Sally Baxter

Research Fellow, University of California, San Diego

22 active projects

Duplicate of Glaucoma and genetic main 2

In our investigative endeavor, the entirety of our genetic dataset is employed to elucidate the genetic risk factors influencing Primary Open Angle Glaucoma (POAG). The pivotal inquiries guiding our research are as follows: 1. What constitutes the discernible genetic risk…

Scientific Questions Being Studied

In our investigative endeavor, the entirety of our genetic dataset is employed to elucidate the genetic risk factors influencing Primary Open Angle Glaucoma (POAG). The pivotal inquiries guiding our research are as follows:

1. What constitutes the discernible genetic risk factors attributable to POAG?
2. What is the computed polygenic risk score associated with POAG?
3. Which specific genetic loci exert the most pronounced influence on POAG?
4. In what manner does the genetic impact of POAG vary across distinct ancestral populations?
To what extent does the socio-economic status of individuals contribute to the modulation of genetic risk factors associated with POAG?
The pursuit of answers to these questions forms the basis of our comprehensive and rigorous scientific inquiry, aimed at advancing our understanding of the intricate interplay between genetics, environmental factors, and the manifestation of POAG.

Project Purpose(s)

  • Ancestry

Scientific Approaches

In our study, we categorized individuals based on the presence or absence of Primary Open Angle Glaucoma (POAG) using short and long-read genome sequencing. Employing Python and the Hail environment, we conducted Genome-Wide Association Studies (GWAS) targeted at POAG, generating plots and applying linear and logistic regression models tailored to POAG's characteristics.

We delved into GWAS results for POAG across all chromosomes, computing Polygenic Risk Scores (PRS) in the PLINK environment to quantify genetic predispositions.

Expanding our analysis, we integrated socio-economic data using Hail, constructing a matrix table. Reapplying regression models with socio-economic variables, we identified potential correlations between genetic risk factors for POAG and individuals' backgrounds. This approach contributes to understanding the interplay between genetics and environmental influences in POAG manifestation.

Anticipated Findings

Our study on Primary Open Angle Glaucoma (POAG) identifies genetic risk factors for early diagnosis and prevention, crucial in reducing global blindness. Analyzing diverse populations allows targeted disease management using genetic markers for timely intervention. Considering socio-economic factors enriches our understanding, guiding tailored public health strategies and personalized interventions. Economically, early prevention based on genetic insights may decrease health insurance payments, lessening the strain on healthcare systems. In essence, our study transforms the approach to managing POAG by integrating genetics, socio-economic factors, and preventive measures.
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Demographic Categories of Interest

This study will not center on underrepresented populations.

Data Set Used

Controlled Tier

Research Team

Owner:

  • Sally Baxter - Research Fellow, University of California, San Diego
  • Kiana Tavakoli - Research Fellow, University of California, San Diego

Collaborators:

  • Bonnie Huang - Graduate Trainee, Northwestern University
  • Cameron Kilpatrick - Project Personnel, All of Us Program Operational Use

v7 Afib and glaucoma progression to surgery

We are exploring the relationship between atrial fibrillation and glaucoma to determine if atrial fibrillation is a risk factor for glaucomatous progression.

Scientific Questions Being Studied

We are exploring the relationship between atrial fibrillation and glaucoma to determine if atrial fibrillation is a risk factor for glaucomatous progression.

Project Purpose(s)

  • Disease Focused Research (Atrial fibrillation and glaucoma)

Scientific Approaches

We will likely perform multivariable logistic regression to determine whether a comorbidity (atrial fibrillation) is associated with glaucomatous progression, as defined by progression to surgery.

Anticipated Findings

Our findings would help determine whether atrial fibrillation should be considered as a risk factor for glaucomatous progression, thereby informing decision to monitor patients more closely or intervene sooner in the disease process.

Demographic Categories of Interest

This study will not center on underrepresented populations.

Data Set Used

Registered Tier

Research Team

Owner:

  • Sally Baxter - Research Fellow, University of California, San Diego
  • Kaela Acuff - Graduate Trainee, University of California, San Diego

Collaborators:

  • Varsha Varkhedi - Undergraduate Student, University of California, San Diego

AMD_v2

Is genomic data in All of Us consistent with prior known polymorphisms? What clinicodemographic features are associated with AMD? How are lipid profiles associated with AMD?

Scientific Questions Being Studied

Is genomic data in All of Us consistent with prior known polymorphisms?
What clinicodemographic features are associated with AMD?
How are lipid profiles associated with AMD?

Project Purpose(s)

  • Disease Focused Research (Age related macular degeneration)

Scientific Approaches

Univariate and multivariate analyses will be primarily employed. Linear mixed effect models may be used to incorporate confounding factors
GWAS
Genomic, demographic, and clinical cohorts from All of Us

Anticipated Findings

AMD is associated with certain genes such as ARMS2, CFH. It may also be associated with CV diseases but these will need to be controlled.

Demographic Categories of Interest

This study will not center on underrepresented populations.

