Ran Balicer

Ben-Gurion University of the Negev | bgu · Department of Public Health

Mathematical and statistical models have played an important role in the analysis of data from COVID-19. They are important for tracking the progress of the pandemic, for understanding its spread in the population, and perhaps most significantly for forecasting the future course of the pandemic and evaluating potential policy options. This article...

Over 10 million doses of Covid‐19 vaccines based on RNA technology, viral vectors, recombinant protein, and inactivated virus have been administered worldwide. Although generally very safe, post‐vaccine myocarditis can result from adaptive humoral and cellular, cardiac‐specific inflammation within days and weeks of vaccination. Rates of vaccine‐ass...

Background Diabetes is a major public health issue. Because lifetime risk, life expectancy, and years of life lost are meaningful metrics for clinical decision making, we aimed to estimate these measures for type 2 diabetes in the high-income setting. Methods For this multinational, population-based study, we sourced data from 24 databases for 23...

Background: The oral protease inhibitor nirmatrelvir has shown substantial efficacy in high-risk, unvaccinated patients infected with the B.1.617.2 (delta) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Data regarding the effectiveness of nirmatrelvir in preventing severe coronavirus disease 2019 (Covid-19) outcomes from...

REGEN-COV, a combination of the monoclonal antibodies casirivimab and imdevimab, has been approved as a treatment for high-risk patients infected with SARS-CoV-2 within five days of their diagnosis. We performed a retrospective cohort study, and used data repositories of Israel’s largest healthcare organization to determine the real-world effective...

Background chronic kidney disease (CKD) is a risk factor for severe COVID-19. We aimed to evaluate real-life effectiveness of the BNT162b2 mRNA vaccine for a range of outcomes in patients with CKD compared to matched controls. Methods Data from Israel's largest healthcare organization were retrospectively used. Vaccinated CKD (eGFR<60ml/min/1.73m2...

Background: Limited evidence is available on the real-world effectiveness of the BNT162b2 vaccine against coronavirus disease 2019 (Covid-19) and specifically against infection with the omicron variant among children 5 to 11 years of age. Methods: Using data from the largest health care organization in Israel, we identified a cohort of children...

Introduction Throughout the SARS-CoV-2 pandemic, resources for various aspects of patient care have been limited, necessitating risk-stratification. The need for good risk-stratification tools has been enhanced by the availability of new Covid-19 therapeutics that are effective at preventing severe disease among high-risk patients if given promptly...

Background: The association between use of renin-angiotensin-aldosterone (RAAS) inhibitors and both SARS-CoV-2 infection and the development of severe COVID-19 has been presented in the recent medical literature with inconsistent results. Objectives: To assess the association between RAAS inhibitor use and two outcomes: infection with SARS-CoV-2...

Aim: To quantify the healthcare costs associated with opioid use disorder among members in a public healthcare system, and compare them with healthcare costs in the general population. Design: Retrospective cohort study. Setting: Inpatient and outpatient care settings of Israel's largest public healthcare provider (that covers 4.7 million memb...

With the COVID-19 pandemic ongoing, accurate assessment of population immunity and the effectiveness of booster and enhancer vaccine doses is critical. We compare COVID-19-related hospitalization incidence rates in 2,412,755 individuals across four exposure levels: non-recent vaccine immunity (two BNT162b2 COVID-19 vaccine doses five or more months...

Background: With large waves of infection driven by the B.1.1.529 (omicron) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), alongside evidence of waning immunity after the booster dose of coronavirus disease 2019 (Covid-19) vaccine, several countries have begun giving at-risk persons a fourth vaccine dose. Methods: To ev...

Background: Pre and perinatal events may be associated with increased risk of inflammatory bowel disease (IBD). We aimed to investigate the role of pre- and peri-natal factors as potential risk factors for the development of IBD in a population with a follow-up of 50 years. Methods: We conducted a nested case-control study, reporting IBD inciden...

