Associate Professor of Biostatistics
Associate Professor of Computer Science and Engineering, Tandon
Director of Center for Health Data Science
The overarching goal of Dr. Rumi Chunara's research is to develop computational and statistical approaches for acquiring, integrating and using data to improve population-level public health. She focuses on the design and development of data mining and machine learning methods to address challenges related to data and goals of public health, as well as fairness and ethics in the design and use of data and algorithms embedded in social systems.
At NYU, Dr. Chunara also leads the Chunara Lab, which develops computational and statistical methods across data mining, natural language processing, spatio-temporal analyses and machine learning, to study population health. Previously, she was a Postdoctoral Fellow and Instructor at HealthMap and the Children's Hospital Informatics Program at Harvard Medical School. She completed her PhD at the Harvard-MIT Division of Health Sciences and Technology and BSc at Caltech.
BS, Electrical Engineering (Honors), CaltechMS, Electrical Engineering and Computer Science, MITPhD, Medical and Electrical Engineering, MIT (Harvard-MIT Division of Health Sciences and Technology)
Max Planck Sabbatical Award (2021)speaker at NSF Computer and Information Science and Engineering Directorate Career Proposal Writing Workshop (2020)Invited tutorial on Public Health and Machine Learning at ACM Conference on Health, Inference and Learning (2020)Keynote at Human Computation and Crowdsourcing (2019)Invited Speaker at Expert Group Meeting at United Nations Population Fund, Advances in Mobile Technologies for Data Collection Panel (2019)Keynote at ''Mapping the Equity Dimensions of Artificial Intelligence in Public Health'', University of Toronto (2019)Facebook Research Award (2019)Gates Foundation Grand Challenges Exploration Award (2019)NSF CAREER Award (2019)MIT Technology Review Top 35 Innovators Under 35 (2014)MIT Presidential Fellow (2004)
Health DisparitiesMachine learningSocial ComputingSocial Determinants of Health
National cervical cancer burden estimation through systematic review and analysis of publicly available data in PakistanChughtai, N., Perveen, K., Gillani, S. R., Abbas, A., Chunara, R., Manji, A. A., Karani, S., Noorali, A. A., Zakaria, M., Shamsi, U., Chishti, U., Khan, A. A., Soofi, S., Pervez, S., & Samad, Z. (n.d.).
Journal titleBMC public health
Issue1AbstractBackground: Cervical cancer is a major cause of cancer-related deaths among women worldwide. Paucity of data on cervical cancer burden in countries like Pakistan hamper requisite resource allocation. Objective: To estimate the burden of cervical cancer in Pakistan using available data sources. Methods: We performed a systematic review to identify relevant data on Pakistan between 1995 to 2022. Study data identified through the systematic review that provided enough information to allow age specific incidence rates and age standardized incidence rates (ASIR) calculations for cervical cancer were merged. Population at risk estimates were derived and adjusted for important variables in the care-seeking pathway. The calculated ASIRs were applied to 2020 population estimates to estimate the number of cervical cancer cases in Pakistan. Results: A total of 13 studies reported ASIRs for cervical cancer for Pakistan. Among the studies selected, the Karachi Cancer Registry reported the highest disease burden estimates for all reported time periods: 1995–1997 ASIR = 6.81, 1998–2002 ASIR = 7.47, and 2017–2019 ASIR = 6.02 per 100,000 women. Using data from Karachi, Punjab and Pakistan Atomic Energy Cancer Registries from 2015–2019, we derived an unadjusted ASIR for cervical cancer of 4.16 per 100,000 women (95% UI 3.28, 5.28). Varying model assumptions produced adjusted ASIRs ranging from 5.2 to 8.4 per 100,000 women. We derived an adjusted ASIR of 7.60, (95% UI 5.98, 10.01) and estimated 6166 (95% UI 4833, 8305) new cases of cervical cancer per year. Conclusion: The estimated cervical cancer burden in Pakistan is higher than the WHO target. Estimates are sensitive to health seeking behavior, and appropriate physician diagnostic intervention, factors that are relevant to the case of cervical cancer, a stigmatized disease in a low-lower middle income country setting. These estimates make the case for approaching cervical cancer elimination through a multi-pronged strategy.
Prevalence of familial hypercholesterolemia in a country-wide laboratory network in Pakistan: 10-year data from 988, 306 patientsFarhad, A., Noorali, A. A., Tajuddin, S., Khan, S. D., Ali, M., Chunara, R., Khan, A. H., Zafar, A., Merchant, A., Bokhari, S. S., Virani, S. S., & Samad, Z. (n.d.).