Data Set Used

Controlled Tier

Research Team

Owner:

  • Sally Baxter - Research Fellow, University of California, San Diego
  • Jimmy Chen - Research Fellow, University of California, San Diego

Metformin and Glaucoma

There remain limited treatment options for glaucoma outside lowering intraocular pressure, which is not effective in all patients. Metformin, an antihyperglycemic drug used for the management of diabetes, is being increasingly explored for its neuroprotective effects in the eye. We…

Scientific Questions Being Studied

There remain limited treatment options for glaucoma outside lowering intraocular pressure, which is not effective in all patients. Metformin, an antihyperglycemic drug used for the management of diabetes, is being increasingly explored for its neuroprotective effects in the eye. We would like to investigate the relationship between metformin use and primary open-angle glaucoma incidence and progression using All of Us Data, given the limited studies focusing on this topic.

Project Purpose(s)

  • Drug Development

Scientific Approaches

We will build a cohort of patients with diabetes aged 40 and older, with no prior glaucoma diagnosis at baseline to assess glaucoma incidence. We will build a cohort of patients with diabetes aged 40 and older with an existing diagnosis of glaucoma to assess glaucoma progression. Then we will develop concept sets and extract data on outcomes (i.e. diagnosis of glaucoma, glaucoma progression represented by need for glaucoma surgery), as well as predictors including clinical data and social data. Analyses will be performed in R notebooks within the All of Us Workbench environment.

Anticipated Findings

We anticipate that metformin use will be associated with a reduced risk of developing primary open-angle glaucoma and reduced risk of progression to glaucoma surgery.

Demographic Categories of Interest

  • Race / Ethnicity
  • Age
  • Geography
  • Disability Status
  • Access to Care
  • Education Level
  • Income Level

Data Set Used

Registered Tier

Research Team

Owner:

Collaborators:

  • Kaela Acuff - Graduate Trainee, University of California, San Diego
  • Alison Chan - Graduate Trainee, University of California, San Diego

Metformin and Glaucoma v7

There remain limited treatment options for glaucoma outside lowering intraocular pressure, which is not effective in all patients. Metformin, an antihyperglycemic drug used for the management of diabetes, is being increasingly explored for its neuroprotective effects in the eye. We…

Scientific Questions Being Studied

There remain limited treatment options for glaucoma outside lowering intraocular pressure, which is not effective in all patients. Metformin, an antihyperglycemic drug used for the management of diabetes, is being increasingly explored for its neuroprotective effects in the eye. We would like to investigate the relationship between metformin use and primary open-angle glaucoma incidence and progression using All of Us Data, given the limited studies focusing on this topic.

Project Purpose(s)

  • Drug Development

Scientific Approaches

We will build a cohort of patients with diabetes aged 40 and older, with no prior glaucoma diagnosis at baseline to assess glaucoma incidence. We will build a cohort of patients with diabetes aged 40 and older with an existing diagnosis of glaucoma to assess glaucoma progression. Then we will develop concept sets and extract data on outcomes (i.e. diagnosis of glaucoma, glaucoma progression represented by need for glaucoma surgery), as well as predictors including clinical data and social data. Analyses will be performed in R notebooks within the All of Us Workbench environment.

Anticipated Findings

We anticipate that metformin use will be associated with a reduced risk of developing primary open-angle glaucoma and reduced risk of progression to glaucoma surgery.

Demographic Categories of Interest

  • Race / Ethnicity
  • Age
  • Geography
  • Disability Status
  • Access to Care
  • Education Level
  • Income Level

Data Set Used

Registered Tier

Research Team

Owner:

Collaborators:

  • Niloofar Radgoudarzi - Graduate Trainee, University of California, San Diego
  • Kaela Acuff - Graduate Trainee, University of California, San Diego
  • Alison Chan - Graduate Trainee, University of California, San Diego

Calcium channel blocker and Glaucoma

We look at the patients who used calcium channel blockers(CCB) and analyze if it affects the prevalence or progression of primary open-angle glaucoma(POAG) patients by using the All of Us research data set. the specific questions we will ask are:…

Scientific Questions Being Studied

We look at the patients who used calcium channel blockers(CCB) and analyze if it affects the prevalence or progression of primary open-angle glaucoma(POAG) patients by using the All of Us research data set. the specific questions we will ask are:
1.what is the population of patients who use CCBrand have/ have not POAG?
2. What is the effect of using CCB on POAG people? is it increase the prevalence or progression of POAG?
3. What other factors will CCB affect that affect the POAG people too?
4. What is the effect of CCB on Glaucoma?
5. What is the reason for the change in glaucoma prevalence and progression by using CCB?
6 What is the effect of other Blood pressure medication on POAG?
we hypothesized that using the CCB may cause the increased prevalence and progression of Glaucoma in POAG patients. This study will give a better understanding of blood pressure medication's effect on Glaucoma.

Project Purpose(s)

  • Educational

Scientific Approaches

We use All of the US data sets for people who have POAG and using CCB and are more than 40 years old. We will use R to analyze the data with the t-test and chi-square test, and use multivariant and single variant models with logistic regression. First, describe the characteristic data of our population and analyze characteristic data (Sex, Race, Ethnicity, Age,...). Second, we analyze with the t-test and chi-square test between the patient who uses/does not CCB and has/has not POAG and calculate the p-value. Third, we analyze by using logistic and linear regression between the variables we have including the CCB, POAG, systolic and diastolic blood pressure, age, race, sex, ethnicity, lipid profile, and BMI. we will describe the effect of CCB by using the other factors on the prevalence and progression of POAG. The limitation is we don't have series eye pressure and visual field of POAG and nonPOAG people and we don't know if the patient was adherent to the CCB medication or not.

