...

Background Ambient air pollution has been widely linked with morbidity and mortality of stroke. However, its effects on dynamic progression trajectory of stroke remain unknown. Objective To investigate the effects of ambient air pollution on progression trajectory from healthy to incident stroke, post-stroke cardiovascular diseases, and subsequent...

Foreign-born immigrants are at greater risks of both food insecurity and depressive symptoms, while the association between the two has yet to be elucidated. Our sample includes 6,857 adults aged 20 years and older from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2016. Multivariable logistic regression was used to exa...

Youth from resettled refugee families have elevated risk of developing serious mental health challenges. However, there is a gap in the scientific literature in that studies that investigate mental problems among youth in resettled refugee communities seldom distinguish between those who were resettled in the USA as refugees themselves and those bo...

Purpose Maternal depression and neighborhood characteristics are known to be associated both with each other and with adolescent mental health outcomes. These exposures are also subject to change throughout the life of a child. This study sought to identify multi-trajectories of maternal depression (MD) and self-reported neighborhood collective eff...

Background Ambient fine particulate matter (PM2.5) pollution has been associated with mortality from various diseases, however, its association with under-five mortality rate (U5MR) has remained largely unknown. Methods Based on the U5MR data across 2851 counties in Mainland China from 1999 to 2012, we employed approximate Bayesian latent Gaussian...

Objective To determine associations of alcohol use with cognitive aging among middle-aged men. Method 1,608 male twins (mean 57 years at baseline) participated in up to three visits over 12 years, from 2003–2007 to 2016–2019. Participants were classified into six groups based on current and past self-reported alcohol use: lifetime abstainers, form...

Magnetic resonance imaging data are being used in statistical models to predicted brain ageing (PBA) and as biomarkers for neurodegenerative diseases such as Alzheimer’s Disease. Despite their increasing application, the genetic and environmental etiology of global PBA indices is unknown. Likewise, the degree to which genetic influences in PBA are...

Objective: The objectives of this study are to identify patterns of anxiety symptomology over time among patients with systemic lupus erythematosus (SLE) and to assess the longitudinal relationship between SLE disease activity and anxiety symptomology. Methods: Longitudinal data from 139 patients with American College of Rheumatology or Systemic...

Classes of obsessive-compulsive features differing both quantitatively and qualitatively have been linked to gambling disorder. This secondary data analysis sought to extend this line of investigation to examine the extent to which previously reported latent obsessive-compulsive classes may relate to externalizing conditions in a sample of 1675 twi...

Background Opioid doses declined after the Centers for Disease Control (CDC) opioid prescribing guideline was published. However, it is unknown if dose declines occurred in patients with ≥ 3 years of continuous opioid use. Methods Optum® de-identified integrated Electronic Health Record and claims data were used to create an adult sample (n = 400)...

Background and aims Smoking is associated with increased risk for brain aging/atrophy and dementia. Few studies have examined early associations with brain aging. This study aimed to measure whether adult men with a history of heavier smoking in early midlife would have older than predicted brain age 16 to 28 years later. Design Prospective cohort...

Because longitudinal studies of aging typically lack cognitive data from earlier ages, it is unclear how general cognitive ability (GCA) changes throughout the life course. In 1,173 Vietnam Era Twin Study of Aging (VETSA) participants, we assessed young adult GCA at average age 20 and current GCA at three VETSA assessments beginning at average age...

Despite their increasing application, the genetic and environmental etiology of global predicted brain ageing (PBA) indices is unknown. Likewise, the degree to which genetic influences in PBA are longitudinally stable and how PBA changes over time are also unknown. We analyzed data from 734 men from the Vietnam Era Twin Study of Aging with repeated...

We examined the influence of lifestyle on brain aging after nearly 30 years, and tested the hypothesis that young adult general cognitive ability (GCA) would moderate these effects. In the community-dwelling Vietnam Era Twin Study of Aging (VETSA), 431 largely non-Hispanic white men completed a test of GCA at mean age 20. We created a modifiable li...