Journal titleProgress in Cardiovascular Diseases
Page(s)19-27AbstractIntroduction: Familial hypercholesterolemia (FH) is a modifiable risk factor for premature coronary heart disease but is poorly diagnosed and treated. We leveraged a large laboratory network in Pakistan to study the prevalence, gender and geographic distribution of FH. Methodology: Data were curated from the Aga Khan University Hospital clinical laboratories, which comprises of 289 laboratories and collection points spread over 94 districts. Clinically ordered lipid profiles from 1st January 2009 to 30th June 2018 were included and data on 1,542,281 LDL-C values was extracted. We used the Make Early Diagnosis to Prevent Early Death (MEDPED) criteria to classify patients as FH and reported data on patients with low-density liporotein -cholesterol (LDL-C) ≥ 190 mg/dL. FH cases were also examined by their spatial distribution. Results: After applying exclusions, the final sample included 988,306 unique individuals, of which 24,273 individuals (1:40) had LDL-C values of ≥190 mg/dL. Based on the MEDPED criteria, 2416 individuals (1:409) had FH. FH prevalence was highest in individuals 10–19 years (1:40) and decreased as the patient age increased. Among individuals ≥40 years, the prevalence of FH was higher for females compared with males (1:755 vs 1:1037, p < 0.001). Median LDL-C for the overall population was 112 mg/dL (IQR = 88-136 mg/dL). The highest prevalence after removing outliers was observed in Rajan Pur district (1.23% [0.70–2.10%]) in Punjab province, followed by Mardan (1.18% [0.80–1.70%]) in Khyber Pakhtunkhwa province, and Okara (0.99% [0.50–1.80%]) in Punjab province. Conclusion: There is high prevalence of actionable LDL-C values in lipid samples across a large network of laboratories in Pakistan. Variable FH prevalence across geographic locations in Pakistan may need to be explored at the population level for intervention and management of contributory factors. Efforts at early diagnosis and treatment of FH are urgently needed.
Structural racism and homophobia evaluated through social media sentiment combined with activity spaces and associations with mental health among young sexual minority menDuncan, D. T., Cook, S. H., Wood, E. P., Regan, S. D., Chaix, B., Tian, Y., & Chunara, R. (n.d.).
Journal titleSocial Science and Medicine
Volume320AbstractBackground: Research suggests that structural racism and homophobia are associated with mental well-being. However, structural discrimination measures which are relevant to lived experiences and that evade self-report biases are needed. Social media and global-positioning systems (GPS) offer opportunity to measure place-based negative racial sentiment linked to relevant locations via precise geo-coding of activity spaces. This is vital for young sexual minority men (YSMM) of color who may experience both racial and sexual minority discrimination and subsequently poorer mental well-being. Methods: P18 Neighborhood Study (n = 147) data were used. Measures of place-based negative racial and sexual-orientation sentiment were created using geo-located social media as a proxy for racial climate via socially-meaningfully-defined places. Exposure to place-based negative sentiment was computed as an average of discrimination by places frequented using activity space measures per person. Outcomes were number of days of reported poor mental health in last 30 days. Zero-inflated Poisson regression analyses were used to assess influence of and type of relationship between place-based negative racial or sexual-orientation sentiment exposure and mental well-being, including the moderating effect of race/ethnicity. Results: We found evidence for a non-linear relationship between place-based negative racial sentiment and mental well-being among our racially and ethnically diverse sample of YSMM (p <.05), and significant differences in the relationship for different race/ethnicity groups (p <.05). The most pronounced differences were detected between Black and White non-Hispanic vs. Hispanic sexual minority men. At two standard deviations above the overall mean of negative racial sentiment exposure based on activity spaces, Black and White YSMM reported significantly more poor mental health days in comparison to Hispanic YSMM. Conclusions: Effects of discrimination can vary by race/ethnicity and discrimination type. Experiencing place-based negative racial sentiment may have implications for mental well-being among YSMM regardless of race/ethnicity, which should be explored in future research including with larger samples sizes.
Association Between Copayment Amount and Filling of Medications for Angiotensin Receptor Neprilysin Inhibitors in Patients With Heart FailureMukhopadhyay, A., Adhikari, S., Li, X., Dodson, J. A., Kronish, I. M., Shah, B., Ramatowski, M., Chunara, R., Kozloff, S., & Blecker, S. (n.d.).
