Ang Yu

Objective: While quality lupus care is associated with lower lupus-related damage, the impact of access and process quality measures on other lupus outcomes remains unclear. Given high acute care in young adults, our objective was to evaluate two process quality measures, visit-based retention in lupus care and receipt of lupus-specific serologic testing, and associations with subsequent acute care use. Methods: This cohort study used a 20% national sample of young adult (ages 18–35) Medicare beneficiaries with lupus to first measure visit-based retention in rheumatology care and receipt of ≥1 complement or dsDNA test over 1 year. Acute care use (Emergency Department visits and hospitalizations) was then assessed in the subsequent 6 months. Associations of visit-based retention and serologic testing with acute care were evaluated with Cox regressions. Results: Among 1036 young adults with lupus, acute care use was very high – nearly 60% at 6 months. Observed acute care-free survival time was longer in patients who had visit-based retention (154 vs 104 days, p = 0.02) or serologic testing (166 vs 101 days, p = 0.002). Only 28% of beneficiaries had serologic testing, but this was associated with 21% lower incidence of acute care (aHR 0.79, 95% CI 0.65, 0.97) after adjustment; visit-based retention was not associated with acute care after adjustment. Conclusion: Receipt of complement or dsDNA antibody testing, a lupus-specific care quality indicator, was associated with reduced acute care use in young adults. Improving lupus care quality measures, like complement or dsDNA testing, may improve lupus outcomes including reduced acute care use.

This article addresses two prominent theses in social stratification research, the great equalizer thesis and Mare’s school transition thesis. Both theses describe the role of an intermediate educational transition in the association between socioeconomic status and an outcome variable. However, the descriptive regularities of the two theses may be driven by differential selection into the intermediate transition, which prevents the two theses from having substantive interpretations. The authors propose a set of novel counterfactual slope estimands, which capture these theses under hypothetical interventions that would eliminate the differential selection. The authors thereby construct selection-free tests for these theses. The authors are the first to explicitly provide nonparametric causal estimands for the great equalizer thesis and the school transition thesis, which enable them to conduct more principled analysis. The authors are also the first to develop flexible, efficient, and robust estimators for the two theses on the basis of efficient influence functions. The authors apply this framework to a nationally representative data set in the United States and reevaluate the two theses. Findings from the selection-free tests suggest that the descriptive regularities are misleading for the substantive interpretation of the great equalizer thesis, but not for the school transition thesis. Additionally, the counterfactual slopes provide a new framework for evaluating the inequality impacts of policy interventions.

We introduce a new nonparametric causal decomposition approach that identifies the mechanisms by which a treatment variable contributes to a group-based outcome disparity. Our approach distinguishes three mechanisms: group differences in: (1) treatment prevalence, (2) average treatment effects, and (3) selection into treatment based on individual-level treatment effects. Our approach reformulates classic Kitagawa–Blinder–Oaxaca decompositions in causal and nonparametric terms, complements causal mediation analysis by explaining group disparities instead of group effects, and isolates conceptually distinct mechanisms conflated in recent random equalization decompositions. In contrast to all prior approaches, our framework uniquely identifies differential selection into treatment as a novel disparity-generating mechanism. Our approach can be used for both the retrospective causal explanation of disparities and the prospective planning of interventions to change disparities. We present both an unconditional and a conditional decomposition, where the latter quantifies the contributions of the treatment within levels of certain covariates. We develop nonparametric estimators that are n-consistent, asymptotically normal, semiparametrically efficient, and multiply robust. We apply our approach to analyze the mechanisms by which college graduation causally contributes to intergenerational income persistence (the disparity in adult income between the children of high- vs. low-income parents). Empirically, we demonstrate a previously undiscovered role played by the new selection component in intergenerational income persistence.

Objective: Patients with systemic lupus erythematosus experience the sixth highest rate of 30‐day readmissions among chronic diseases. Timely postdischarge follow‐up is a marker of ambulatory care quality that can reduce readmissions in other chronic conditions. Our objective was to test the hypotheses that 1) beneficiaries from populations experiencing health disparities, including patients from disadvantaged neighborhoods, will have lower odds of completed follow‐up, and that 2) follow‐up will predict longer time without acute care use (readmission, observation stay, or emergency department visit) or mortality.Methods: This observational cohort study included hospitalizations in January–November 2014 from a 20% random sample of Medicare adults. Included hospitalizations had a lupus code, discharge to home without hospice, and continuous Medicare A/B coverage for 1 year before and 1 month after hospitalization. Timely follow‐up included visits with primary care or rheumatology within 30 days. Thirty‐day survival outcomes were acute care use and mortality adjusted for sociodemographic information and comorbidities.Results: Over one‐third (35%) of lupus hospitalizations lacked 30‐day follow‐up. Younger age, living in disadvantaged neighborhoods, and rurality were associated with lower odds of follow‐up. Follow‐up was not associated with subsequent acute care or mortality in beneficiaries age <65 years. In contrast, follow‐up was associated with a 27% higher hazard for acute care use (adjusted hazard ratio [HR] 1.27 [95% confidence interval (95% CI) 1.09–1.47]) and 65% lower mortality (adjusted HR 0.35 [95% CI 0.19–0.67]) among beneficiaries age ≥65 years.Conclusion: One‐third of lupus hospitalizations lacked follow‐up, with significant disparities in rural and disadvantaged neighborhoods. Follow‐up was associated with increased acute care, but 65% lower mortality in older systemic lupus erythematosus patients. Further development of lupus‐specific postdischarge strategies is needed. image

