About

Evelyn Hsieh, MD, PhD, is an Associate Professor of Medicine in Rheumatology and Epidemiology (Chronic Diseases) at Yale University. She serves as the Chief of Rheumatology at the VA Connecticut Healthcare System and is involved in multiple roles including Associate Program Director for the Global Health Emerging Scholars Program and Program Director for the CMB Global Health Fellowship Programs. Her research focuses on bridging biomedical and behavioral sciences methodologies to risk stratify and identify feasible prevention strategies for osteoporosis, fractures, and sarcopenia among individuals with HIV in low-resource settings. She has conducted extensive research in countries undergoing economic transition, such as China and Peru, where she explores mechanistic, epidemiologic, health services, and behavioral aspects of these conditions, particularly among vulnerable populations like persons with HIV. Her work aims to develop tools and models for prevention and management of musculoskeletal outcomes, and she co-directs the Rheumatology, Endocrine, and Geriatric Syndromes Core of the Veterans Aging Cohort Study. Dr. Hsieh is dedicated to mentoring research scholars and has been supported by multiple NIH institutes, foundations, and organizations. She has also contributed to global health initiatives, served on the Board of the American College of Rheumatology, and was a Fulbright Scholar.

Research topics

• Medicine
• Internal medicine
• Immunology
• Pediatrics
• Physical therapy
• Virology
• Biology

Selected publications

• Development and Validation of Case‐Finding Algorithms to Identify Periprosthetic Joint Infections After Total Hip Arthroplasty in Veterans Health Administration Data

  Pharmacoepidemiology and Drug Safety · 2026-01-01

  articleOpen access

  PURPOSE: To determine the positive predictive values (PPVs) of ICD-9- and ICD-10-based diagnostic coding algorithms to identify periprosthetic joint infection (PJI) following total hip arthroplasty (THA) within the United States (US) Veterans Health Administration (VHA). METHODS: We selected patients with: (1) any position hospital discharge ICD-9 or ICD-10 diagnosis of PJI, (2) ICD-9, ICD-10, or current procedural terminology (CPT) procedure codes for THA any time prior to PJI diagnosis, (3) CPT code for hip X-ray within ±90 days of the PJI diagnosis, and (4) 1 or more CPT codes for arthrocentesis, arthrotomy, or revision arthroplasty all occurring within ±90 days of the PJI diagnosis date. We obtained separate samples of patients for ICD-9 and ICD-10-based PJI diagnoses. These samples were stratified by THA medical center volume. Infectious disease physicians adjudicated each identified PJI event. The PPV (95% confidence interval [CI]) for the ICD-9 and ICD-10 PJI algorithms were calculated. RESULTS: Among the 90 sampled hip PJI events for the ICD-9 era, 79 were confirmed PJIs (PPV 87.8%, 95% CI 79.2%-93.7%). For the 90 sampled hip PJI events for the ICD-10 era, 72 were confirmed PJIs (PPV 80.0%, 95% CI 70.3%-87.7%). CONCLUSION: These algorithms yielded a PPV of 87.8% (ICD-9) and 80.0% (ICD-10), for confirmed PJI events and could be considered for use in future pharmacoepidemiologic studies.

  PublisherOA PDFDOI

• Efficacy and safety of immunosuppressive therapy in connective tissue disease-related immune thrombocytopenia: a systematic review and meta-analysis