Journal titleJournal of the American Heart Association
Issue24AbstractBACKGROUND: Angiotensin receptor neprilysin inhibitors (ARNI) reduce mortality and hospitalization for patients with heart failure. However, relatively high copayments for ARNI may contribute to suboptimal adherence, thus potentially limiting their benefits. METHODS AND RESULTS: We conducted a retrospective cohort study within a large, multi-site health system. We included patients with: ARNI prescription between November 20, 2020 and June 30, 2021; diagnosis of heart failure or left ventricular ejection fraction ≤40%; and available pharmacy or pharmacy benefit manager copayment data. The primary exposure was copayment, categorized as $0, $0.01 to $10, $10.01 to $100, and >$100. The primary outcome was prescription fill nonadherence, defined as the proportion of days covered <80% over 6 months. We assessed the association between copayment and nonadherence using multivariable logistic regression, and nonbinarized proportion of days covered using multivariable Poisson regression, adjusting for demographic, clinical, and neighborhood-level covariates. A total of 921 patients met inclusion criteria, with 192 (20.8%) having $0 copayment, 228 (24.8%) with $0.01 to $10 copayment, 206 (22.4%) with $10.01 to $100, and 295 (32.0%) with >$100. Patients with higher copayments had higher rates of nonadherence, ranging from 17.2% for $0 copayment to 34.2% for copayment >$100 (P<0.001). After multivariable adjustment, odds of nonadherence were significantly higher for copayment of $10.01 to $100 (odds ratio [OR], 1.93 [95% CI, 1.15– 3.27], P=0.01) or >$100 (OR, 2.58 [95% CI, 1.63– 4.18], P<0.001), as compared with $0 copayment. Similar associations were seen when assessing proportion of days covered as a proportion. CONCLUSIONS: We found higher rates of not filling ARNI prescriptions among patients with higher copayments, which persisted after multivariable adjustment. Our findings support future studies to assess whether reducing copayments can increase adherence to ARNI and improve outcomes for heart failure.
Association of U.S. birth, duration of residence in the U.S., and atherosclerotic cardiovascular disease risk factors among Asian adultsAl Rifai, M., Kianoush, S., Jain, V., Joshi, P. H., Cainzos-Achirica, M., Nasir, K., Merchant, A. T., Dodani, S., Wong, S. S., Samad, Z., Mehta, A., Chunara, R., Kalra, A., & Virani, S. S. (n.d.).
Journal titlePreventive Medicine Reports
Volume29AbstractIntroduction: Prior studies have shown a direct association between U.S. birth and duration of residence with atherosclerotic cardiovascular disease (ASCVD) though, few have specifically focused on Asian Americans. Methods: We utilized cross-sectional data from the 2006 to 2015 National Health Interview Survey. We compared prevalent cardiovascular risk factors and ASCVD among Asian American individuals by U.S. birth and duration of time spent in the U.S. Results: The study sample consisted of 18,150 Asian individuals of whom 20.5 % were Asian Indian, 20.5 % were Chinese, 23.4 % were Filipino, and 35.6 % were of other Asian ethnic groups. The mean (standard error) age was 43.8 (0.21) years and 53 % were women. In multivariable-adjusted logistic regression models, U.S. birth was associated with a higher prevalence odds ratio (95 % confidence interval) of current smoking 1.31 (1.07,1.60), physical inactivity 0.62 (0.54,0.72), obesity 2.26 (1.91,2.69), hypertension 1.33 (1.12,1.58), and CAD 1.96 (1.24,3.11), but lower prevalence of stroke 0.28 (0.11,0.71). Spending greater than 15 years in the U.S. was associated with a higher prevalence of current smoking 1.65 (1.24,2.21), obesity 2.33 (1.57,3.47), diabetes 2.68 (1.17,6.15), and hyperlipidemia 1.72 (1.09,2.71). Conclusion: Heterogeneity exists in cardiovascular risk factor burden among Asian Americans according to Asian ethnicity, U.S. birth, and duration of time living in the U.S.
Building Public Health Surveillance 3.0: Emerging Timely Measures of Physical, Economic, and Social Environmental Conditions Affecting HealthThorpe, L. E., Chunara, R., Roberts, T., Pantaleo, N., Irvine, C., Conderino, S., Li, Y., Hsieh, P. Y., Gourevitch, M. N., Levine, S., Ofrane, R., & Spoer, B. (n.d.).
Journal titleAmerican journal of public health
Page(s)1436-1445AbstractIn response to rapidly changing societal conditions stemming from the COVID-19 pandemic, we summarize data sources with potential to produce timely and spatially granular measures of physical, economic, and social conditions relevant to public health surveillance, and we briefly describe emerging analytic methods to improve small-area estimation. To inform this article, we reviewed published systematic review articles set in the United States from 2015 to 2020 and conducted unstructured interviews with senior content experts in public heath practice, academia, and industry. We identified a modest number of data sources with high potential for generating timely and spatially granular measures of physical, economic, and social determinants of health. We also summarized modeling and machine-learning techniques useful to support development of time-sensitive surveillance measures that may be critical for responding to future major events such as the COVID-19 pandemic.
Discrimination is associated with C-reactive protein among young sexual minority menCook, S. H., Slopen, N., Scarimbolo, L., Mirin, N., Wood, E. P., Rosendale, N., Chunara, R., Burke, C. W., & Halkitis, P. N. (n.d.).