Anticipated Findings

For this study, we expected to realize the effect of systemic medication on Glaucoma. because glaucoma is the first cause of blindness in the world it is so important to find out different factors that affect glaucoma, where we can slow the progression or decrease the prevalence rate. we will find out if the dosing and duration of usage of systemic medication will affect glaucoma and we can compound it for glaucoma patients. importantly, the detailed code developed will be made available within the researcher workbench, so other researchers may more easily extract systemic medication data in glaucoma patients. we believe this study will help both ophthalmologists and internists a lot, besides it is great for glaucoma patients and public health by reducing the risk of the first cause of blindness in the world.

Demographic Categories of Interest

This study will not center on underrepresented populations.

Data Set Used

Registered Tier

Research Team

Owner:

Collaborators:

  • Sophia Sidhu - Graduate Trainee, University of California, San Diego

Calcium channel blocker and Glaucoma v7

We look at the patients who used calcium channel blockers(CCB) and analyze if it affects the prevalence or progression of primary open-angle glaucoma(POAG) patients by using the All of Us research data set. the specific questions we will ask are:…

Scientific Questions Being Studied

We look at the patients who used calcium channel blockers(CCB) and analyze if it affects the prevalence or progression of primary open-angle glaucoma(POAG) patients by using the All of Us research data set. the specific questions we will ask are:
1.what is the population of patients who use CCBrand have/ have not POAG?
2. What is the effect of using CCB on POAG people? is it increase the prevalence or progression of POAG?
3. What other factors will CCB affect that affect the POAG people too?
4. What is the effect of CCB on Glaucoma?
5. What is the reason for the change in glaucoma prevalence and progression by using CCB?
6 What is the effect of other Blood pressure medication on POAG?
we hypothesized that using the CCB may cause the increased prevalence and progression of Glaucoma in POAG patients. This study will give a better understanding of blood pressure medication's effect on Glaucoma.

Project Purpose(s)

  • Educational

Scientific Approaches

We use All of the US data sets for people who have POAG and using CCB and are more than 40 years old. We will use R to analyze the data with the t-test and chi-square test, and use multivariant and single variant models with logistic regression. First, describe the characteristic data of our population and analyze characteristic data (Sex, Race, Ethnicity, Age,...). Second, we analyze with the t-test and chi-square test between the patient who uses/does not CCB and has/has not POAG and calculate the p-value. Third, we analyze by using logistic and linear regression between the variables we have including the CCB, POAG, systolic and diastolic blood pressure, age, race, sex, ethnicity, lipid profile, and BMI. we will describe the effect of CCB by using the other factors on the prevalence and progression of POAG. The limitation is we don't have series eye pressure and visual field of POAG and nonPOAG people and we don't know if the patient was adherent to the CCB medication or not.

Anticipated Findings

For this study, we expected to realize the effect of systemic medication on Glaucoma. because glaucoma is the first cause of blindness in the world it is so important to find out different factors that affect glaucoma, where we can slow the progression or decrease the prevalence rate. we will find out if the dosing and duration of usage of systemic medication will affect glaucoma and we can compound it for glaucoma patients. importantly, the detailed code developed will be made available within the researcher workbench, so other researchers may more easily extract systemic medication data in glaucoma patients. we believe this study will help both ophthalmologists and internists a lot, besides it is great for glaucoma patients and public health by reducing the risk of the first cause of blindness in the world.

Demographic Categories of Interest

This study will not center on underrepresented populations.

Data Set Used

Registered Tier

Research Team

Owner:

Collaborators:

  • Sophia Sidhu - Graduate Trainee, University of California, San Diego

Depression Fitbit Study (Clinical Phenotyping)

Major depressive disorder (MDD) is associated with changes in physical activity, fidgeting/restlessness, energy levels, and sleep patterns. It has also been established that most MDD patients have recurrent episodes, separated by periods of "remission" that may last 2 months or…

Scientific Questions Being Studied

Major depressive disorder (MDD) is associated with changes in physical activity, fidgeting/restlessness, energy levels, and sleep patterns. It has also been established that most MDD patients have recurrent episodes, separated by periods of "remission" that may last 2 months or more. The purpose of this study is to assess the ability of the Fitbit data to longitudinally distinguish individuals with and without a depression diagnosis during a transitional phase coded in the medical record (i.e., a new or change in diagnostic code). We will focus primarily on daily physical activity (minutes of activity, steps traveled, elevation traveled), energy expenditure (calories burned), and heart rate.

Project Purpose(s)

  • Disease Focused Research (major depressive disorder)
  • Social / Behavioral

Scientific Approaches

We will build datasets and cohorts of individuals meeting the MDD/depression diagnostic criteria, as well as subsets for severity and additional modifiers. We will perform time series analysis of the Fitbit data with machine learning models, and assess their performance in the above questions. We will look specifically for trends and patterns in the time series Fitbit data that may be unique to the MDD/depression group.

Anticipated Findings

Consumer-grade technology has been pushing into the field of health and wellness. While previous studies have evaluated the performance of wearables in psychiatric and cardiovascular diseases, few have the sample sizes or data collection lengths made possible by the All of Us. We know that MDD comes with it changes in physical activity, and positive results may reinforce the role of wearable technology as a confirmatory step in the diagnostic process. Null results, on the other hand, will highlight the unique challenges of consumer health-related technologies, especially as these devices are becoming more and more common.