  Therapeutic Advances in Hematology · 2026-02-01

  articleOpen access

  Background: Connective tissue diseases (CTDs) are a group of autoimmune disorders in which immune thrombocytopenia (ITP) represents a common and important manifestation. Current CTD-ITP management mainly relies on glucocorticoids and immunosuppressive agents. Objectives: This systematic review and meta-analysis aims to evaluate the efficacy and safety of immunosuppressive agents in patients with CTD-ITP. Design: Systematic review and meta-analysis. Methods: This study was conducted using eight databases up to July 22, 2024. Observational studies and experimental trials with relevant efficacy and safety data were included. Methodological quality were evaluated using the Newcastle-Ottawa Scale and the ROBINS-I tool. The Mantel-Haenszel formula with a random effect model was employed to estimate the overall effect size. Subgroup analyses were performed based on the study characteristics, clinical features, and treatment regimen. Results: Through integrating 24 studies (1 single-arm clinical trial, 1 case-control, and 22 cohort studies) involving 775 CTD-ITP patients, the pooled estimates of the optimal overall and complete response rate for immunosuppressive therapy were 82% (95% CI: 75-88) and 64% (95% CI: 56-72), with stable results after sensitivity analysis. The combined side-effect incidence was 31% (95% CI: 24-39). The pooled relapse rate was 30% (95% CI: 18-43) among 403 immunosuppressive therapy responders. Conclusion: Immunosuppressive treatments exhibited favorable efficacy and safety in CTD-ITP patients. Future larger-scale multicenter studies are needed.

  PublisherDOI

• The Global Rheumatology Workforce

  Rheumatic Disease Clinics of North America · 2026-03-11

  article1st author
  PublisherDOI

• The global, regional, and national burden attributable to low bone mineral density, 1990–2020:an analysis of a modifiable risk factor from the Global Burden of Disease Study 2021

  Utrecht University Repository (Utrecht University) · 2025-12-01

  articleOpen access1st authorCorresponding

  Background: Fractures related to osteoporosis and low bone mineral density lead to substantial morbidity, mortality, and cost to individuals and health systems. Here we present the most up-to-date global, regional, and national estimates of the contribution of low bone mineral density to the burden of fractures from falls and additional categories of injuries from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. Methods: The burden of low bone mineral density was estimated from 1990 to 2020 in terms of years lived with disability (YLDs), disability-adjusted life years (DALYs), and deaths, for individuals aged 40 years and older, using data from population-based studies from 48 countries or territories (169 unique sources). Mean standardised femoral neck bone mineral density values were estimated by GBD location, age, and sex by meta-regression. Based on a separate meta-analysis of population-based studies from nine countries (12 unique sources), we also estimated the pooled relative risk of fractures per unit decrease in bone mineral density (g/cm2). The population-attributable fraction for low bone mineral density was calculated by comparing the observed distributions of standardised femoral neck bone mineral density to an age-specific and sex-specific counterfactual distribution, defined as the 99th percentile of five rounds of the National Health and Nutrition Examination Survey in the USA, by 5-year age group and sex. Hospital and emergency department data were used to derive the incidence of fractures for six categories of injury (road injuries, other transport injuries, falls, non-venomous animal contact, exposure to mechanical forces, and physical interpersonal violence) using ICD codes. Deaths due to fractures were estimated as the proportion of in-hospital deaths due to the specified injury causes for which a fracture (nature of injury code) was more severe than the cause of injury code. YLDs and DALYs attributable to low bone mineral density by cause of injury were also determined according to previous GBD methods. Findings: In 2020, 8·32 million (95% UI 5·58–10·84) YLDs, 17·2 million (14·1–20·2) DALYs, and 477 000 (411 000–536 000) deaths were attributable to low bone mineral density globally in individuals aged 40 years and older. Between 1990 and 2020, global YLDs, DALYs, and deaths attributable to low bone mineral density increased by 91·8% (88·5–95·1), 89·8% (81·5–99·0), and 127·1% (108·5–144·5), respectively. Over this period, the age-standardised global rates of YLDs, DALYs, and deaths attributable to low bone mineral density showed modest decreases. In 2020, falls accounted for 76·2% (95% UI 74·2–78·3) of YLDs, 65·2% (62·9–67·6) of DALYs, and 71·0% (67·4–72·8) of deaths attributable to low bone mineral density, and road injuries largely accounted for the remaining amount: 12·4% (11·1–13·6) of YLDs, 24·6% (22·5–27·1) of DALYs, and 23·1% (21·6–26·2) of deaths. As a proportion of all fall-related burden, low bone mineral density accounted for 26·6% (23·2–28·7) of YLDs, 25·6% (22·1–27·4) of DALYs, and 40·6% (35·4–44·0) of deaths in 2020. Of all road injury-related burden, 12·6% (10·8–13·5) of YLDs, 6·3% (5·4–6·9) of DALYs, and 8·9% (7·6–9·6) of deaths were attributable to low bone mineral density. In men, road injuries accounted for the largest proportion of DALYs attributable to low bone mineral density in those aged 40–59 years and the largest proportion of deaths in those aged 40–64 years. In women, road injuries were the leading cause of DALYs attributable to low bone mineral density in those aged 40–44 years and the leading cause of deaths attributable to low bone mineral density in those aged 40–54 years. In older age groups among both men and women, falls were the leading cause of the burden attributable to low bone mineral density. Interpretation: Low bone mineral density is a crucial modifiable risk factor for fractures, which are an important cause of morbidity and mortality particularly in ageing populations. This analysis highlights low bone mineral density as a cause of health loss not just from falls, but also from road injuries. Funding: Gates Foundation.