Journal titleJournal of Behavioral Medicine
Page(s)649-657AbstractThis report examines associations between everyday discrimination, microaggressions, and CRP to gain insight on potential mechanisms that may underlie increased CVD risk among sexual minority male young adults. The sample consisted of 60 participants taken from the P18 cohort between the ages of 24 and 28 years. Multinomial logistic regression models were used to examine the association between perceived everyday discrimination and LGBQ microaggressions with C-reactive protein cardiovascular risk categories of low-, average-, and high-risk, as defined by the American Heart Association and Centers for Disease Control. Adjustments were made for BMI. Individuals who experienced more everyday discrimination had a higher risk of being classified in the high-risk CRP group compared to the low-risk CRP group (RRR = 3.35, p = 0.02). Interpersonal LGBQ microaggressions were not associated with CRP risk category. Everyday discrimination, but not specific microaggressions based on sexual orientation, were associated with elevated levels of CRP among young sexual minority men (YSMM). Thus, to implement culturally and age-appropriate interventions, further researcher is needed to critically examine the specific types of discrimination and the resultant impact on YSMM’s health.
Evidence for Telemedicine’s Ongoing Transformation of Health Care Delivery Since the Onset of COVID-19: Retrospective Observational StudyMandal, S., Wiesenfeld, B. M., Mann, D., Lawrence, K., Chunara, R., Testa, P., & Nov, O. (n.d.).
Journal titleJMIR Formative Research
Issue10AbstractBackground: The surge of telemedicine use during the early stages of the COVID-19 pandemic has been well documented. However, scarce evidence considers the use of telemedicine in the subsequent period. Objective: This study aims to evaluate use patterns of video-based telemedicine visits for ambulatory care and urgent care provision over the course of recurring pandemic waves in 1 large health system in New York City (NYC) and what this means for health care delivery. Methods: Retrospective electronic health record (EHR) data of patients from January 1, 2020, to February 28, 2022, were used to longitudinally track and analyze telemedicine and in-person visit volumes across ambulatory care specialties and urgent care, as well as compare them to a prepandemic baseline (June-November 2019). Diagnosis codes to differentiate suspected COVID-19 visits from non–COVID-19 visits, as well as evaluating COVID-19–based telemedicine use over time, were compared to the total number of COVID-19–positive cases in the same geographic region (city level). The time series data were segmented based on change-point analysis, and variances in visit trends were compared between the segments. Results: The emergence of COVID-19 prompted an early increase in the number of telemedicine visits across the urgent care and ambulatory care settings. This use continued throughout the pandemic at a much higher level than the prepandemic baseline for both COVID-19 and non–COVID-19 suspected visits, despite the fluctuation in COVID-19 cases throughout the pandemic and the resumption of in-person clinical services. The use of telemedicine-based urgent care services for COVID-19 suspected visits showed more variance in response to each pandemic wave, but telemedicine visits for ambulatory care have remained relatively steady after the initial crisis period. During the Omicron wave, the use of all visit types, including in-person activities, decreased. Patients between 25 and 34 years of age were the largest users of telemedicine-based urgent care. Patient satisfaction with telemedicine-based urgent care remained high despite the rapid scaling of services to meet increased demand. Conclusions: The trend of the increased use of telemedicine as a means of health care delivery relative to the pre–COVID-19 baseline has been maintained throughout the later pandemic periods despite fluctuating COVID-19 cases and the resumption of in-person care delivery. Overall satisfaction with telemedicine-based care is also high. The trends in telemedicine use suggest that telemedicine-based health care delivery has become a mainstream and sustained supplement to in-person-based ambulatory care, particularly for younger patients, for both urgent and nonurgent care needs. These findings have implications for the health care delivery system, including practice leaders, insurers, and policymakers. Further investigation is needed to evaluate telemedicine adoption by key demographics, identify ongoing barriers to adoption, and explore the impacts of sustained use of telemedicine on health care outcomes and experience.
Impact of COVID-19 forecast visualizations on pandemic risk perceptionsPadilla, L., Hosseinpour, H., Fygenson, R., Howell, J., Chunara, R., & Bertini, E. (n.d.).
Journal titleScientific reports
Issue1AbstractPeople worldwide use SARS-CoV-2 (COVID-19) visualizations to make life and death decisions about pandemic risks. Understanding how these visualizations influence risk perceptions to improve pandemic communication is crucial. To examine how COVID-19 visualizations influence risk perception, we conducted two experiments online in October and December of 2020 (N = 2549) where we presented participants with 34 visualization techniques (available at the time of publication on the CDC’s website) of the same COVID-19 mortality data. We found that visualizing data using a cumulative scale consistently led to participants believing that they and others were at more risk than before viewing the visualizations. In contrast, visualizing the same data with a weekly incident scale led to variable changes in risk perceptions. Further, uncertainty forecast visualizations also affected risk perceptions, with visualizations showing six or more models increasing risk estimates more than the others tested. Differences between COVID-19 visualizations of the same data produce different risk perceptions, fundamentally changing viewers’ interpretation of information.