Cardiovascular disease (CVD) prediction models are widely used in modern medicine and are incorporated into prominent guidelines. Coronary artery calcium (CAC) is a marker of coronary atherosclerotic disease and has proven utility for predicting cardiovascular disease. Despite this, current guidelines recommend against including CAC scores in CVD p...

Background and objectives: Both perianal and pediatric-onset Crohn's disease (CD) disease are associated with complicated disease course and higher drug utilization. We aimed to explore the differences between pediatric and adult-onset perianal CD and their disease course. Methods: We included all patients with newly diagnosed CD from 2005 to 20...

REGEN-COV, a combination of the monoclonal antibodies casirivimab and imdevimab, has been approved as a treatment for high-risk patients infected with SARS-CoV-2 within 5 days of their diagnosis. We used the data repositories of Israel’s largest healthcare organization to determine the real-world effectiveness of REGEN-COV treatment against COVID-1...

Children unvaccinated against SARS-CoV-2 may still benefit through protection from vaccinated contacts. We estimated the protection provided to children through parental vaccination with the BNT162b2 vaccine. We studied households without prior infection, consisting of two parents and unvaccinated children, estimating the effect of parental vaccina...

Heart failure (HF) prevalence is increasing worldwide and is associated with significant morbidity and mortality. Guidelines emphasize prevention in those at-risk, but HF-specific risk prediction equations developed in United States population-based cohorts lack external validation in large, real-world datasets outside of the United States. The pur...

Background Population-level trends in mortality among people with diabetes are inadequately described. We aimed to examine the magnitude and trends in excess all-cause mortality in people with diabetes. Methods In this retrospective, multicountry analysis, we collected aggregate data from 19 data sources in 16 high-income countries or jurisdiction...

Inducing people to get vaccinated is critical for controlling the spread of COVID-19. We explored the effectiveness of two text messaging strategies for encouraging unvaccinated individuals to get their COVID-19 vaccination. One message emphasized social norms to harness people’s tendency to act in ways that line up with society’s expectations. The...

Introduction With the COVID-19 pandemic ongoing, accurate assessment of population immunity and the effectiveness of booster and enhancer vaccines is critical. Methods We compare COVID-19-related hospitalization incidence rate ratios, adjusted for potential demographic, clinical and health-seeking-behavior confounders, in 2,412,755 individuals (23...

Breakthrough infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in fully vaccinated individuals are receiving intense scrutiny because of their importance in determining how long restrictions to control virus transmission will need to remain in place in highly vaccinated populations as well as in determining the need for a...

Background Methodologically rigorous studies on Covid-19 vaccine effectiveness (VE) in preventing SARS-CoV-2 infection are critically needed to inform national and global policy on Covid-19 vaccine use. In Israel, healthcare personnel (HCP) were initially prioritized for Covid-19 vaccination, creating an ideal setting to evaluate early real-world V...

Background: Emerging data suggest increased arterial thrombosis risk in the months preceding a cancer diagnosis. Objectives: Assess whether patients without documented vascular risk factors or pre-existent cardiovascular disease have a higher relative risk of cancer 12 months after arterial thrombotic events (ATE), compared to unselected patient...

Background Pediatric-onset IBD (PIBD) is characterized by a more extensive phenotype than adults and a higher utilization of immunosuppressive medications; both may be associated with malignancy. We aimed to assess the risk of cancer in a nationwide cohort of PIBD and to explore the risks associated with medical treatments. Methods PIBD-cases (<18...

Background COVID-19 continues to spread throughout the world. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) is used to diagnose COVID-19, with its cycle threshold (Ct) value inversely related to the viral load. The association between Ct values and COVID-19 related outcomes has been studied in the hospital setting but less so i...

Background Schizophrenia patients have shorter life expectancy often owing to preventable physical illnesses and sub-optimal utilization of medical services. However, the association between service-utilization and mortality has not been explored. Aim To assess whether medical service-utilization moderates the association between physical morbidit...

