About

Dr. Mari Armstrong-Hough is an Associate Professor in the Department of Social & Behavioral Sciences and in the Department of Epidemiology at NYU School of Global Public Health. She is a medical sociologist and epidemiologist specializing in respiratory disease. Her global health research examines the epidemiologic interfaces among tuberculosis (TB), HIV, and non-communicable diseases. Combining training in epidemiology and sociology, her work develops and evaluates interventions to increase early case-finding, status awareness, and linkage to care in high-burden settings such as Uganda and South Africa. She has published on predictors of evaluation for TB among high-risk groups, novel approaches to active case-finding for TB and HIV, and the ways that providers and patients imagine and communicate risk for respiratory infection, as well as the availability of essential medicines in settings with double burdens of infectious and non-communicable disease. Her first book, 'Biomedicalization and the Practice of Culture: Globalization and Type 2 Diabetes in the United States and Japan,' examined how the practice and experience of global evidence-based medicine is shaped by local cultural repertoires. Her recent work has appeared in prominent journals including the Journal of AIDS, International Journal of Tuberculosis and Lung Disease, and The Lancet Respiratory Medicine. She co-directs the NIH-funded Mixed-Methods Fellowship of the Pulmonary Complications of AIDS Research Training Program at Makerere University in Kampala, Uganda, and is PI of a prospective cohort study of patients initiating treatment for pulmonary TB in Uganda. Her US-based research focuses on racial and ethnic disparities in survival of respiratory failure and developing interventions to ensure equitable, evidence-based care for all patients. Prior to her current position, she was an Associate Research Scientist at Yale School of Public Health and has taught at Davidson College, Meiji University in Tokyo, and Duke University. She has conducted fieldwork in the United States, Japan, Uganda, Ethiopia, and Nepal, and holds a BA in Sociology, History, and Political Science from the University of Wisconsin–Madison, an MA in East Asian Studies from Duke University, a PhD in Sociology from Duke University, and a Postdoctoral MPH in Applied Biostatistics and Epidemiology from Yale.

Research topics

• Internal medicine
• Medicine
• Intensive care medicine
• Emergency medicine
• Psychiatry
• Anesthesia
• Environmental health
• Virology
• Pathology
• Medical emergency
• Pediatrics
• Surgery

Selected publications

• Ethnic Disparities in Deep Sedation of Patients with Acute Respiratory Distress Syndrome in the United States: Secondary Analysis of a Multicenter Randomized Trial

  Annals of the American Thoracic Society · 2024 · 12 citations

  1st authorCorresponding
  • Medicine
  • Emergency medicine
  • Pediatrics

  Hispanic patients are at higher risk of exposure to deep sedation than non-Hispanic White patients. There is an urgent need to understand and address disparities in sedation delivery.

  PublisherOA PDFDOI

• Disparities among patients with respiratory failure

  Current Opinion in Critical Care · 2023 · 7 citations

  • Medicine
  • Intensive care medicine
  • Environmental health

  PURPOSE OF REVIEW: Disparities are common within healthcare, and critical illness is no exception. This review summarizes recent literature on health disparities within respiratory failure, focusing on race, ethnicity, socioeconomic status, and sex. RECENT FINDINGS: Current evidence indicates that Black patients have higher incidence of respiratory failure, while the relationships among race, ethnicity, and mortality remains unclear. There has been renewed interest in medical device bias, specifically pulse oximetry, for which data demonstrate patients with darker skin tones may be at risk for undetected hypoxemia and worse outcomes. Lower socioeconomic status is associated with higher mortality, and respiratory failure can potentiate socioeconomic inequities via illness-related financial toxicity. Literature on sex-based disparities is limited; however, evidence suggests males receive more invasive care, including mechanical ventilation. SUMMARY: Most studies focused on disparities in incidence and mortality associated with respiratory failure, but few relied on granular clinical data of patients from diverse backgrounds. Future studies should evaluate processes of care for respiratory failure that may mechanistically contribute to disparities in order to develop interventions that improve outcomes.

  DOI

• Associations Among Patient Race, Sedation Practices, and Mortality in a Large Multi-Center Registry of COVID-19 Patients

  2021 · 2 citations

  Senior authorCorresponding
  • Medicine
  • Emergency medicine
  • Medical emergency

  Introduction: Racial and ethnic minorities have accounted for the majority of intensive care unit (ICU) hospitalizations for COVID-19. At the same time, ICUs were forced to deviate from long-established care processes in response to a steep increase in admissions and to prevent healthcare worker infections. These shifts may have resulted in changes to sedation practices, such as level of sedation or sedation holidays, that differed by patient race or ethnicity. We aimed to examine associations among patient race and ethnicity, sedation practices, and mortality in a large, national sample of patients receiving mechanical ventilation for COVID-19. Methods: We analyzed granular daily data from the Viral Infection and Respiratory Illness Universal Study (VIRUS) Registry for COVID-19 patients admitted to ICUs between February and November 2020. We included patients over 18 years of age, who were mechanically ventilated following clinical or PCR-confirmed COVID-19 diagnosis. We will calculate descriptive statistics for mortality at discharge and 28 days by patient race/ethnicity, sex, and two care processes associated with mechanical ventilation: sedation level and sedation holidays. We will estimate risk-adjusted, hospital-level mortality differentials by race. We will use mixed effects logistic regression and causal mediation analysis to test associations among patient race/ethnicity, sedation practices for mechanical ventilation, and mortality at 28 days, controlling for comorbidities, markers of severity, and time to admission, and adjusting for clustering by ICU. Results: Among 19,626 patients hospitalized for COVID-19, 8,668 (14.6%) received mechanical ventilation at 238 hospitals. The median age was 62 (IQR 40-72) and 45.1% were female. Among hospitalized patients, 23.3% self-identified as Hispanic, 26.6% as non-Hispanic Black, 35.6% as non-Hispanic White, and 14.5% as non-Hispanic and another racial group. Approximately 1% (n=236) of patients were missing race/ethnicity. At 28 days, 20.7% (n=4,076) of hospitalized patients were deceased. Use of benzodiazepines was highly clustered by hospital (intraclass correlation coefficient of 0.63). In cluster-adjusted analyses, Hispanic patients were more likely to receive benzodiazepines at least once during hospitalization than either non-Hispanic White (Odds Ratio (OR) 0.76, p=0.013) or non-Hispanic Black (OR 0.70, p=0.003) patients. Multivariable mixed effects and causal mediation analyses are ongoing. Conclusions: Sedation practices, such as level of sedation and sedation holidays, are associated with mortality;yet these practices may differ based on a patient's race or ethnicity. We will leverage a unique, multi-center database with granular clinical information to understand how these differences may influence racial and ethnic disparities in respiratory failure.

  DOI

Frequent coauthors

• Thomas S. Valley

  VA Ann Arbor Healthcare System

  14 shared

• Theodore J. Iwashyna

  VA Center for Clinical Management Research

  6 shared

• Catherine L. Hough

  Oregon Health & Science University

  3 shared

• A. Schütz

  University of Michigan–Ann Arbor

  2 shared

• Savannah Diaz

  New York University

  2 shared

• Robert J. Flick

  Johns Hopkins University

  2 shared

• Emily A. Harlan

  RELX Group (United States)

  2 shared

• Jahshara Bulgin

  New York University

  2 shared

Awards & honors

• Robert E. Leet and Clara Guthrie Patterson Trust Mentored Re…

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