Search Term Identification Methods for Computational Health Communication: Word Embedding and Network Approach for Health Content on YouTubeTong, C., Margolin, D., Chunara, R., Niederdeppe, J., Taylor, T., Dunbar, N., & King, A. J. (n.d.).
Journal titleJMIR Medical Informatics
Issue8AbstractBackground: Common methods for extracting content in health communication research typically involve using a set of well-established queries, often names of medical procedures or diseases, that are often technical or rarely used in the public discussion of health topics. Although these methods produce high recall (ie, retrieve highly relevant content), they tend to overlook health messages that feature colloquial language and layperson vocabularies on social media. Given how such messages could contain misinformation or obscure content that circumvents official medical concepts, correctly identifying (and analyzing) them is crucial to the study of user-generated health content on social media platforms. Objective: Health communication scholars would benefit from a retrieval process that goes beyond the use of standard terminologies as search queries. Motivated by this, this study aims to put forward a search term identification method to improve the retrieval of user-generated health content on social media. We focused on cancer screening tests as a subject and YouTube as a platform case study. Methods: We retrieved YouTube videos using cancer screening procedures (colonoscopy, fecal occult blood test, mammogram, and pap test) as seed queries. We then trained word embedding models using text features from these videos to identify the nearest neighbor terms that are semantically similar to cancer screening tests in colloquial language. Retrieving more YouTube videos from the top neighbor terms, we coded a sample of 150 random videos from each term for relevance. We then used text mining to examine the new content retrieved from these videos and network analysis to inspect the relations between the newly retrieved videos and videos from the seed queries. Results: The top terms with semantic similarities to cancer screening tests were identified via word embedding models. Text mining analysis showed that the 5 nearest neighbor terms retrieved content that was novel and contextually diverse, beyond the content retrieved from cancer screening concepts alone. Results from network analysis showed that the newly retrieved videos had at least one total degree of connection (sum of indegree and outdegree) with seed videos according to YouTube relatedness measures. Conclusions: We demonstrated a retrieval technique to improve recall and minimize precision loss, which can be extended to various health topics on YouTube, a popular video-sharing social media platform. We discussed how health communication scholars can apply the technique to inspect the performance of the retrieval strategy before investing human coding resources and outlined suggestions on how such a technique can be extended to other health contexts.
Machine learning and algorithmic fairness in public and population healthMhasawade, V., Zhao, Y., & Chunara, R. (n.d.).
Journal titleNature Machine Intelligence
Page(s)659-666AbstractUntil now, much of the work on machine learning and health has focused on processes inside the hospital or clinic. However, this represents only a narrow set of tasks and challenges related to health; there is greater potential for impact by leveraging machine learning in health tasks more broadly. In this Perspective we aim to highlight potential opportunities and challenges for machine learning within a holistic view of health and its influences. To do so, we build on research in population and public health that focuses on the mechanisms between different cultural, social and environmental factors and their effect on the health of individuals and communities. We present a brief introduction to research in these fields, data sources and types of tasks, and use these to identify settings where machine learning is relevant and can contribute to new knowledge. Given the key foci of health equity and disparities within public and population health, we juxtapose these topics with the machine learning subfield of algorithmic fairness to highlight specific opportunities where machine learning, public and population health may synergize to achieve health equity.
Social Determinants in Machine Learning Cardiovascular Disease Prediction Models: A Systematic ReviewZhao, Y., Wood, E. P., Mirin, N., Cook, S. H., & Chunara, R. (n.d.).
Journal titleAmerican journal of preventive medicine
Page(s)596-605AbstractIntroduction: Cardiovascular disease is the leading cause of death worldwide, and cardiovascular disease burden is increasing in low-resource settings and for lower socioeconomic groups. Machine learning algorithms are being developed rapidly and incorporated into clinical practice for cardiovascular disease prediction and treatment decisions. Significant opportunities for reducing death and disability from cardiovascular disease worldwide lie with accounting for the social determinants of cardiovascular outcomes. This study reviews how social determinants of health are being included in machine learning algorithms to inform best practices for the development of algorithms that account for social determinants. Methods: A systematic review using 5 databases was conducted in 2020. English language articles from any location published from inception to April 10, 2020, which reported on the use of machine learning for cardiovascular disease prediction that incorporated social determinants of health, were included. Results: Most studies that compared machine learning algorithms and regression showed increased performance of machine learning, and most studies that compared performance with or without social determinants of health showed increased performance with them. The most frequently included social determinants of health variables were gender, race/ethnicity, marital status, occupation, and income. Studies were largely from North America, Europe, and China, limiting the diversity of the included populations and variance in social determinants of health. Discussion: Given their flexibility, machine learning approaches may provide an opportunity to incorporate the complex nature of social determinants of health. The limited variety of sources and data in the reviewed studies emphasize that there is an opportunity to include more social determinants of health variables, especially environmental ones, that are known to impact cardiovascular disease risk and that recording such data in electronic databases will enable their use.
