Active Research Projects
Real-World Effectiveness of GLP-1/GIP Medications for Reducing the Cardiovascular Disease Burden
Sponsored by the American Heart Association
Semaglutide and tirzepatide, two novel glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic (GIP) polypeptide receptor agonists (RAs), have shown strong potential as treatments for cardiovascular disease (CVD) in clinical trials. However, access to GLP-1/GIP RAs remains limited, with early evidence indicating that higher-income adults, urban residents, and those living in the Northeast are primarily benefiting, despite obesity disproportionately affecting Black and Hispanic adults, adults with lower incomes, and adults in the South and Midwest. In this project, we will use electronic health record data to examine the effectiveness of GLP-1/GIP RAs in reducing CVD risk in real-world settings where access and adherence to treatment may differ compared to clinical trials. Dr. Stokes and team will use comprehensive data from Dandelion Health to examine heterogeneity in use of GLP-1/GIP RAs by sex, race, ethnicity, and religion among patients living with obesity. The team also seeks to investigate whether GLP-1/GIP RA initiation has a causal effect on CVD risk reduction as identified by CVD biomarkers overall and in different population subgroups. Finally, we aim to apply novel artificial intelligence methods to predict potential population-level reductions in risk for major adverse cardiovascular events (MACEs) if all patients with CVD were treated with GLP-1/GIP RAs. Through this research, we seek to inform treatment practices for CVD and efforts to expand use of GLP-1/GIP RAs, addressing inequities in access.
Investigating How Glucagon-like Peptide-1 Inhibitors Are Changing Obesity Care in the U.S.
Sponsored by the Robert Wood Johnson Foundation
The use of obesity-related health care remains low, especially by populations disproportionately impacted by food deserts and other contextual determinants that contribute to high BMI. The emergence of Glucagon-Like Peptide-1 (GLP-1) inhibitors may hold promise for improving care of health conditions associated with obesity. However, preliminary evidence indicates that use in populations most impacted by obesity, diabetes, and other associated health conditions is low. In this research, Dr. Stokes and collaborators seek to investigate how the emergence of GLP-1 inhibitors is changing the obesity-related care continuum in the U.S., whether health effects of GLP-1 inhibitors observed in clinical trials translate in real-world settings and across subpopulations, and the projected population health effects of GLP-1 inhibitors under various health policy scenarios. In this work, the team is interested in examining effects in both the overall U.S. population and in subpopulations disproportionately impacted by obesity (e.g. racially minoritized populations, people living below the poverty line, rural residents, persons with disabilities, and sexual and gender minorities). The team also seeks to give attention to issues of health equity, weight-based discrimination, and structural determinants of obesity, acknowledging the complexity of this health issue.
Racial/Ethnic Inequities, Data Integrity, and the Hidden Deaths of the Covid-19 Pandemic
Sponsored by the W.K. Kellogg Foundation
The accuracy of COVID-19 death certification is a public health issue at the intersection of racial justice and data integrity. Revealing the true mortality impact of the pandemic across the United States has the potential to have an immediate impact by influencing individuals and communities to pursue vaccination and other protective behaviors and by informing federal and state programs that seek to provide funds to those most impacted by the pandemic (i.e. FEMA funeral assistance). By producing estimates of excess mortality by race and ethnicity at the county-level and and estimates of excess mortality by race and ethnicity and place of death, our team wil examine racial and ethnic and geographic disparities in excess mortality during the COVID-19 pandemic. We will also work to identify communities and populations where large proportions of COVID-19 appear to have gone unrecognized, such as assessing whether there was differential under-reporting of COVID-19 deaths by race and ethnicity. Lastly, we will assess characteristics of health systems, death investigation systems, and other structural determinants associated with unrecognized COVID-19 deaths.
Novel Methods for Evaluating the Association Of Electronic Cigarette Use With Cardiovascular Health
Sponsored by the National Heart, Lung, and Blood Institute at the National Institutes of Health
Population-based evidence on the cardiovascular (CV) effects of e-cigarette use is sparse, and the particular components of e-cigarette aerosols that may be responsible for CV harm remain poorly elucidated. In this 5-year K01 study, Dr. Stokes seeks to integrate state-of-the-art causal inference methods, mediation analyses, and unsupervised data clustering approaches with the study of the CV effects of e-cigarette use. He will examine the association of e-cigarette use and product transitions with incident CV events, estimate associations of e-cigarette use with risk factors and preclinical biomarkers of CV injury, analyze biomarkers of exposure as potential mediators, and identify unique biomarker signatures of e-cigarette exposure using a data-driven clustering approach, and associate clusters with preclinical biomarkers of CV injury. With high quality population data and novel statistical methods to optimally control for cigarette smoking and other tobacco product use, the results of this project will provide timely and rigorous evidence on the CV effects of e-cigarette use. Together with evaluating the mediating role of exposure biomarkers and clustered e-cigarette use behavior patterns, the results will aim to inform Food and Drug Administration regulatory standards for product safety and guide primary and secondary public health interventions that seek to reduce tobacco-related CV harm. The methods and findings will also inform future studies focused on other non-cigarette tobacco products, such as little cigars, cigarillos, and smokeless tobacco products.