Demographic Categories of Interest

This study will not center on underrepresented populations.

Data Set Used

Registered Tier

Research Team

Owner:

Collaborators:

  • Tonya Lee - Graduate Trainee, University of California, San Diego
  • James Ades - Project Personnel, University of California, San Diego

Alcohol and Glaucoma (V7)

Scientific research question: How does alcohol affect glaucoma prevalence, risk, and severity? Why this is important: There has been contradicting evidence on how alcohol affects glaucoma. Research has shown acute alcohol consumption reduces intraocular pressure while the evidence for chronic…

Scientific Questions Being Studied

Scientific research question: How does alcohol affect glaucoma prevalence, risk, and severity?
Why this is important: There has been contradicting evidence on how alcohol affects glaucoma. Research has shown acute alcohol consumption reduces intraocular pressure while the evidence for chronic consumption is unclear. Our study hopes to better elucidate how alcohol affects glaucoma, which deserves particular attention given the high prevalence of alcohol consumption and the danger of glaucoma.

Project Purpose(s)

  • Disease Focused Research (Glaucoma)

Scientific Approaches

The datasets that we will be using are mainly: alcohol data, primary open-angle glaucoma data, and genetic data. Research methods: we will analyze any association between alcohol and glaucoma outcomes, detect whether there is a dose-response relationship to this association, if any, and whether genetics modulate the association. Guided statistics will be used to answer our research questions.

Anticipated Findings

Given the conflicting evidence regarding alcohol use on glaucoma, the anticipated findings are hard to predict. This highlights the importance of our project, as All of Us provides a large and diverse participant pool for us to better validate existing literature findings on alcohol and glaucoma.

Demographic Categories of Interest

This study will not center on underrepresented populations.

Data Set Used

Controlled Tier

Research Team

Owner:

Alcohol and Glaucoma (V6)

Scientific research question: How does alcohol affect glaucoma prevalence, risk, and severity? Why this is important: There has been contradicting evidence on how alcohol affects glaucoma. Research has shown acute alcohol consumption reduces intraocular pressure while the evidence for chronic…

Scientific Questions Being Studied

Scientific research question: How does alcohol affect glaucoma prevalence, risk, and severity?
Why this is important: There has been contradicting evidence on how alcohol affects glaucoma. Research has shown acute alcohol consumption reduces intraocular pressure while the evidence for chronic consumption is unclear. Our study hopes to better elucidate how alcohol affects glaucoma, which deserves particular attention given the high prevalence of alcohol consumption and the danger of glaucoma.

Project Purpose(s)

  • Disease Focused Research (Glaucoma)

Scientific Approaches

The datasets that we will be using are mainly: alcohol data, primary open-angle glaucoma data, and genetic data. Research methods: we will analyze any association between alcohol and glaucoma outcomes, detect whether there is a dose-response relationship to this association, if any, and whether genetics modulate the association. Guided statistics will be used to answer our research questions.

Anticipated Findings

Given the conflicting evidence regarding alcohol use on glaucoma, the anticipated findings are hard to predict. This highlights the importance of our project, as All of Us provides a large and diverse participant pool for us to better validate existing literature findings on alcohol and glaucoma.

Demographic Categories of Interest

This study will not center on underrepresented populations.

Data Set Used

Controlled Tier

Research Team

Owner:

SDHA in Eye Conditions - v6 Dataset

We are planning to explore disparities in healthcare access and utilization for patients with eye conditions across different demographic groups. We would like to evaluate risk of developing advanced/severe disease in different eye conditions, and understand how social determinants contribute…

Scientific Questions Being Studied

We are planning to explore disparities in healthcare access and utilization for patients with eye conditions across different demographic groups. We would like to evaluate risk of developing advanced/severe disease in different eye conditions, and understand how social determinants contribute to this risk while adjusting for other known risk factors. We are also interested in understanding the availability of social determinants of health data in this data repository compared to EHR clinical data warehouses alone.

Project Purpose(s)

  • Population Health

Scientific Approaches

We will build cohorts of patients with various eye diseases (i.e. diabetic retinopathy, retinal vein occlusions, glaucoma, etc.). Then we will develop concept sets and extract data on outcomes (i.e. development of complications), as well as predictors including clinical data and social data. We will draw on survey data and EHR data within All of Us. When genomic data and wearable data become available, we are interested in evaluating those data sources as well. We will use statistical modeling and machine learning to generate predictive models.

Anticipated Findings

We anticipate that there may be differential risk for developing complications based on disparities in healthcare access and utilization for patients with eye conditions.

Demographic Categories of Interest

  • Race / Ethnicity
  • Age
  • Geography
  • Disability Status
  • Access to Care
  • Education Level
  • Income Level

Data Set Used

Registered Tier

Research Team

Owner:

Collaborators:

  • Joy Guo - Graduate Trainee, University of California, San Diego
  • Bonnie Huang - Graduate Trainee, Northwestern University
  • Kiana Tavakoli - Research Fellow, University of California, San Diego

Genetics and Glaucoma

We are studying genomic variation in glaucoma and would like to use the AllofUs dataset to validate prior GWASes. This question is important because a lot of studies have been performed on populations of European descent, but it is important…

Scientific Questions Being Studied

We are studying genomic variation in glaucoma and would like to use the AllofUs dataset to validate prior GWASes. This question is important because a lot of studies have been performed on populations of European descent, but it is important to look at genetic variation in non-European populations as well. AllofUs has a diverse enrollment, which is perfect for this study.