Telemedicine and healthcare disparities: a cohort study in a large healthcare system in New York City during COVID-19Chunara, R., Zhao, Y., Chen, J., Lawrence, K., Testa, P. A., Nov, O., & Mann, D. M. (n.d.).
Journal titleJournal of the American Medical Informatics Association
Page(s)33-41AbstractObjective: Through the coronavirus disease 2019 (COVID-19) pandemic, telemedicine became a necessary entry point into the process of diagnosis, triage, and treatment. Racial and ethnic disparities in healthcare have been well documented in COVID-19 with respect to risk of infection and in-hospital outcomes once admitted, and here we assess disparities in those who access healthcare via telemedicine for COVID-19. Materials and Methods: Electronic health record data of patients at New York University Langone Health between March 19th and April 30, 2020 were used to conduct descriptive and multilevel regression analyses with respect to visit type (telemedicine or in-person), suspected COVID diagnosis, and COVID test results. Results: Controlling for individual and community-level attributes, Black patients had 0.6 times the adjusted odds (95% CI: 0.58-0.63) of accessing care through telemedicine compared to white patients, though they are increasingly accessing telemedicine for urgent care, driven by a younger and female population. COVID diagnoses were significantly more likely for Black versus white telemedicine patients. Discussion: There are disparities for Black patients accessing telemedicine, however increased uptake by young, female Black patients. Mean income and decreased mean household size of a zip code were also significantly related to telemedicine use. Conclusion: Telemedicine access disparities reflect those in in-person healthcare access. Roots of disparate use are complex and reflect individual, community, and structural factors, including their intersection - many of which are due to systemic racism. Evidence regarding disparities that manifest through telemedicine can be used to inform tool design and systemic efforts to promote digital health equity.
Comparison of Social Media, Syndromic Surveillance, and Microbiologic Acute Respiratory Infection Data: Observational StudyDaughton, A. R., Chunara, R., & Paul, M. J. (n.d.).
Journal titleJMIR Public Health and Surveillance
Issue2AbstractBackground: Internet data can be used to improve infectious disease models. However, the representativeness and individual-level validity of internet-derived measures are largely unexplored as this requires ground truth data for study. Objective: This study sought to identify relationships between Web-based behaviors and/or conversation topics and health status using a ground truth, survey-based dataset. Methods: This study leveraged a unique dataset of self-reported surveys, microbiological laboratory tests, and social media data from the same individuals toward understanding the validity of individual-level constructs pertaining to influenza-like illness in social media data. Logistic regression models were used to identify illness in Twitter posts using user posting behaviors and topic model features extracted from users’ tweets. Results: Of 396 original study participants, only 81 met the inclusion criteria for this study. Of these participants’ tweets, we identified only two instances that were related to health and occurred within 2 weeks (before or after) of a survey indicating symptoms. It was not possible to predict when participants reported symptoms using features derived from topic models (area under the curve [AUC]=0.51; P=.38), though it was possible using behavior features, albeit with a very small effect size (AUC=0.53; P≤.001). Individual symptoms were also generally not predictable either. The study sample and a random sample from Twitter are predictably different on held-out data (AUC=0.67; P≤.001), meaning that the content posted by people who participated in this study was predictably different from that posted by random Twitter users. Individuals in the random sample and the GoViral sample used Twitter with similar frequencies (similar @ mentions, number of tweets, and number of retweets; AUC=0.50; P=.19). Conclusions: To our knowledge, this is the first instance of an attempt to use a ground truth dataset to validate infectious disease observations in social media data. The lack of signal, the lack of predictability among behaviors or topics, and the demonstrated volunteer bias in the study population are important findings for the large and growing body of disease surveillance using internet-sourced data.
COVID-19 transforms health care through telemedicine: Evidence from the fieldMann, D. M., Chen, J., Chunara, R., Testa, P. A., & Nov, O. (n.d.).
Journal titleJournal of the American Medical Informatics Association
Page(s)1132-1135AbstractThis study provides data on the feasibility and impact of video-enabled telemedicine use among patients and providers and its impact on urgent and nonurgent healthcare delivery from one large health system (NYU Langone Health) at the epicenter of the coronavirus disease 2019 (COVID-19) outbreak in the United States. Between March 2nd and April 14th 2020, telemedicine visits increased from 102.4 daily to 801.6 daily. (683% increase) in urgent care after the system-wide expansion of virtual urgent care staff in response to COVID-19. Of all virtual visits post expansion, 56.2% and 17.6% urgent and nonurgent visits, respectively, were COVID-19-related. Telemedicine usage was highest by patients 20 to 44 years of age, particularly for urgent care. The COVID-19 pandemic has driven rapid expansion of telemedicine use for urgent care and nonurgent care visits beyond baseline periods. This reflects an important change in telemedicine that other institutions facing the COVID-19 pandemic should anticipate.
