Sebastien Haneuse

Harvard University | Harvard · Department of Biostatistics

Target trial emulation (TTE) is a popular framework for observational studies based on electronic health records (EHR). A key component of this framework is determining the patient population eligible for inclusion in both a target trial of interest and its observational emulation. Missingness in variables that define eligibility criteria, however,...

Missing data arise in most applied settings and are ubiquitous in electronic health records (EHR). When data are missing not at random (MNAR) with respect to measured covariates, sensitivity analyses are often considered. These solutions, however, are often unsatisfying in that they are not guaranteed to yield actionable conclusions. Motivated by a...

Multimorbidity is the co-occurrence of multiple chronic health problems, associated with aging, frailty, and poor functioning. Children born preterm experience more multimorbid conditions in early life compared to term-born peers. Though neonatal multimorbidity is linked to poor health-related quality of life, functional outcomes, and peer group pa...

OBJECTIVE To evaluate whether disparities exist in adverse neonatal outcomes among the offspring of lesbian, gay, bisexual, and other sexually minoritized (LGB+) birthing people. METHODS We used longitudinal data from 1995 to 2017 from the Nurses' Health Study II, a cohort of nurses across the United States. We restricted analyses to those who rep...

Large observational databases are often subject to missing data. As such, methods for causal inference must simultaneously handle confounding and missingness; surprisingly little work has been done at this intersection. Motivated by this, we propose an efficient and robust estimator of the causal average treatment effect from cohort studies when co...

Rationale Despite guideline warnings, older acute ischemic stroke (AIS) survivors still receive benzodiazepines (BZD) for agitation, insomnia, and anxiety despite being linked to severe adverse effects, such as excessive somnolence and respiratory depression. Due to polypharmacy, drug metabolism, comorbidities, and complications during the sub-acut...

Introduction Despite the progress in reducing child mortality, the rate remains high, particularly in sub-Saharan African countries. Limited data exist on child survival and other birth outcomes by sex. This study compared survival rates and birth outcomes by sex among neonates and children under 2 in Ethiopia. Methods Women who gave birth after 2...

Health facility delivery is one of the critical indicators to monitor progress towards the provision of skilled delivery care and reduction in perinatal mortality. In Ethiopia, utilization of health facilities for skilled delivery care has been increasing but varies greatly by region and among specific socio-demography groups. We aimed to measure t...

Fall-related injuries (FRIs) are a major cause of hospitalizations among older patients, but identifying them in unstructured clinical notes poses challenges for large-scale research. In this study, we developed and evaluated Natural Language Processing (NLP) models to address this issue. We utilized all available clinical notes from the Mass Gener...

An important task in health research is to characterize time-to-event outcomes such as disease onset or mortality in terms of a potentially high-dimensional set of risk factors. For example, prospective cohort studies of Alzheimer’s disease (AD) typically enroll older adults for observation over several decades to assess the long-term impact of gen...

Preeclampsia is a pregnancy‐associated condition posing risks of both fetal and maternal mortality and morbidity that can only resolve following delivery and removal of the placenta. Because in its typical form preeclampsia can arise before delivery, but not after, these two events exemplify the time‐to‐event setting of “semi‐competing risks” in wh...

Causal inference methods based on electronic health record (EHR) databases must simultaneously handle confounding and missing data. Vast scholarship exists aimed at addressing these two issues separately, but surprisingly few papers attempt to address them simultaneously. In practice, when faced with simultaneous missing data and confounding, analy...

Background Sexual minority (SM) individuals (e.g., those with same‐sex attractions/partners or who identify as lesbian/gay/bisexual) experience a host of physical and mental health disparities. However, little is known about sexual orientation‐related disparities in gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP; g...

Target trial emulation (TTE) is a popular framework for observational studies based on electronic health records (EHR). A key component of this framework is determining the patient population eligible for inclusion in both a target trial of interest and its observational emulation. Missingness in variables that define eligibility criteria, however,...

There is increasing interest in combining information from experimental studies, including randomized and single-group trials, with information from external experimental or observational data sources. Such efforts are usually motivated by the desire to compare treatments evaluated in different studies -- for instance, through the introduction of e...

It is estimated that billions of people around the world are affected by micronutrient deficiencies. Madagascar is considered to be particularly nutritionally vulnerable, with nearly half of the population stunted, and parts of the country facing emergency, near famine-like conditions (IPC4). Although Madagascar is generally considered among the mo...