Project Purpose(s)

  • Disease Focused Research (Glaucoma)
  • Ancestry

Scientific Approaches

For this study, we plan on performing a GWAS to identify variants associated with glaucoma in the AllofUs dataset. For cases, we plan on including patients with POAG diagnosis codes and surgical codes and genomic data, while the control cohort would consist of adults with genomic data but without POAG. Tools we plan on using include HAIL in accordance with the All of Us example notebooks to perform the GWAS. Data visualization methods will include Manhattan plots, QQ plots, and identification of significant genetic variants associated with glaucoma.

Anticipated Findings

Using the AllofUs dataset, which contains data from diverse populations, we are hoping to validate previous GWAS results that have mostly been performed on European populations. Our findings would contribute by identifying genetic variants associated with glaucoma in non-European populations. Furthermore, in the future we also hope to use these results to study the relative contribution of genetic variation versus social determinants to glaucoma.

Demographic Categories of Interest

  • Race / Ethnicity

Data Set Used

Controlled Tier

Research Team

Owner:

  • Sally Baxter - Research Fellow, University of California, San Diego
  • Bonnie Huang - Graduate Trainee, Northwestern University

Metformin and Glaucoma v6

There remain limited treatment options for glaucoma outside lowering intraocular pressure, which is not effective in all patients. Metformin, an antihyperglycemic drug used for the management of diabetes, is being increasingly explored for its neuroprotective effects in the eye. We…

Scientific Questions Being Studied

There remain limited treatment options for glaucoma outside lowering intraocular pressure, which is not effective in all patients. Metformin, an antihyperglycemic drug used for the management of diabetes, is being increasingly explored for its neuroprotective effects in the eye. We would like to investigate the relationship between metformin use and primary open-angle glaucoma incidence and progression using All of Us Data, given the limited studies focusing on this topic.

Project Purpose(s)

  • Drug Development

Scientific Approaches

We will build a cohort of patients with diabetes aged 40 and older, with no prior glaucoma diagnosis at baseline to assess glaucoma incidence. We will build a cohort of patients with diabetes aged 40 and older with an existing diagnosis of glaucoma to assess glaucoma progression. Then we will develop concept sets and extract data on outcomes (i.e. diagnosis of glaucoma, glaucoma progression represented by need for glaucoma surgery), as well as predictors including clinical data and social data. Analyses will be performed in R notebooks within the All of Us Workbench environment.

Anticipated Findings

We anticipate that metformin use will be associated with a reduced risk of developing primary open-angle glaucoma and reduced risk of progression to glaucoma surgery.

Demographic Categories of Interest

  • Race / Ethnicity
  • Age
  • Geography
  • Disability Status
  • Access to Care
  • Education Level
  • Income Level

Data Set Used

Registered Tier

Research Team

Owner:

Collaborators:

  • Bonnie Huang - Graduate Trainee, Northwestern University

Glaucoma Severity

This study intends to analyze various socioeconomic characteristics across glaucoma stages to assess if disease severity correlates with factors such as race/ethnicity, income, education level, or insurance status. The same cohort will then be used to see if certain barriers…

Scientific Questions Being Studied

This study intends to analyze various socioeconomic characteristics across glaucoma stages to assess if disease severity correlates with factors such as race/ethnicity, income, education level, or insurance status. The same cohort will then be used to see if certain barriers to care identified in the Health Care Access and Utilization Survey correlate with worsening glaucoma severity. This will help guide interventions to improve eye care utilization and eye care disparities.

Project Purpose(s)

  • Population Health

Scientific Approaches

Our cohort is made up of patients diagnosed with glaucoma and separated by stage to include mild, moderate, severe, and unspecified with limits to ensure patients are not counted multiple times. Patients with multiple glaucoma diagnoses are excluded. The desired characteristics such as age, age at first diagnosis, income, education, insurance status, and race/ethnicity have been added to the concept set as well as questions relating to eye care and barriers to care chosen from the HCAUS. Variables will be compared across glaucoma stages using chi square analysis and odds ratios. Findings will guide us towards potential interventions to improve healthcare disparities. Analysis will be conducted within the NIH All of Us Workspace.

Anticipated Findings

Anticipated findings include disparities based on socioeconomic factors leading to increased severity of disease among patients from disadvantaged backgrounds. It is anticipated that answers to the HCAUS will highlight barriers to care which may be contributing to these disparities and lead to the development of action plans which will help alleviate these disparities.

Demographic Categories of Interest

  • Race / Ethnicity
  • Age
  • Geography
  • Access to Care
  • Education Level

Data Set Used

Registered Tier

Research Team

Owner:

Social Determinants and Healthcare Access in Glaucoma

Glaucoma is a progressive optic neuropathy and the leading cause of irreversible blindness worldwide. Glaucoma care is costly because proper management consists of close monitoring of optic nerve health and may include complicated and costly medical and surgical regimens. The…

Scientific Questions Being Studied

Glaucoma is a progressive optic neuropathy and the leading cause of irreversible blindness worldwide. Glaucoma care is costly because proper management consists of close monitoring of optic nerve health and may include complicated and costly medical and surgical regimens.