Quality in the trucking industry involves several facets, including on-time performance and safety. In the largest naturalistic driving study to-date, with 496 drivers and 13 M miles driven, we address two safety questions: (a) does the occurrence of safety critical events increase during a driving shift? and (b) what is the effect of rest breaks o...

Neuroimaging signatures based on composite scores of cortical thickness and hippocampal volume predict progression from mild cognitive impairment to Alzheimer’s disease. However, little is known about the ability of these signatures among cognitively normal adults to predict progression to mild cognitive impairment. Towards that end, a signature se...

Background The Department of Veterans Affairs (DVA) provides comprehensive medical care at minimal or no cost to 9 million veterans annually through 170 medical centers and 1074 outpatient clinics across the United States. In 1999, the DVA established a national, fully integrated electronic health record (EHR), which now includes approximately 24 m...

The past decade has witnessed continuous growth of naturalistic driving studies (NDSs). When analysing NDS data, safety-critical events (SCEs) are commonly used as surrogates for safety, since actual crashes are very rare. However, the association between SCEs and crashes is not consistent in previous studies and has not been verified among commerc...

Background China had the second largest proportion of preterm birth (PTB) internationally. However, only 11% of pregnant women in China meet international guidelines for maternal physical activity, a significantly lower proportion than that in Western countries. This study aims to examine the association between outdoor physical exercise during pre...

Introduction: The locus coeruleus (LC) undergoes extensive neurodegeneration in early Alzheimer's disease (AD). The LC is implicated in regulating the sleep-wake cycle, modulating cognitive function, and AD progression. Methods: Participants were 481 men (ages 62 to 71.7) from the Vietnam Era Twin Study of Aging. LC structural integrity was inde...

Background Clarifying the relationship between depression symptoms and cardiometabolic and related health could clarify risk factors and treatment targets. The objective of this study was to assess whether depression symptoms in midlife are associated with the subsequent onset of cardiometabolic health problems. Methods The study sample comprised...

Several cardiovascular risk factors (CVRFs) have been associated with poor cognitive function. However, few studies have examined these factors longitudinally during midlife. We hypothesized that more midlife CVRFs would predict worse cognitive function approximately six years later. Participants were 886 men who participated in waves 2 and 3 of th...

Background Longitudinal studies of aging are central to identifying early predictors of and mechanisms underlying late‐life cognitive decline and dementia. However, these studies typically lack cognitive data from earlier ages. It is therefore unclear how peak young adult general cognitive ability (GCA) and maintenance of GCA from young adulthood i...

Importance Both cognitive reserve and modifiable lifestyle behaviors are associated with dementia risk. The effect of early lifestyle behaviors and cognitive reserve on late midlife brain aging could inform early identification and risk reduction of future dementia. Objective Determine associations of young adult cognitive reserve, early midlife l...

Background The short‐term effect of ambient air pollution on atopic dermatitis (AD), along with its effect modifiers, has not been fully addressed in previous studies. Objective To examine the short‐term associations between air pollution and AD, and identify effect modifications by age and season. Methods We used the Generalized Additive Model t...

Background: Low vitality is a common symptom of testosterone deficiency; however, clinical trial results remain inconclusive regarding the responsiveness of this symptom to hormone replacement. Aim: The aim of the present study was to determine if the relationship between circulating testosterone levels and vitality would be moderated by the CAG...

It is well documented that war trauma inflicts serious damage on the mental health of populations affected. Despite having experienced near constant conflict for more than six decades, the paucity of studies assessing the prevalence of trauma-associated disorders among adult South Sudanese resettled in the USA, numbering over 30,000, is concerning....

Posttraumatic stress disorder (PTSD) is known to persist, eliciting early medical co-morbidity, and accelerated aging. Although PTSD diagnosis has been found to be associated with smaller volume in multiple brain regions, posttraumatic stress (PTS) symptoms and their associations with brain morphometry are rarely assessed over long periods of time....