Introduction Cancer risk factors are more common among sexual minority populations (e.g., lesbian, bisexual) than their heterosexual peers, yet little is known about cancer incidence across sexual orientation groups. Methods The 1989–2017 data from the Nurses’ Health Study II, a longitudinal cohort of female nurses across the United States, were a...

Purpose Bariatric surgery is associated with a greater venous thromboembolism (VTE) risk in the weeks following surgery, but the long-term risk of VTE is incompletely characterized. We evaluated bariatric surgery in relation to long-term VTE risk. Materials and Methods This population-based retrospective matched cohort study within three United St...

STUDY QUESTION Does medically assisted reproduction (MAR) use among cisgender women differ among those with same-sex partners or lesbian/bisexual identities compared to peers with different-sex partners or heterosexual identities? SUMMARY ANSWER Women with same-sex partners or lesbian/bisexual identities are more likely to utilize any MAR but are...

Importance Extensive evidence documents health disparities for lesbian, gay, and bisexual (LGB) women, including worse physical, mental, and behavioral health than heterosexual women. These factors have been linked to premature mortality, yet few studies have investigated premature mortality disparities among LGB women and whether they differ by le...

Objectives To examine the association between parents’ influenza vaccination and their children’s coronavirus disease 2019 (COVID-19) vaccination status. Methods Participants included father-mother dyads from Fathers & Families, a cohort of fathers and their co-parents living in the United States. Parents’ influenza vaccination status and children...

Background: Benzodiazepine use in older adults following acute ischemic stroke (AIS) is common, yet short-term safety concerning falls or fall-related injuries remains unexplored. Methods: We emulated a hypothetical randomized trial of benzodiazepine use during the acute post stroke recovery period to assess incidence of falls or fall related injur...

Sexually minoritized women (SMW) may be at an increased risk of adverse perinatal mental health, though prior research is limited. We examined sexual orientation-related differences in perinatal mental health (i.e., stress and depression), and antidepressant utilization among those at different severities of clinically significant perinatal depress...

Antenatal care (ANC) coverage estimates commonly rely on self-reported data, which may carry biases. Leveraging prospectively collected longitudinal data from the Birhan field site and its pregnancy and birth cohort, the Birhan Cohort, this study aimed to estimate the coverage of ANC, minimizing assumptions and biases due to self-reported informati...

Background Despite the increasing number of primary studies on the quality of health care for sick children in Ethiopia, the findings have not been systematically synthesized to inform quality improvement in policies or strategies. This systematic review synthesized published evidence on the quality of care provided to sick children in Ethiopia's h...

In this study, the authors assessed whether publication of a visual abstract on social media was associated with reader engagement online.

Cluster randomized trials (CRTs) refer to a popular class of experiments in which randomization is carried out at the group level. While methods have been developed for planning CRTs to study the average treatment effect, and more recently, to study the heterogeneous treatment effect, the development for the latter objective has currently been limi...

Background: An increasingly industrialized food system has marginalized local, traditional food cultures in Puerto Rico (PR). Recent efforts to decolonize diets have promoted local food intake; however, how resulting dietary patterns may influence cardiometabolic disease remains unknown. Objectives: This study aimed to 1) identify dietary patter...

Background: Post-traumatic stress disorder (PTSD) is associated with cognitive impairments. It is unclear whether problems persist after PTSD symptoms remit. Methods: Data came from 12 270 trauma-exposed women in the Nurses' Health Study II. Trauma and PTSD symptoms were assessed using validated scales to determine PTSD status as of 2008 (trauma...

Health facility delivery is one of the critical indicators to monitor progress towards the provision of skilled delivery care and reduction in perinatal mortality. In Ethiopia, utilization of health facilities for skilled delivery care has been increasing but varies greatly by region and among specific socio-demography groups. We aim to measure the...

Background: Preterm birth complications are the leading causes of death among children under five years. However, the inability to accurately identify pregnancies at high risk of preterm delivery is a key practical challenge, especially in resource-constrained settings with limited availability of biomarkers assessment. Methods: We evaluated whe...

Objective: Although there has been a reduction in stunting (low height/length for age), the prevalence of malnutrition in Ethiopia is still high. Child growth patterns and estimates of stunting are needed to determine vulnerabilities and potential for recovery. We collected longitudinal data to determine the prevalence, incidence and reversal of st...