The cost of glaucoma care may be unmanageable for lower income patients in the United States. There is evidence that lower socioeconomic status is associated with glaucoma progression, which may be mediated through poor medication adherence. However, whether glaucoma patients differ with respect to other barriers of healthcare access and utilization, such as affordability and delays in care, is less clear.

In this workspace, we aim to explore demographics, socioeconomic factors, and barriers to healthcare access and utilization for patients with glaucoma. This will provide insights into existing disparities and health inform subsequent public health interventions to improve access to vision-preserving eye care.

Project Purpose(s)

  • Population Health

Scientific Approaches

We will study adult participants diagnosed with glaucoma and analyze data from the Basics survey as well as the Healthcare Access and Utilization Survey. Variables will include age, gender, race/ethnicity, marital status, education, employment, income, housing status, insurance status. For healthcare access and utilization, we will study questions pertaining to access to seeing healthcare professionals and ability to afford care. We will also examine reasons for delaying care, such as delayed care due to co-pay, childcare, elderly care, out of pocket costs, not being able to get time off work, transportation issues, and living in a rural area in the past year. Analyses will include descriptive statistics as well as multivariable logistic regression modeling.

Anticipated Findings

We anticipate that there may be gender-related, race-related, or socioeconomic disparities in healthcare access and utilization for patients with glaucoma. We also hypothesize that glaucoma patients may face more barriers to care than those without glaucoma, due to the need for chronic care management, presence of visual impairment, and based on prior studies in this area. These analyses will be useful because glaucoma disproportionately affects women and minorities, who have not always been well-represented in prior datasets. All of Us has excellent representation of these populations, and so findings generated will likely be more generalizable and help inform downstream interventions aimed at improving access and utilization of eye care.

Demographic Categories of Interest

  • Race / Ethnicity
  • Age
  • Geography
  • Disability Status
  • Access to Care
  • Education Level
  • Income Level

Data Set Used

Registered Tier

Research Team

Owner:

  • Sally Baxter - Research Fellow, University of California, San Diego

Original - Social Determinants and Healthcare Access in Eye Conditions

We are planning to explore disparities in healthcare access and utilization for patients with eye conditions across different demographic groups. We would like to evaluate risk of developing advanced/severe disease in different eye conditions, and understand how social determinants contribute…

Scientific Questions Being Studied

We are planning to explore disparities in healthcare access and utilization for patients with eye conditions across different demographic groups. We would like to evaluate risk of developing advanced/severe disease in different eye conditions, and understand how social determinants contribute to this risk while adjusting for other known risk factors. We are also interested in understanding the availability of social determinants of health data in this data repository compared to EHR clinical data warehouses alone.

Project Purpose(s)

  • Population Health

Scientific Approaches

We will build cohorts of patients with various eye diseases (i.e. diabetic retinopathy, retinal vein occlusions, glaucoma, etc.). Then we will develop concept sets and extract data on outcomes (i.e. development of complications), as well as predictors including clinical data and social data. We will draw on survey data and EHR data within All of Us. When genomic data and wearable data become available, we are interested in evaluating those data sources as well. We will use statistical modeling and machine learning to generate predictive models.

Anticipated Findings

We anticipate that there may be differential risk for developing complications based on disparities in healthcare access and utilization for patients with eye conditions.

Demographic Categories of Interest

  • Race / Ethnicity
  • Age
  • Geography
  • Disability Status
  • Access to Care
  • Education Level
  • Income Level

Data Set Used

Registered Tier

Research Team

Owner:

Collaborators:

  • Hua Ou - Mid-career Tenured Researcher, National Institute of Child Health and Human Development (NIH - NICHD)

SDHA in Eye Conditions - v5 Dataset

We are planning to explore disparities in healthcare access and utilization for patients with eye conditions across different demographic groups. We would like to evaluate risk of developing advanced/severe disease in different eye conditions, and understand how social determinants contribute…

Scientific Questions Being Studied

We are planning to explore disparities in healthcare access and utilization for patients with eye conditions across different demographic groups. We would like to evaluate risk of developing advanced/severe disease in different eye conditions, and understand how social determinants contribute to this risk while adjusting for other known risk factors. We are also interested in understanding the availability of social determinants of health data in this data repository compared to EHR clinical data warehouses alone.

Project Purpose(s)

  • Population Health

Scientific Approaches

We will build cohorts of patients with various eye diseases (i.e. diabetic retinopathy, retinal vein occlusions, glaucoma, etc.). Then we will develop concept sets and extract data on outcomes (i.e. development of complications), as well as predictors including clinical data and social data. We will draw on survey data and EHR data within All of Us. When genomic data and wearable data become available, we are interested in evaluating those data sources as well. We will use statistical modeling and machine learning to generate predictive models.

Anticipated Findings

We anticipate that there may be differential risk for developing complications based on disparities in healthcare access and utilization for patients with eye conditions.