Digital transformations are well underway in all areas of life. These have brought about substantial and wide-reaching changes, in many areas, including health. But large gaps remain in our understanding of the interface between digital technologies and health, particularly for young people. The Lancet and Financial Times Commission on governing h...

Aim This study explores the potential benefit of combining clinicians’ risk assessments and the automated 30-day readmission prediction model. Background Automated readmission prediction models based on electronic health records are increasingly applied as part of prevention efforts, but their accuracy is moderate. Methods This prospective multi-...

Evidence regarding the effectiveness of covid-19 vaccine in patients with impaired immunity, is limited. Initial observations suggest a lower humoral response in these patients. We evaluated the relative effectiveness of the mRNA BNT162b2 vaccine in patients with hematological neoplasms compared to matched controls. Data on patients with hematologi...

Background Reports have suggested an association between the development of myocarditis and the receipt of messenger RNA (mRNA) vaccines against coronavirus disease 2019 (Covid-19), but the frequency and severity of myocarditis after vaccination have not been extensively explored. Methods We searched the database of Clalit Health Services, the lar...

To evaluate the effectiveness of the BNT162b2 messenger RNA vaccine in pregnant women, we conducted an observational cohort study of pregnant women aged 16 years or older, with no history of SARS-CoV-2, who were vaccinated between 20 December 2020 and 3 June 2021. A total of 10,861 vaccinated pregnant women were matched to 10,861 unvaccinated pregn...

Background Many countries are experiencing a resurgence of COVID-19, driven predominantly by the delta (B.1.617.2) variant of SARS-CoV-2. In response, these countries are considering the administration of a third dose of mRNA COVID-19 vaccine as a booster dose to address potential waning immunity over time and reduced effectiveness against the delt...

Background Methodologically rigorous studies on Covid-19 vaccine effectiveness (VE) in preventing SARS-CoV-2 infection are critically needed to inform national and global policy on Covid-19 vaccine use. In Israel, healthcare personnel (HCP) were initially prioritized for Covid-19 vaccination, creating an ideal setting to evaluate real-world VE in a...

Standardized lab tests are central for patient evaluation, differential diagnosis and treatment. Interpretation of these data is nevertheless lacking quantitative and personalized metrics. Here we report on the modeling of 2.1 billion lab measurements of 92 different lab tests from 2.8 million adults over a span of 18 years. Following unsupervised...

Background There are limited data on influenza vaccine effectiveness (IVE) in preventing laboratory-confirmed influenza illness among healthcare personnel (HCP). Methods HCP with direct patient contact working full-time in hospitals were followed during three influenza seasons in Israel (2016–2017 to 2018–2019) and Peru (2016 to 2018). Trivalent i...

Background Preapproval trials showed that messenger RNA (mRNA)–based vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had a good safety profile, yet these trials were subject to size and patient-mix limitations. An evaluation of the safety of the BNT162b2 mRNA vaccine with respect to a broad range of potential adverse e...

HLA haplotypes were found to be associated with increased risk for viral infections or disease severity in various diseases, including SARS. Several genetic variants are associated with COVID-19 severity. Studies have proposed associations, based on a very small sample and a large number of tested HLA alleles, but no clear association between HLA a...

The BNT162b2 mRNA vaccine is highly effective against SARS-CoV-2. However, apprehension exists that variants of concern (VOCs) may evade vaccine protection, due to evidence of reduced neutralization of the VOCs B.1.1.7 and B.1.351 by vaccine sera in laboratory assays. We performed a matched cohort study to examine the distribution of VOCs in infect...

We study the sources of high end-of-life spending for cancer patients. Even among patients with similar initial prognoses, spending in the year post diagnosis is over twice as high for those who die within the year than those who survive. Elevated spending on decedents is predominantly driven by higher inpatient spending, particularly low-intensity...