Violence victimization may cause child behavior problems and neurostructural differences associated with them. Healthy family environments may buffer these effects, but neural pathways explaining these associations remain inadequately understood. We used data from 3154 children (x̅age = 10.1) to test whether healthy family functioning moderated pos...

Importance: Antenatal care prevents maternal and neonatal deaths and improves birth outcomes. There is a lack of predictive models to identify pregnant women who are at high risk of failing to attend antenatal care in low-resource settings. Objective: To develop a series of predictive models to identify women who are at high risk of failing to a...

Antenatal care (ANC) coverage estimates commonly rely on self-reported data, which may carry biases. Leveraging prospectively collected longitudinal data, this study aimed to estimate the coverage of ANC, minimizing assumptions and biases due to self-reported information and describing retention patterns in ANC in rural Amhara, Ethiopia. This is a...

Formal definition of the subjective machine learning process vs. the classical objective randomised, controlled experiment approach. This is an old one that draws on the work of Dr. Andreas Wiegand, Dr. Andrew Ng and Dr. Sebastien Haneuse which forms the basis of an updated process for modelling and decision making. The ML process of modelling &...

Fall-related injuries (FRIs) are a leading cause of hospitalizations among older patients, yet the large-scale research needed to investigate these injuries is stymied by an inability to identify FRIs efficiently and accurately in unstructured clinical notes. In this study, we developed and evaluated the performance Natural Language Processing (NLP...

Importance: Prior studies using large registries have suggested a modest increase in risk for neurodevelopmental diagnoses among children of mothers with immune activation during pregnancy, and such risk may be sex-specific. Objective: To determine whether in utero exposure to SARS-CoV-2 is associated with sex-specific risk for neurodevelopmenta...

Prolonged marginalization of traditional food cultures has diminished local food production and increased dependence on highly processed imports in Puerto Rico (PR), contributing to low-quality diets and cardiometabolic disease. Recent efforts have been made to decolonize diets by increasing local food intake; however, what dietary patterns (DPs) e...

Cluster‐based outcome‐dependent sampling (ODS) has the potential to yield efficiency gains when the outcome of interest is relatively rare, and resource constraints allow only a certain number of clusters to be visited for data collection. Previous research has shown that when the intended analysis is inverse‐probability weighted generalized estima...

Objective: To ascertain the impact of Affordable Care Act (ACA) state Medicaid expansion on human papillomavirus (HPV) vaccination among both adolescent and young adult U.S. women. Data sources: We used state-level data on ACA Medicaid expansion and individual-level data on U.S. women aged 15-25 years living at or below 138% of the federal pover...

Background This study reports the outcomes of Communities for Healthy Living (CHL), a cluster randomized obesity prevention trial implemented in partnership with Head Start, a federally-funded preschool program for low-income families. Methods Using a stepped wedge design, Head Start programs (n = 16; Boston, MA, USA) were randomly assigned to one...

PURPOSE To improve skin cancer screening among survivors of childhood cancer treated with radiotherapy where skin cancers make up 58% of all subsequent neoplasms. Less than 30% of survivors currently complete recommended skin cancer screening. PATIENTS AND METHODS This randomized controlled comparative effectiveness trial evaluated patient and pro...

An important task in survival analysis is choosing a structure for the relationship between covariates of interest and the time-to-event outcome. For example, the accelerated failure time (AFT) model structures each covariate effect as a constant multiplicative shift in the outcome distribution across all survival quantiles. Though parsimonious, th...

An important task in survival analysis is choosing a structure for the relationship between covariates of interest and the time-to-event outcome. For example, the accelerated failure time (AFT) model structures each covariate effect as a constant multiplicative shift in the outcome distribution across all survival quantiles. Though parsimonious, th...

Importance: Although peer review is an important component of publication for new research, the viability of this process has been questioned, particularly with the added stressors of the COVID-19 pandemic. Objective: To characterize rates of peer reviewer acceptance of invitations to review manuscripts, reviewer turnaround times, and editor-ass...

BACKGROUND Older adults occasionally receive seizure prophylaxis in an acute ischemic stroke (AIS) setting, despite safety concerns. There are no trial data available about the net impact of early seizure prophylaxis on post-AIS survival. METHODS Using a stroke registry (American Heart Association’s Get With the Guidelines) individually linked to...