Demographic Categories of Interest

  • Race / Ethnicity
  • Age
  • Geography
  • Disability Status
  • Access to Care
  • Education Level
  • Income Level

Data Set Used

Registered Tier

Research Team

Owner:

  • Terrence Lee - Graduate Trainee, University of California, San Diego
  • Tonya Lee - Graduate Trainee, University of California, San Diego
  • Sophia Sidhu - Graduate Trainee, University of California, San Diego
  • Sally Baxter - Research Fellow, University of California, San Diego
  • Kaela Acuff - Graduate Trainee, University of California, San Diego
  • John McDermott - Graduate Trainee, University of California, San Diego
  • Grace Ahn - Graduate Trainee, University of California, San Diego
  • Gordon Ye - Undergraduate Student, University of California, San Diego
  • Alison Chan - Graduate Trainee, University of California, San Diego
  • Bita Shahrvini - Graduate Trainee, University of California, San Diego
  • Bharanidharan Radha Saseendrakumar - Project Personnel, University of California, San Diego
  • Arash Delavar - Research Fellow, Baylor College of Medicine

Collaborators:

  • Francis Ratsimbazafy - Other, All of Us Program Operational Use
  • Jun Qian - Other, All of Us Program Operational Use
  • Joy Guo - Graduate Trainee, University of California, San Diego
  • Bonnie Huang - Graduate Trainee, Northwestern University

Evaluating the Role of Potential Neuroprotective Agents in Glaucoma

Glaucoma, a chronic neurodegenerative disease of retinal ganglion cells (RGCs), is a leading cause of irreversible blindness worldwide. Its management currently focuses on lowering intraocular pressure to slow disease progression. However, disease-modifying, neuroprotective treatments for glaucoma remain a major unmet…

Scientific Questions Being Studied

Glaucoma, a chronic neurodegenerative disease of retinal ganglion cells (RGCs), is a leading cause of irreversible blindness worldwide. Its management currently focuses on lowering intraocular pressure to slow disease progression. However, disease-modifying, neuroprotective treatments for glaucoma remain a major unmet need. Several studies have been performed demonstrating potential for "repurposing" existing medications for protecting RGCs and mitigating the risk of developing glaucoma and/or slowing the progression of glaucoma. However, many of these studies have been performed in basic science settings using animal models and lack large-scale human data for validation. In this workspace, we plan to explore existing data on a diverse nationwide cohort to further evaluate the potential validity of candidate neuroprotective medications for influencing risk of glaucoma.

Project Purpose(s)

  • Disease Focused Research (Glaucoma)

Scientific Approaches

We will primarily employ methods in clinical epidemiology, biostatistics, and machine learning. For questions relating to risk of developing glaucoma, we will examine data from a general older adult population and investigate whether use of candidate medications decreases the risk of developing glaucoma. For questions relating to risk of progressing glaucoma, we will examine data from a cohort of participants with existing diagnoses of glaucoma and evaluate whether use of candidate medications increases the risk of diagnosis codes related to greater severity. Depending on cohort size and the specific medication of interest, we may use cohort study or case-control study approaches. To examine associations of risk, we may use regression modeling, chi-squared analyses, longitudinal modeling, or machine learning methods, depending on the available cohort sizes and the characteristics of the predictor and outcome variables.

Anticipated Findings

We anticipate that this work will provide some validation of findings from the basic science literature by using real-world clinical data to support findings in animal models. Some of the medications may prove to be supported by human data, whereas others may not. Furthermore, we may even identify novel candidate medications not previously identified in the literature. This will advance the scientific knowledge of novel therapeutics for the prevention and treatment of glaucoma.

Demographic Categories of Interest

  • Age

Data Set Used

Registered Tier

Research Team

Owner:

Research Program for Vision Surveillance: Diabetes and Diabetic Retinopathy

How do data from the All of Us database compare against known data sources that are considered to be representative of the general population and have been traditionally used in vision health surveillance activities (such as NHANES, NHIS, etc.)? How…

Scientific Questions Being Studied

How do data from the All of Us database compare against known data sources that are considered to be representative of the general population and have been traditionally used in vision health surveillance activities (such as NHANES, NHIS, etc.)? How does All of Us compare to existing big-data sources such as IQVIA?

There is increasing interest in understanding how social factors impact health and vision outcomes. Social determinants of health are important considerations for disease management and prognosis, and our representative use case (diabetes and diabetic retinopathy) has huge implications for our health system as the leading cause of blindness and visual impairment among working-age adults in the United States. By answering the above questions, we can determine whether the All of Us database is representative and may be broadly generalizable for future studies.

Project Purpose(s)

  • Control Set

Scientific Approaches

- Develop standard cohort definition for diabetes
- Develop standard cohort definition for diabetic retinopathy
- Determine prevalence of diabetes and compare across different data sources – All of Us, NHANES, NHIS, IQVIA
o Numerator: Number of adults with diabetes
o Denominator: Total number of adults available in data source
- Determine prevalence of diabetic retinopathy and compare across different data sources – All of Us, NHANES, NHIS, IQVIA
o Numerator: Number of adults with diabetic retinopathy
o Denominator: Total number of adults available in data source vs. total number of adults with diabetes
- For prevalence calculations, will need to establish defined study periods and ensure consistency across data sources
- Potential analyses:
o Look at state/regional variations
o Examine demographics (age, gender, race, ethnicity) of cohorts across data sources
- Identify areas of similarity/alignment vs. differences

Anticipated Findings

If we are able to demonstrate that the All of Us database is representative and aligns with existing nationwide data sources, then findings regarding links between social determinants and vision health outcomes using All of Us would be felt to be more broadly generalizable. On the other hand, if there are major discrepancies between All of Us and previously established data sources, this would be important information for the vision research community to be aware of, and this could even inform future efforts to make the database more representative.