Background: As mass vaccination campaigns against COVID-19 accelerate worldwide, there remains only limited evidence regarding vaccine effectiveness (VE) among pregnant women. Pregnant women have been shown to be at risk for severe COVID-19, resulting in adverse obstetrics outcomes, and their immune system is known to undergo alterations during pre...

Viral variants of concern may emerge with dangerous resistance to the immunity generated by the current vaccines to prevent coronavirus disease 2019 (Covid-19). Moreover, if some variants of concern have increased transmissibility or virulence, the importance of efficient public health measures and vaccination programs will increase. The global res...

Background and objectives: To quantify the healthcare costs associated with opioid use disorder among members in a public healthcare system, and compare them to healthcare costs in the general population. Methods: Retrospective cohort study in inpatient and outpatient care settings of Israel's largest public healthcare provider (that covers 4.7 mil...

As several countries now confront COVID-19 surges, Israel may be crossing over to other side of the pandemic. Whereas 5.5 million new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections were reported globally last week, Israel reported only 398 (compared with >50,000 in January). Already, 54% of Israel's 9.2 million citizens hav...

Introduction Depression and anxiety have been associated with type 2 diabetes mellitus and metabolic syndrome, major causes of cardiovascular morbidity and mortality. The effect of antidepressants in this association is unknown. This study aimed to examine the association between adherence to selective serotonin receptor inhibitors (SSRIs) and all-...

AimsManagement of patients with a single CHA2DS2-VASc score risk factor is controversial. We attempt to identify the “truly low risk” AF patients who will not benefit from oral anticoagulation (OAC) treatment.Methods Retrospective cohort analysis, all incident non-valvular AF (NVAF) cases between 2004 and 2015, and age 21 and older, with up to one...

The SARS-CoV-2 pandemic has been raging for over a year, creating global detrimental impact. The BNT162b2 mRNA vaccine has demonstrated high protection levels, yet apprehension exists that several variants of concerns (VOCs) can surmount the immune defenses generated by the vaccines. Neutralization assays have revealed some reduction in neutralizat...

Background & Aims Limited population-based data have explored perianal involvement in Crohn’s disease (CD) and compared the disease course between severe and non-severe perianal CD (PCD). We aimed to explore the disease course of these phenotypes in a population-based study of CD. Methods Cases were identified from the epi-IIRN cohort and included...

We study the role of person- and place-specific factors in explaining geographic variation in emergency department utilization using detailed data on 150,000 patients who moved regions within Israel. We document that about half of the destination-origin differences in the average emergency department utilization rate across districts translates to...

Background: As mass vaccination campaigns against coronavirus disease 2019 (Covid-19) commence worldwide, vaccine effectiveness needs to be assessed for a range of outcomes across diverse populations in a noncontrolled setting. In this study, data from Israel's largest health care organization were used to evaluate the effectiveness of the BNT162b...

Background: Pneumonia is more common in smokers compared with non-smokers. A high one-year prevalence of lung cancer following hospitalization for pneumonia was demonstrated in heavy smokers. Aim: To assess the association between hospitalization for pneumonia among ever-smokers and subsequent lung cancer risk. Design: Retrospective analysis....

Objectives: The impact of pediatric-onset inflammatory bowel disease (IBD) on growth is debated. We aimed to investigate the effect of IBD on anthropometric measures at young adulthood. Methods: Children diagnosed with Crohn disease (CD) or ulcerative colitis (UC) (2005-2019) were identified in a national database along with matched non-IBD cont...

Objective Data are sparse regarding the survival benefit of bariatric surgery on mortality among persons with diabetes. We aimed to investigate the association of bariatric surgery, compared with usual care, on all-cause mortality in individuals who underwent surgery and matched controls, stratified by the presence of diabetes. Research Design and...

Objective To evaluate body mass index (BMI) acceleration patterns in children and to develop a prediction model targeted to identify children at high risk for obesity prior to the critical time-window in which the largest increase in BMI percentile occurs Study design We analyzed electronic health records of children from Israel's largest healthca...