Objective: Older adults receive benzodiazepines for agitation, anxiety, and insomnia after acute ischemic stroke (AIS). No trials have been conducted to determine if benzodiazepine use affects post-stroke mortality in the elderly. Study design and setting: We examined the association between initiating benzodiazepines within one week after AIS a...

Background. In low-resource settings, coverage of at least four antenatal care (ANC) visits remains low. As a first step towards enhancing ANC attendance, this study aims to develop a series of predictive models to identify women who are at high risk of failing to attend ANC in a rural setting in Ethiopia. Methods. This is a cohort study conducted...

Introduction: Globally around 5 million children under the age of 5 years die every year. Ethiopia is one of five countries that contribute to more than half of these deaths. In the absence of a national vital registry system in Ethiopia, there is a lack of high-quality data regarding causes of death. Methods: We conducted a verbal autopsy study am...

Importance: Prior studies using large registries suggested a modest increase in risk for neurodevelopmental diagnoses among children of mothers with immune activation during pregnancy, and such risk may be sex-specific. Objective: To determine whether in utero exposure to the novel coronavirus SARS-CoV-2 is associated with sex-specific risk for neu...

Importance: There is a lack of accurate predictive models to identify pregnancies that are at high risk of preterm delivery, especially in resource-limited settings. Objective: To assess whether it is possible to develop highly accurate prognostic predictive models for preterm delivery using data from a resource-limited setting in Ethiopia. Design:...

A stepped wedge cluster randomized trial is a unidirectional crossover study in which timings of treatment initiation for clusters are randomized. Because the timing of treatment initiation is different for each cluster, an emerging question is whether the treatment effect depends on the exposure time, namely, the time duration since the initiation...

Semi‐competing risks refers to the time‐to‐event analysis setting where the occurrence of a non‐terminal event is subject to whether a terminal event has occurred, but not vice versa. Semi‐competing risks arise in a broad range of clinical contexts, including studies of preeclampsia, a condition that may arise during pregnancy and for which deliver...

In clinical and public health studies, it is often the case that some variables relevant to the analysis are too difficult or costly to measure for all individuals in the population of interest. Rather, a subsample of these individuals must be identified for additional data collection. A sampling scheme that incorporates readily-available informati...

Background In Latin America and the Caribbean, historical shifts away from traditional, plant-sourced food production and consumption patterns may undermine both nutritional status and environmental sustainability. Although agricultural intensification and increasingly animal-centric dietary preferences in the region are well-documented, their infl...

Background Preeclampsia is a pregnancy complication that contributes substantially to perinatal morbidity and mortality worldwide. Existing approaches to modeling and prediction of preeclampsia typically focus either on predicting preeclampsia risk alone, or on the timing of delivery following a diagnosis of preeclampsia. As such, they are misalign...

Although not without controversy, readmission is entrenched as a hospital quality metric with statistical analyses generally based on fitting a logistic-Normal generalized linear mixed model. Such analyses, however, ignore death as a competing risk, although doing so for clinical conditions with high mortality can have profound effects; a hospital'...

Importance: Data on birth outcomes and early mortality are scarce, especially in settings with limited resources. Total births, both stillbirths and live births, are often not counted, yet such data are critical to allocate resources and target interventions to improve survival. Objective: To estimate the prevalence of stillbirths, neonatal deat...

Sexual health education experienced by lesbian, gay, and bisexual (LGB) youth varies widely in relevancy and representation. However, associations among sexual orientation, type of sex education, and exposure to affirming or disaffirming content have yet to be examined. Understanding these patterns can help to address gaps in LGB-sensitive sex educ...

Background Preconception pregnancy risk profiles—characterizing the likelihood that a pregnancy attempt results in a full-term birth, preterm birth, clinical pregnancy loss, or failure to conceive—can provide critical information during the early stages of a pregnancy attempt, when obstetricians are best positioned to intervene to improve the chanc...

Background Causes of childhood behavior problems remain poorly understood. Enriched family environments and corresponding brain development may reduce the risk of their onset, but research investigating white matter neurodevelopmental pathways explaining associations between the family environment and behavior remains limited. We hypothesized that...

Objectives To examine associations of maternal consumption of 100% juice and sugar-sweetened beverages (SSBs) in the third trimester of pregnancy with infant weight status at 6 and 12 months. Methods We studied 379 mother-infant dyads from Rise & SHINE, a prospective cohort study. Exposures were maternal consumption of 100% juice and SSBs in the t...