Quantifying depression-related language on social media during the COVID-19 pandemicDavis, B. D., McKnight, D. E., Teodorescu, D., Quan-Haase, A., Chunara, R., Fyshe, A., & Lizotte, D. J. (n.d.).
Journal titleInternational Journal of Population Data Science
Issue4AbstractIntroduction The COVID-19 pandemic had clear impacts on mental health. Social media presents an opportunity for assessing mental health at the population level. Objectives 1) Identify and describe language used on social media that is associated with discourse about depression. 2) Describe the associations between identified language and COVID-19 incidence over time across several geographies. Methods We create a word embedding based on the posts in Reddit's/r/Depression and use this word embedding to train representations of active authors. We contrast these authors against a control group and extract keywords that capture differences between the two groups. We filter these keywords for face validity and to match character limits of an information retrieval system, Elasticsearch. We retrieve all geo-tagged posts on Twitter from April 2019 to June 2021 from Seattle, Sydney, Mumbai, and Toronto. The tweets are scored with BM25 using the keywords. We call this score rDD. We compare changes in average score over time with case counts from the pandemic's beginning through June 2021. Results We observe a pattern in rDD across all cities analyzed: There is an increase in rDD near the start of the pandemic which levels off over time. However, in Mumbai we also see an increase aligned with a second wave of cases. Conclusions Our results are concordant with other studies which indicate that the impact of the pandemic on mental health was highest initially and was followed by recovery, largely unchanged by subsequent waves. However, in the Mumbai data we observed a substantial rise in rDD with a large second wave. Our results indicate possible un-captured heterogeneity across geographies, and point to a need for a better understanding of this differential impact on mental health.
Quantifying the localized relationship between vector containment activities and dengue incidence in a real-world setting: A spatial and time series modelling analysis based on geo-located data from PakistanRehman, N. A., Salje, H., Kraemer, M. U., Subramanian, L., Saif, U., & Chunara, R. (n.d.).
Journal titlePLoS neglected tropical diseases
Page(s)1-22AbstractIncreasing urbanization is having a profound effect on infectious disease risk, posing significant challenges for governments to allocate limited resources for their optimal control at a sub-city scale. With recent advances in data collection practices, empirical evidence about the efficacy of highly localized containment and intervention activities, which can lead to optimal deployment of resources, is possible. However, there are several challenges in analyzing data from such real-world observational settings. Using data on 3.9 million instances of seven dengue vector containment activities collected between 2012 and 2017, here we develop and assess two frameworks for understanding how the generation of new dengue cases changes in space and time with respect to application of different types of containment activities. Accounting for the non-random deployment of each containment activity in relation to dengue cases and other types of containment activities, as well as deployment of activities in different epidemiological contexts, results from both frameworks reinforce existing knowledge about the efficacy of containment activities aimed at the adult phase of the mosquito lifecycle. Results show a 10% (95% CI: 1–19%) and 20% reduction (95% CI: 4–34%) reduction in probability of a case occurring in 50 meters and 30 days of cases which had Indoor Residual Spraying (IRS) and fogging performed in the immediate vicinity, respectively, compared to cases of similar epidemiological context and which had no containment in their vicinity. Simultaneously, limitations due to the real-world nature of activity deployment are used to guide recommendations for future deployment of resources during outbreaks as well as data collection practices. Conclusions from this study will enable more robust and comprehensive analyses of localized containment activities in resource-scarce urban settings and lead to improved allocation of resources of government in an outbreak setting.
Role of the built and online social environments on expression of dining on instagramMhasawade, V., Elghafari, A., Duncan, D. T., & Chunara, R. (n.d.).
Journal titleInternational journal of environmental research and public health
Issue3AbstractOnline social communities are becoming windows for learning more about the health of populations, through information about our health-related behaviors and outcomes from daily life. At the same time, just as public health data and theory has shown that aspects of the built environment can affect our health-related behaviors and outcomes, it is also possible that online social environments (e.g., posts and other attributes of our online social networks) can also shape facets of our life. Given the important role of the online environment in public health research and implications, factors which contribute to the generation of such data must be well understood. Here we study the role of the built and online social environments in the expression of dining on Instagram in Abu Dhabi; a ubiquitous social media platform, city with a vibrant dining culture, and a topic (food posts) which has been studied in relation to public health outcomes. Our study uses available data on user Instagram profiles and their Instagram networks, as well as the local food environment measured through the dining types (e.g., casual dining restaurants, food court restaurants, lounges etc.) by neighborhood. We find evidence that factors of the online social environment (profiles that post about dining versus profiles that do not post about dining) have different influences on the relationship between a user’s built environment and the social dining expression, with effects also varying by dining types in the environment and time of day. We examine the mechanism of the relationships via moderation and mediation analyses. Overall, this study provides evidence that the interplay of online and built environments depend on attributes of said environments and can also vary by time of day. We discuss implications of this synergy for precisely-targeting public health interventions, as well as on using online data for public health research.