Objectives To examine the effects of holiday and weekend admission on in-hospital mortality for patients with acute myocardial infarction (AMI) in China.Methods Patients with AMI in 31 tertiary hospitals in Shanxi, China from 2014 to 2017 were included (N = 54,968). Multivariable logistic regression models were used to examine the effects of holida...

Objective Heavy alcohol consumption is associated with poorer cognitive function in older adults. Although understudied in middle-aged adults, the relationship between alcohol and cognition may also be influenced by genetics such as the apolipoprotein (ApoE) ε4 allele, a risk factor for Alzheimer’s disease. We examined the relationship between alco...

Objective To test the hypothesis that individual differences in episodic memory and verbal fluency in cognitively normal middle-aged adults will predict progression to amnestic MCI after 6 years. Method The cohort analyzed here included 842 male twins who were cognitively normal at baseline (M=56 years), completed measures of episodic memory and v...

Objectives: First, we test for differences in various cognitive abilities across trajectories of body mass index (BMI) over the later life course. Second, we examine whether genetic risk factors for unhealthy BMIs—assessed via polygenic risk scores (PRS)—predict cognitive abilities in late-life. Methods: The study used a longitudinal sample of Viet...

Epidemiologic observations suggest that exposure to ambient fine particulate matter (PM2.5) is associated with increased risk of chronic kidney disease (CKD) and diabetes, a causal driver of CKD. We evaluated whether diabetes mediates the association between PM2.5 and CKD. A cohort of 2,444,157 United States veterans were followed over a median 8.5...

Arthritis is a leading cause of disability in the United States, with the most efficacious treatments being physical activity (PA). Arthritis patients are less likely to meet PA recommendations and the neighborhood environment may play a role. This study examines the effect of neighborhood walkability and social cohesion on PA among arthritis patie...

Objective: In this study, we sought to identify latent classes of adolescents with distinct profiles of adverse mental and behavioral health, and to determine whether short sleep duration was associated with these classes. Methods: The 2015 Youth Risk Behavior Survey data were propensity score matched with short sleep duration as the exposure. We p...

Gestational hypertension (GH) is a common complication during pregnancy. GH is regarded as a potential public health challenge for pregnant women and infants. Limited evidence has linked ambient air pollution to an increased GH risk. However, most of the studies were conducted in developed countries, with inconsistent results obtained. The present...

Background: Little information exists on interaction effects between air pollution and influenza vaccination on allergic respiratory diseases. We conducted a large population-based study to evaluate the interaction effects between influenza vaccination and long-term exposure to ambient air pollution on allergic respiratory diseases in children and...

Objective The similarity in size among siblings has implications for neonatal death, but research in this area is lacking in the United States. We examined the association between small-for-gestational age (SGA), defined as a birthweight <10th percentile for gestational age, and neonatal death, defined as death within the first 28 days of life, amo...

This study aimed to determine the relationship between latent classes of adverse childhood experience (ACEs) and internalizing disorders (anxiety and depression) among US children. The 2016 National Survey of Children’s Health data for children aged 6–17 was used. Latent class analysis was performed to identify distinct sub-types of ACE exposures a...

Objective Test the hypothesis that individual differences in episodic memory and verbal fluency in cognitively normal middle-aged adults will predict progression to amnestic MCI after 6 years. Method The analysis sample included 842 male twins who were cognitively normal at baseline (M=56 years), completed measures of episodic memory and verbal fl...

Objective To estimate all cause mortality and cause specific mortality among patients taking proton pump inhibitors (PPIs). Design Longitudinal observational cohort study. Setting US Department of Veterans Affairs. Participants New users of PPIs (n=157 625) or H2 blockers (n=56 842). Main outcome measures All cause mortality and cause specific...

Importance Breastfeeding and exposure to ambient air pollutants have been found to be independently associated with respiratory health in children; however, previous studies have not examined the association of breastfeeding as a potential moderator of the association. Objective To assess associations of breastfeeding and air pollution with lung f...