  Publisher

• Development and validation of case-finding algorithms to identify periprosthetic joint infections after total hip arthroplasty in Veterans Health Administration data

  2025-03-08

  preprintOpen access

  not-yet-known not-yet-known not-yet-known unknown Purpose: To determine the positive predictive values (PPVs) of ICD-9 and ICD-10-based diagnostic coding algorithms to identify periprosthetic joint infection (PJI) following total hip arthroplasty (THA) within the United States (US) Veterans Health Administration (VHA). Methods: We selected patients with: (1) any position hospital discharge ICD-9 or ICD-10 diagnosis of PJI, (2) ICD-9, ICD-10, or Current Procedural Terminology (CPT) procedure codes for THA any time prior to PJI diagnosis, (3) CPT code for hip X-ray within ±90 days of the PJI diagnosis, and (4) 1 or more CPT codes for arthrocentesis, arthrotomy, or revision arthroplasty all occurring within ±90 days of the PJI diagnosis date. We obtained separate samples of patients for ICD-9 and ICD-10-based PJI diagnoses. These samples were stratified by THA medical center volume. Infectious disease physicians adjudicated each identified PJI event. The PPV (95% confidence interval [CI]) for the ICD-9 and ICD-10 PJI algorithms were calculated. Results: Among the 90 sampled hip PJI events for the ICD-9 era, 79 were confirmed PJIs (PPV, 87.8%; 95% CI, 79.2%-93.7%). For the 90 sampled hip PJI events for the ICD-10 era, 72 were confirmed PJIs (PPV, 80.0%; 95% CI, 70.3%-87.7%). Conclusion: These algorithms yielded a PPV of 87.8% (ICD-9) and 80.0% (ICD-10), for confirmed PJI events and could be considered for use in future pharmacoepidemiologic studies.

  PublisherOA PDFDOI

• Non-communicable disease care for persons living with HIV in Peru: A national physician cross-sectional study