Using Digital Data to Protect and Promote the Most Vulnerable in the Fight Against COVID-19Chunara, R., & Cook, S. H. (n.d.).
Journal titleFrontiers in Public Health
Reports of the workshops held at the 2019 international AAAI conference on web and social mediaAlburez-Gutierrez, D., Chandrasekharan, E., Chunara, R., Gil-Clavel, S., Hannak, A., Interdonato, R., Joseph, K., Kalimeri, K., Kairam, S., Malik, M. M., Mayer, K., Mejova, Y., Paolotti, D., & Zagheni, E. (n.d.).
Journal titleAI Magazine
Quantitative methods for measuring neighborhood characteristics in neighborhood health researchDuncan, D. T., Goedel, W. C., & Chunara, R. (n.d.). In Neighborhoods and Health.
Reports of the workshops held at the 2018 international AAAI conference on web and social mediaAn, J., Chunara, R., Crandall, D. J., Frajberg, D., French, M., Jansen, B. J., Kulshrestha, J., Mejova, Y., Romero, D. M., Salminen, J., Sharma, A., Sheth, A., Tan, C., Taylor, S. H., & Wijeratne, S. (n.d.).
Journal titleAI Magazine
Socio-spatial self-organizing maps: Using social media to assess relevant geographies for exposure to social processesRelia, K., Akbari, M., Duncan, D., & Chunara, R. (n.d.).
Journal titleProceedings of the ACM on Human-Computer Interaction
Volume2AbstractSocial media offers a unique window into attitudes like racism and homophobia, exposure to which are important, hard to measure and understudied social determinants of health. However, individual geo-located observations from social media are noisy and geographically inconsistent. Existing areas by which exposures are measured, like Zip codes, average over irrelevant administratively-defined boundaries. Hence, in order to enable studies of online social environmental measures like attitudes on social media and their possible relationship to health outcomes, first there is a need for a method to define the collective, underlying degree of social media attitudes by region. To address this, we create the Socio-spatial-Self organizing map, “SS-SOM” pipeline to best identify regions by their latent social attitude from Twitter posts. SS-SOMs use neural embedding for text-classification, and augment traditional SOMs to generate a controlled number of non-overlapping, topologically-constrained and topically-similar clusters. We find that not only are SS-SOMs robust to missing data, the exposure of a cohort of men who are susceptible to multiple racism and homophobia-linked health outcomes, changes by up to 42% using SS-SOM measures as compared to using Zip code-based measures.
Tracking health seeking behavior during an Ebola outbreak via mobile phones and SMSFeng, S., Grépin, K. A., & Chunara, R. (n.d.).
Journal titlenpj Digital Medicine
Issue1AbstractThe recent Ebola outbreak in West Africa was an exemplar for the need to rapidly measure population-level health-seeking behaviors, in order to understand healthcare utilization during emergency situations. Taking advantage of the high prevalence of mobile phones, we deployed a national SMS-poll and collected data about individual-level health and health-seeking behavior throughout the outbreak from 6694 individuals from March to June 2015 in Liberia. Using propensity score matching to generate balanced subsamples, we compared outcomes in our survey to those from a recent household survey (the 2013 Liberian Demographic Health Survey). We found that the matched subgroups had similar patterns of delivery location in aggregate, and utilizing data on the date of birth, we were able to show that facility-based deliveries were significantly decreased during, compared to after the outbreak (p < 0.05) consistent with findings from retrospective studies using healthcare-based data. Directly assessing behaviors from individuals via SMS also enabled the measurement of public and private sector facility utilization separately, which has been a challenge in other studies in countries including Liberia which rely mainly on government sources of data. In doing so, our data suggest that public facility-based deliveries returned to baseline values after the outbreak. Thus, we demonstrate that with the appropriate methodological approach to account for different population denominators, data sourced via mobile tools such as SMS polling could serve as an important low-cost complement to existing data collection strategies especially in situations where higher-frequency data than can be feasibly obtained through surveys is useful.
Denominator Issues for Personally Generated Data in Population Health MonitoringChunara, R., Wisk, L. E., & Weitzman, E. R. (n.d.).
Journal titleAmerican journal of preventive medicine