Unlabelled: To compare hypertension remission and relapse after bariatric surgery compared with usual care. Background: The effect of Roux-en-Y gastric bypass and sleeve gastrectomy on hypertension remission and relapse has not been studied in large, multicenter studies over long periods and using clinical blood pressure (BP) measurements. Meth...

Missing data arise almost ubiquitously in applied settings, and can pose a substantial threat to the validity of statistical analyses. In the context of comparative effectiveness research, such as in large observational databases (e.g., those derived from electronic health records), outcomes may be missing not at random with respect to measured cov...

Objective To characterize family and environmental correlates of sleep patterns that may contribute to differences in infant sleep. Methods We studied 313 infants in the Rise & SHINE (Sleep Health in Infancy & Early Childhood study) cohort. Our main exposures were the parent-reported sleep environment, feeding method and sleep parenting strategies...

Background. The Communities for Healthy Living (CHL) research team partnered with staff at Head Start, a national preschool program for low-income households, and parents of enrolled children to design and implement a family-centered wellness intervention in Greater Boston. This study examined whether Head Start parents experienced greater increase...

Importance: The association of surgeons' and hospitals' operative volumes with postoperative patient outcomes has been studied for decades and holds important policy implications; however, in many volume-outcome analyses, this association is described without the envisioning of a clear intervention, which often introduces unintentional bias. Actin...

Studies of critically ill, hospitalized patients often follow participants and characterize daily health status using an ordinal outcome variable. Statistically, longitudinal proportional odds models are a natural choice in these settings since such models can parsimoniously summarize differences across patient groups and over time. However, when o...

Fathers’ engagement in infant caregiving is linked with positive social, emotional, and developmental outcomes in children; however, its relationship with fathers’ own health is largely unknown. This longitudinal study examined associations between fathers’ caregiving engagement with their 6-month-old infants and their physical activity, sugar-swee...

Semi-competing risks refers to the survival analysis setting where the occurrence of a non-terminal event is subject to whether a terminal event has occurred, but not vice versa. Semi-competing risks arise in a broad range of clinical contexts, with a novel example being the pregnancy condition preeclampsia, which can only occur before the `termina...

Introduction Parent health-related empowerment is defined as the process by which parents realize control over their life situation and take action to promote a healthier lifestyle. For decades, researchers have described the theoretical potential of empowerment in health promotion efforts, though few have empirically examined this hypothesized rel...

Importance As public health emergencies become more prevalent, it is crucial to identify adverse physical and mental health conditions that may be triggered by natural disasters. There is a lack of data on whether Hurricane Maria in 2017 influenced the disease burden of adults in Puerto Rico. Objective To estimate the prevalence of chronic disease...

Background To determine the impact of an intensive perioperative nutritional and lifestyle support protocol on long-term outcomes of bariatric surgery.MethodsA retrospective observational study was conducted of 955 patients who underwent gastric bypass surgery between 2005 and 2015. Patients were divided into two cohorts: (1) 2005 through August 20...

The two-phase study design is a cost-efficient sampling strategy when certain data elements are expensive and, thus, can only be collected on a sub-sample of subjects. To date guidance on how best to allocate resources within the design has assumed that primary interest lies in estimating association parameters. When primary interest lies in the de...

Isolation guidelines for severe acute respiratory syndrome-cornavirus-2 (SARS-CoV-2) are largely derived from data collected prior to emergence of the delta variant. We followed a cohort of ambulatory patients with post-vaccination breakthrough SARS-CoV-2 infections with longitudinal collection of nasal swabs for SARS-CoV-2 viral load quantificatio...

Although infants’ sleep behaviors are shaped by their interactions with parents at bedtime, few tools exist to capture parents’ sleep parenting practices. This study developed a Sleep Parenting Scale for Infants (SPS-I) and aimed to (1) explore and validate its factorial structure, (2) examine its measurement invariance across mothers and fathers,...

Background Neurodevelopmental studies of childhood adversity often define threatening experiences as those involving harm or the threat of harm. Whether effects differ between experiences involving harm (“physical attack”) versus the threat of harm alone (“threatened violence”) remains underexplored. We hypothesized that while both types of experie...

Study Objectives Suboptimal sleep is associated with obesity and its sequelae in children and adults. However, few studies have examined the association between sleep and physical growth in infants who experience rapid changes in sleep/wake patterns. We examined the longitudinal association of changes in objectively assessed sleep/wake patterns wit...