  PLOS Global Public Health · 2025-08-04

  articleOpen accessSenior authorCorresponding

  Non-communicable diseases (NCDs) are a significant cause of morbidity and mortality for the aging HIV population worldwide. In Peru, no data exists on how providers address NCDs for persons living with HIV (PLWH). This study examines HIV physician confidence and current management practices for NCDs for PLWH in Peru. We recruited public-sector HIV physicians via Peru's National HIV, STI and Hepatitis Program's (NHSTIHP) physician registry and by program coordinator referral. Participants completed a telephone survey encompassing seven NCDs [hyperlipidemia, hypertension, diabetes, osteoporosis, sarcopenia, non-AIDS defining cancers, neurocognitive impairment (NCI)] and three modifiable risk factors (obesity, tobacco, and alcohol use). Survey domains included: (1) provider and practice characteristics (2) NCDs encountered, (3) provider confidence in prevention, diagnosis, and treatment (based upon a four-point Likert scale), (4) screening frequency and management approaches (free response). We obtained contact information from 167 physicians working with the NHSTIHP, and 78 (47%) volunteered to participate (mean age 45.8 ± 9.3 years; 26% women; 78% infectious disease trained) across 23 of the 25 regions of Peru. The majority (>50%) of physicians reported at least one patient with: hyperlipidemia, hypertension, diabetes, NCI, cervical cancer, obesity, tobacco, and/or alcohol use. Physicians felt most confident independently managing metabolic disorders (hyperlipidemia, diabetes, hypertension, obesity), and least confident with NCI and sarcopenia. Most physicians (>50%) would manage the NCDs, although management approaches differed. NCD screening that was part of the NHSTIHP National HIV care guidelines was more consistently performed than screening beyond the scope of the existing guidelines. Peruvian HIV physicians encounter NCDs in their patient population and manage these conditions and risk factors despite variable confidence and/or knowledge of best practices. This study highlights opportunities for expanding physician education, addressing systems-level barriers to NCD care, and the need for locally relevant, epidemiologically-based, HIV-specific NCD care guidelines.

  PublisherDOI

• Prevalence of metabolic syndrome in people living with HIV and its multi-organ damage: a prospective cohort study

  BMC Infectious Diseases · 2025-03-12 · 8 citations

  articleOpen accessCorresponding

  INTRODUCTION: With the global scale-up of antiretroviral therapy (ART) and improved life expectancy, people living with HIV (PLWH) increasingly face non-infectious comorbidities, and metabolic syndrome (MetS) is one of the most prevalent. MetS is associated with unfavorable health outcomes, including cardiovascular disease, chronic kidney disease, and metabolic dysfunction-associated fatty liver disease. However, data on the prevalence and risk factors of MetS among treatment-naïve PLWH in China are limited. The aim was to investigate the prevalence and risk factors of MetS and to understand its association with multi-organ damage. METHODS: Data on sociodemographic, physical, and clinical characteristics were collected from a completed multicenter, prospective cohort study in China. MetS was diagnosed according to criteria proposed by the China Diabetes Society. Univariate and multivariable logistic regression were applied to identify associated risk factors for MetS. The relationship with organ damage, including kidney, liver, heart, and bone health, were also been assessed. RESULTS: Among the 449 participants (median age 30 years; 92.9% male), 16.9% met the criteria for MetS. Patients met MetS criteria in our study presented with low HDL-C concentration (49.8%), hypertriglyceridemia (26.1%), hypertension (23.1%), hyperglycemia (15.4%), and abdominal obesity (8.0%). Risk factors significantly associated with MetS included older age (OR 1.08; 95% CI 1.02-1.15) and alcohol consumption (OR 3.63; 95% CI 1.13-11.67). PLWH with MetS exhibited higher level of organ involvement, including reduced kidney function, elevated liver enzymes, and increased risks for cardiovascular events. Among them, 162 participants (36.0%) were classified as being at moderate or high risk using pooled cohort equations (PCEs). It is worth noting that in the MetS group, the dropped bone mineral density (BMD) in the spine decreased more significantly than that of the non-MetS group (P = 0.007). CONCLUSION: The incidence of MetS in ART-naïve PLWH in China is relatively high. Older age and alcohol consumption are associated with higher risk of MetS. Multiple organ damage may occur accompanied with MetS. Early identification and intervention are critical in managing MetS in PLWH.

  PublisherOA PDFDOI

• Development and validation of case-finding algorithms to identify periprosthetic joint infections after total hip arthroplasty in Veterans Health Administration data