Sociologists are often interested in estimating and testing whether some causal effect varies by a modifier of interest. The conventional regression estimator for effect modification is inflexible in functional form and prone to misspecification bias. Machine Learning (ML) algorithms can aid the estimation of effect modification in observational studies by controlling for confounders in a highly flexible, automated, yet principled way. Therefore, leveraging ML for effect modification helps reduce misspecification bias and enhance the credibility of causal identification. We introduce a novel estimator that estimates effect modification in a familiar regression framework after using ML algorithms to fit nuisance components of the model. We show that this estimator is more flexible than the conventional regression model while more efficient and suitable for theory-driven sociological research than other ML-based methods. We use the new estimator to study the modification in the effect of a college degree on adult family income by gender and family income in adolescence in the United States. Along these two dimensions, the benefits of a college degree are rather equally distributed.

Nearly 20 years after the commercialization of housing, the intergenerational dimension of housing attainment in China has not been fully explored. This paper contributes to the literature by examining the impact of parental wealth on adult children’s transitions to homeownership. Young people’s transitions from renting to owning are conditional on leaving the parental home, and conversely, the prospect of purchasing a self-owned residence within a short period of time may play a role in the decision about moving out. As successive transitions are perhaps interlinked with each other through people’s anticipation, I combine a bivariate probit selection model with a discrete time event history analysis to jointly model the timing of nest-leaving and home acquisition. Based on four waves of China Family Panel Survey data, I find that offspring of wealthy parents are more likely to become homeowners and tend to do so sooner than others once they become financially independent from the parental household. In the case of urban China, this paper thereby provides evidence that parents’ assets can give offspring a head start in living standards and portfolio build-up during their early adulthood. This paper reveals that housing acquisition is a critical mechanism through which the newly emergent wealth inequality is transmitted across generations in post-socialist China. Additionally, it develops an innovative strategy to address interdependent life course transitions which potentially have broad applications.

In the community building campaign launched at the beginning of this century in urban China, the transfer of welfare responsibility to communities and democratization at the grassroots level both have featured prominently. Participation on the part of community residents as volunteers and voters are indispensable to the success of these initiatives. Therefore, grassroots state agents are eager to solicit involvement from those susceptible to their mobilization, including Communist Party members. In this article, we intend to investigate the role of Party members in community volunteering and voting and its differentiation across various social groups and neighborhood contexts. Drawing on nationally representative data, we find that Party members indeed have a stronger propensity to participate than the non- member residents. The effect of Party membership is statistically significant on volunteering but not on voting, and more distinguishable among employed than retired residents. In danwei neighborhoods, the direction of Party membership’s influence is reversed. These findings shed some light on the targets, emphasis, channels and constraints of Party-state’s grassroots mobilization in its quest of maintaining legitimacy in a cost-effective way.

Objective: To compare analgesic and mobility effects of different ropivacaine concentrations in femoral–sciatic nerve block, for postoperative analgesia in knee arthroscopy. Methods: Outpatients (American Society of Anesthesiologists physical classification status of I or II), scheduled for elective knee arthroscopy, were randomly allocated to one of seven groups, prospectively investigating different concentrations of ropivacaine (0.12%; 0.14%; 0.16%; 0.18%; 0.20%; 0.22% or 0.50%), for ultrasound-guided femoral–sciatic nerve block procedures for postoperative analgesia. Visual analogue scale (VAS) pain scores and motor block evaluation scales were observed at 4, 8, 16 and 24 h postsurgery. Results: In total, 105 patients were enrolled; results were analysed for 103. VAS scores for the 0.12%, 0.14% and 0.16% groups were significantly different from the 0.50% group. There were no significant differences between the 0.18%, 0.20%, 0.22% and 0.50% groups: half maximal effective concentrations and 95% maximal effective concentrations of ropivacaine were 0.158 (95% confidence intervals [CI] 0.149, 0.167) and 0.198 (95% CI 0.186, 0.221), respectively. Rates of motor blockade (Bromage score or hip motor function scale > 0) were significantly different between the 0.50% group and all other ropivacaine doses. Conclusion: The 0.20% ropivacaine dose for femoral–sciatic nerve block in knee arthroscopy provided satisfactory postoperative analgesia, while preserving ability of motion.