Objective To quantitate the 2016 global and national burden of chronic kidney disease (CKD) attributable to ambient fine particulate matter air pollution ≤ 2.5 μm in aerodynamic diameter (PM 2.5 ). Design We used the Global Burden of Disease (GBD) study data and methodologies to estimate the 2016 burden of CKD attributable to PM 2.5 in 194 countri...

Evidence strongly suggests that being overweight or obese at midlife confers significantly higher risk for Alzheimer's disease and greater brain atrophy later in life. Few studies, however, examine associations between longitudinal changes in adiposity during early adulthood and later brain morphometry. Measures of body mass index (BMI) were collec...

Introduction Over the past 15 years, changes in demographic, social, and epidemiologic trends occurred in the United States. These changes likely contributed to changes in chronic kidney disease (CKD) epidemiology. Objective To describe the change in burden of CKD at the US state level from 2002 to 2016. Design, Setting, and Participants This sys...

Multiple executive functions (EFs) are associated with trait anxiety and depression symptoms, but it is unclear how genetic and/or environmental factors account for these associations and whether they are explained by general variance underlying multiple EFs (i.e., common EF). In this study, 1,207 male twins completed seven EF tasks and measures of...

Background There has been a call for customized rather than population-based birthweight standards that would classify smallness based on an infant's own growth potential. Thus, this study aimed to examine the association between the difference in sibling birthweight and the likelihood of neonatal death among second births in a U.S. population. Met...

Mounting evidence suggests that measures of phonemic fluency and semantic fluency are differentially associated with other cognitive and health phenotypes, but few studies have examined their shared and unique variance, especially using genetically-informative designs. In this study, 1464 middle-aged twins completed six fluency subtests at up to tw...

Laboratory evidence suggests that urea suppresses insulin secretion and sensitivity. Emerging epidemiologic evidence suggests that higher levels of urea are associated with increased risk of incident diabetes mellitus. However, whether elevated levels of blood urea nitrogen are associated with increased risk of insulin use among people with diabete...

Objective: To assess changes over time in the use of antimuscarinics (AM) among visits in adult men treated with bladder outlet obstruction (BOO) medication therapy (ie, alpha blocker and 5-alpha reductase inhibitors). Methods: We used the National Ambulatory Medicare Care Survey database (2006-2014) to identify men aged 40 or older, who initiat...

Introduction: Although antimuscarinics are typically the first-line pharmacological treatment option for overactive bladder, patients often discontinue therapy. The aim of this research project is to identify the rate of antimuscarinic discontinuation, switching, and continuation and differences in discontinuation among different antimuscarinics....

To assess the relationship between gestational weight gain (GWG) of twin-pregnancy women and twin birth weights, as well as to evaluate whether pre-pregnancy body mass index (BMI) influences this relationship. A cohort study was conducted in Wuhan, China, between 1/01/2011 and 8/31/2017. Women with twin pregnancies who delivered live and non-malfor...

Background: Chronic kidney disease (CKD) is associated with increased all-cause mortality. How non-traditional risk factors modify the mortality risk associated with CKD has not been studied. We approached this question using elevated monocyte count, which is associated with increased risk of death in the general population; however, there is very...

The last quarter century witnessed significant population growth, aging, and major changes in epidemiologic trends, which may have shaped the state of chronic kidney disease (CKD) epidemiology. Here, we used the Global Burden of Disease study data and methodologies to describe the change in burden of CKD from 1990 to 2016 involving incidence, preva...

Background: PM2·5 air pollution is associated with increased risk of diabetes; however, a knowledge gap exists to further define and quantify the burden of diabetes attributable to PM2·5 air pollution. Therefore, we aimed to define the relationship between PM2·5 and diabetes. We also aimed to characterise an integrated exposure response function a...

Objectives: Dihydropyridine calcium channel blockers (DH-CCB) are associated with lower-extremity edema (LEE). Loop diuretics have been used inappropriately to treat DH-CCB-associated LEE, constituting a prescribing cascade (PC). The aim of this work was to identify the prevalence and factors associated with potential DH-CCB-LEE-loop diuretic PC....