  2025-08-27

  articleOpen access

  Purpose: To determine the positive predictive values (PPVs) of ICD-9 and ICD-10-based diagnostic coding algorithms to identify periprosthetic joint infection (PJI) following total hip arthroplasty (THA) within the United States (US) Veterans Health Administration (VHA). Methods: We selected patients with: (1) any position hospital discharge ICD-9 or ICD-10 diagnosis of PJI, (2) ICD-9, ICD-10, or Current Procedural Terminology (CPT) procedure codes for THA any time prior to PJI diagnosis, (3) CPT code for hip X-ray within ±90 days of the PJI diagnosis, and (4) 1 or more CPT codes for arthrocentesis, arthrotomy, or revision arthroplasty all occurring within ±90 days of the PJI diagnosis date. We obtained separate samples of patients for ICD-9 and ICD-10-based PJI diagnoses. These samples were stratified by THA medical center volume. Infectious disease physicians adjudicated each identified PJI event. The PPV (95% confidence interval [CI]) for the ICD-9 and ICD-10 PJI algorithms were calculated. Results: Among the 90 sampled hip PJI events for the ICD-9 era, 79 were confirmed PJIs (PPV, 87.8%; 95% CI, 79.2%-93.7%). For the 90 sampled hip PJI events for the ICD-10 era, 72 were confirmed PJIs (PPV, 80.0%; 95% CI, 70.3%-87.7%). Conclusion: These algorithms yielded a PPV of 87.8% (ICD-9) and 80.0% (ICD-10), for confirmed PJI events and could be considered for use in future pharmacoepidemiologic studies.

  PublisherOA PDFDOI

• Improving osteoporosis prevention and care for patients with HIV: insights from HIV care providers in China

  BMC Health Services Research · 2025-09-24 · 1 citations

  articleOpen access

  Osteoporosis has emerged as an important comorbidity for people living with HIV (PLWH) as life expectancy for this population has increased in the anti-retroviral therapy era. In countries lacking a robust primary care system such as China, chronic co-morbidities of HIV such as osteoporosis and fractures may be particularly under-recognized. Understanding barriers and opportunities for integration of bone health promotion strategies into current HIV care settings can aid in bone health program development and may provide a model of primary/secondary preventive care that is currently lacking. Adopting grounded theory approach, we conducted a qualitative research study between April-July 2021. In-depth interviews were carried out with 13 HIV care providers, including physicians and nurses involved in both clinical care and coordination of HIV care services, from four cities across China. Two independent coders applied the constant comparison method for transcript analysis on providers’ current knowledge and practices on bone health in HIV, as well as opportunities and barriers to future program development. Interviewed providers recognized osteoporosis as a topic of increasing importance in long-term HIV care yet conceded that bone health received less priority than other aging-related comorbidities in routine HIV care. They reported receiving little formalized training on managing osteoporosis and limited access to education on this topic due to financial and human resources constraints. However, providers saw significant potential for program development in three key areas: creation and adoption of population-specific guidelines for osteoporosis prevention, screening, and management practices; increased access to training regarding osteoporosis screening, interpretation of results, and management algorithms; and development of structured interdisciplinary care services and referral networks. Osteoporosis is an issue of increasing importance for the comprehensive care of PLWH. Population-specific recommendations on prevention, screening and management of osteoporosis, targeted education programs and tools, and innovative interdisciplinary expansion of current HIV care networks were identified by HIV care providers as key strategies for osteoporosis and fracture prevention and broader promoting bone health among Chinese PLWH.

  PublisherOA PDFDOI

• Impact of Climate Change on Rheumatology Care

  Rheumatic Disease Clinics of North America · 2025-10-21

  articleSenior authorCorresponding
  PublisherDOI

Recent grants

• Risk for Bone Loss Among Individuals with HIV in a Resource-Limited Environment

  NIH · $693k · 2015–2022

Frequent coauthors

• Taisheng Li

  Tsinghua University

  100 shared

• Weibo Xia

  Temple University

  52 shared

• Xiaojing Song

  Chinese Academy of Medical Sciences & Peking Union Medical College

  47 shared

• Yanling Li

  37 shared

• Liana Fraenkel

  Yale University

  36 shared

• Yang Han

  Sichuan University

  35 shared

• Amy C. Justice

  35 shared

• Jing Xie

  30 shared

Education

• M.D.

  Yale School of Medicine

• Ph.D.

  Yale School of Medicine

Awards & honors

• Fulbright Scholar (2018-2019)