Demographic Categories of Interest

  • Race / Ethnicity
  • Age
  • Geography
  • Access to Care

Data Set Used

Registered Tier

Research Team

Owner:

SDHA in Eye Conditions - v4 Dataset

We are planning to explore disparities in healthcare access and utilization for patients with eye conditions across different demographic groups. We would like to evaluate risk of developing advanced/severe disease in different eye conditions, and understand how social determinants contribute…

Scientific Questions Being Studied

We are planning to explore disparities in healthcare access and utilization for patients with eye conditions across different demographic groups. We would like to evaluate risk of developing advanced/severe disease in different eye conditions, and understand how social determinants contribute to this risk while adjusting for other known risk factors. We are also interested in understanding the availability of social determinants of health data in this data repository compared to EHR clinical data warehouses alone.

Project Purpose(s)

  • Population Health

Scientific Approaches

We will build cohorts of patients with various eye diseases (i.e. diabetic retinopathy, retinal vein occlusions, glaucoma, etc.). Then we will develop concept sets and extract data on outcomes (i.e. development of complications), as well as predictors including clinical data and social data. We will draw on survey data and EHR data within All of Us. When genomic data and wearable data become available, we are interested in evaluating those data sources as well. We will use statistical modeling and machine learning to generate predictive models.

Anticipated Findings

We anticipate that there may be differential risk for developing complications based on disparities in healthcare access and utilization for patients with eye conditions.

Demographic Categories of Interest

  • Race / Ethnicity
  • Age
  • Geography
  • Disability Status
  • Access to Care
  • Education Level
  • Income Level

Data Set Used

Registered Tier

Research Team

Owner:

Social Determinants and Healthcare Access in Eye Conditions - v4 Dataset

We are planning to explore disparities in healthcare access and utilization for patients with eye conditions across different demographic groups. We would like to evaluate risk of developing advanced/severe disease in different eye conditions, and understand how social determinants contribute…

Scientific Questions Being Studied

We are planning to explore disparities in healthcare access and utilization for patients with eye conditions across different demographic groups. We would like to evaluate risk of developing advanced/severe disease in different eye conditions, and understand how social determinants contribute to this risk while adjusting for other known risk factors. We are also interested in understanding the availability of social determinants of health data in this data repository compared to EHR clinical data warehouses alone.

Project Purpose(s)

  • Population Health

Scientific Approaches

We will build cohorts of patients with various eye diseases (i.e. diabetic retinopathy, retinal vein occlusions, glaucoma, etc.). Then we will develop concept sets and extract data on outcomes (i.e. development of complications), as well as predictors including clinical data and social data. We will draw on survey data and EHR data within All of Us. When genomic data and wearable data become available, we are interested in evaluating those data sources as well. We will use statistical modeling and machine learning to generate predictive models.

Anticipated Findings

We anticipate that there may be differential risk for developing complications based on disparities in healthcare access and utilization for patients with eye conditions.

Demographic Categories of Interest

  • Race / Ethnicity
  • Age
  • Geography
  • Disability Status
  • Access to Care
  • Education Level
  • Income Level

Data Set Used

Registered Tier

Research Team

Owner:

Collaborators:

  • Priyanka Soe - Project Personnel, University of California, San Diego
  • Mahasweta Nayak - Undergraduate Student, University of California, San Diego
  • Cecilia Vallejos - Undergraduate Student, University of California, San Diego

Retinal Vein Occlusion and associated risk factors

To assess for risk factors for retinal vein occlusion (RVO) among participants in the NIH All of Us database, particularly social risk factors that have not been well-studied, including substance use.

Scientific Questions Being Studied

To assess for risk factors for retinal vein occlusion (RVO) among participants in the NIH All of Us database, particularly social risk factors that have not been well-studied, including substance use.

Project Purpose(s)

  • Disease Focused Research (retinal vein occlusion)

Scientific Approaches

Data will be extracted regarding demographics, co-morbidities, income, housing, insurance, and substance use. Opioid use will be defined by relevant diagnosis and prescription codes, with prescription use >30 days. Controls will be sampled at a 4:1 control to case ratio from a pool of individuals >18 years of age without a diagnosis of RVO and proportionally matched to the demographic distribution of the 2019 U.S. census. We will use multivariable logistic regression to identify medical and social determinants significantly associated with RVO. Statistical significance will be defined as p<0.05.

Anticipated Findings

Understanding RVO risk factors is important for primary prevention and improving visual outcomes. Several studies have demonstrated an increasing prevalence of RVO with age, but little consensus has been reached regarding associations with race and/or ethnicity. Other studies exploring medical risk factors have shown strong associations with hypertension, hyperlipidemia, diabetes mellitus, glaucoma and cigarette smoking. However, the majority of these studies were conducted on small populations limited to individuals identifying as Asian or white. Few studies have investigated associations with substance use outside of cigarettes and alcohol. The opioid epidemic began in the early 2000s, and as of 2019, more than 1.6 million Americans suffer from opioid use disorder. Given that long term opioid use increases risk of cardiovascular events such as myocardial infarction, an investigation into whether opioid use increases risk of retinal vascular disease, such as RVO, is warranted

Demographic Categories of Interest

This study will not center on underrepresented populations.

Data Set Used

Registered Tier

Research Team

Owner:

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