Background Diabetes prevalence is increasing in most places in the world, but prevalence is affected by both risk of developing diabetes and survival of those with diabetes. Diabetes incidence is a better metric to understand the trends in population risk of diabetes. Using a multicountry analysis, we aimed to ascertain whether the incidence of cli...

HLA haplotypes were found to be associated with increased risk for viral infections or disease severity in various diseases, including SARS. Several genetic variants are associated with Covid-19 severity. However, no clear association between HLA and Covid-19 incidence or severity has been reported. We conducted a large scale HLA analysis of Israel...

Background: There are currently no nationwide data on the epidemiology of inflammatory bowel diseases (IBD) in Israel. We aimed to determine the population-based epidemiological trends of IBD in the diverse Israeli population. Methods: Health-administrative data were retrieved from all 4 Israeli health maintenance organizations, insuring 98% of...

Objectives To assess whether the extent of deviation from chronic disease guideline recommendations is more prominent for specific diseases compared with combined-care across multiple conditions among multimorbid patients, and to examine reasons for this deviation. Design A cross-sectional cohort. Setting Multimorbidity care management programme...

We estimate the impact of increased access to telemedicine that followed widespread adoption during the March-April 2020 lockdown period in Israel (due to COVID-19). We focus on the post-lockdown period, which in Israel was characterized by a temporary return to normalcy. Prior to the lockdown, telemedicine accounted for about 5% of all primary car...

HLA haplotypes were found to be associated with increased risk for viral infections or disease severity in various diseases, including SARS. Several genetic variants are associated with Covid-19 severity. However, no clear association between HLA and Covid-19 incidence or severity has been reported. We conducted a large scale HLA analysis of Israel...

Background Most studies estimate hepatitis C virus (HCV) disease prevalence from convenience samples. Consequently, screening policies may not include those at the highest risk for a new diagnosis. Methods Clalit Health Services members aged 25–74 as of 31 December 2009 were included in the study. Rates of testing and new diagnoses of HCV were cal...

Reasons why care does not conform to single-disease guideline recommendations for multimorbid patients have not been systematically measured in practice. Using a mixed methods approach, we identified and quantified types of reasons why care deviates from nine sets of disease guideline recommendations for multimorbid patients. Utilizing a focus grou...

Background The quality of healthcare in Israel is considered “high”, and this achievement is due to the structure and organization of the healthcare system. The goal of the present review is to describe the major achievements and challenges of quality improvement in the Israeli healthcare system. Body In recent years, the Ministry of Health has ma...

Objective To illustrate the problem of subpopulation miscalibration, to adapt an algorithm for recalibration of the predictions, and to validate its performance. Materials and Methods In this retrospective cohort study, we evaluated the calibration of predictions based on the Pooled Cohort Equations (PCE) and the fracture risk assessment tool (FRA...

Purpose This study assessed associations of the use of statins for primary prevention with cardiovascular outcomes among adults aged ≥70 years. Methods In a retrospective population-based cohort study, new users of statins without cardiovascular disease or diabetes mellitus were stratified by ≥70 years and <70 years. Using a time-dependent approac...

Rapid rise in childhood obesity prevalence worldwide and its major implications for health warrant the development of better prevention strategies. Here, we analyzed electronic health records of children from Israel’s largest healthcare provider from 2002 to 2018 and developed a model for predicting children’s obesity. Data included demographics, a...

Background: The gold standard for COVID-19 diagnosis is detection of viral RNA through PCR. Due to global limitations in testing capacity, effective prioritization of individuals for testing is essential. Methods: We devised a model estimating the probability of an individual to test positive for COVID-19 based on answers to 9 simple questions t...

Clozapine is the only antipsychotic compound indicated for refractory-schizophrenia. However, it is associated with emergent metabolic dysregulation and cardiovascular risk which may lead to mortality. In this study we aimed to explore predictors for mortality in a large cohort of schizophrenia patients treated with long-term clozapine, using the e...