About

Norrina Bai Allen is the Quentin D. Young Professor of Health Policy and a faculty member in the Department of Preventive Medicine at Northwestern University Feinberg School of Medicine. She serves as the Director of the Institute for Public Health and Medicine (IPHAM), specifically within the Center for Health Services & Outcomes Research. Her academic roles span Preventive Medicine (Epidemiology), Medical Social Sciences (Determinants of Health), and Pediatrics. Her research focuses on public health and medicine, with an emphasis on health policy, epidemiology, and health services research, contributing to the advancement of preventive medicine and health outcomes.

Research topics

• Medicine
• Internal medicine
• Gerontology
• Psychology
• Demography
• Cardiology
• Pathology
• Psychiatry
• Neuroscience
• Endocrinology
• Intensive care medicine
• Environmental health
• Developmental psychology
• Physical therapy
• Clinical psychology
• Surgery
• Statistics
• Food science

Selected publications

• Blood Pressure Trajectories in Young Adulthood and Midlife Steatotic Liver Disease

  Hypertension · 2026-03-23

  article

  BACKGROUND: Although high blood pressure (BP) is a risk factor for steatotic liver disease (SLD), whether longitudinal BP trajectories starting in young adulthood are associated with midlife SLD is unclear. METHODS: We used data from a US-based prospective cohort, the CARDIA study (Coronary Artery Risk Development in Young Adults), which enrolled 5115 Black and White adults aged 18 to 30 years in 1985 to 1986 (Year 0, Y0). Diastolic and systolic BP and hypertension trajectories were evaluated based on up to 8 BP measures over a 25-year follow-up. SLD at Y25 was measured using noncontrast abdominal computed tomography scans. RESULTS: Among 2817 participants included in the analytic sample, 622 SLD cases were identified. Compared with the low-stable diastolic BP group, other trajectories showed higher SLD prevalence (22.0%-37.5% versus 12.8%), with multivariable-adjusted relative risks of 1.47 (95% CI, 1.17-1.84) for moderate-stable, 1.77 (1.33-2.35) for moderate-increasing (remaining below the threshold for hypertension), 1.57 (1.21-2.04) for elevated-stable, and 2.02 (1.41-2.88) for the elevated-increasing trajectory. Similar positive associations were observed for systolic BP trajectories. Compared with those persistently normotensive, participants who developed hypertension had significantly higher SLD risks: 1.62-fold for late-onset and 1.75-fold for both mid-adulthood and early onset. Consistently, a faster rate of BP increase was linked to higher SLD risk. CONCLUSIONS: Long-term BP and hypertension patterns in young adulthood were independently associated with increased midlife SLD risk, with rapidly increasing BP exhibiting the greatest risk. Long-term BP changes may assist in more accurate identification of individuals at higher risk of SLD.

  PublisherDOI

• Deep Neural Network With a Smooth Monotonic Output Layer for Dynamic Risk Prediction

  Statistics in Medicine · 2026-02-01

  articleOpen access

  Risk prediction is a key component of survival analysis across various fields, including medicine, public health, economics, engineering, and others. The fundamental concern of risk prediction lies in the joint distribution of risk factors and the time to event. The recent success of survival analysis has already been extended to dynamic risk prediction, which incorporates multiple longitudinal observations into predictive models. However, existing methods often rely on parametric model assumptions or discretely approximate survival functions, potentially introducing more bias in predictions. To address these limitations, we introduce a deep neural network featuring a novel output layer termed the Smooth Monotonic Output Layer (SMOL). This model avoids discretization as well as parametric model assumptions. At its core, SMOL takes a general vector as the input and constructs a monotonic, differentiable function via B-splines. Employing SMOL as the output layer allows for direct, nonparametric estimation of monotonic functions of interest, such as survival and cumulative distribution functions. We performed extensive experiments utilizing data from the Cardiovascular Disease Lifetime Risk Pooling Project (LRPP), which harmonized individual data from multiple longitudinal community-based cardiovascular disease (CVD) studies. Our results demonstrate that the proposed approach achieves state-of-the-art accuracy in predicting individual-level risk for atherosclerotic CVD.

  PublisherOA PDFDOI

• Life's Essential 8 and Risk of Severe COVID‐19 Among Adults Without Clinical Cardiovascular Disease: The C4R Study

  Journal of the American Heart Association · 2026-04-27

  articleOpen access

  BACKGROUND: Cardiovascular disease is a risk factor for severe COVID-19 (ie, hospitalization or death). Whether better cardiovascular health (CVH) is associated with lower risk of severe COVID-19 among adults without cardiovascular disease is unknown. We aimed to test if the American Heart Association's Life's Essential 8 (LE8) metric and its components were associated with severe COVID-19 in the C4R (Collaborative Cohort of Cohorts for COVID-19 Research) consortium. METHODS: Participants with cardiovascular disease were excluded. Two waves of questionnaires, events surveillance, and a serosurvey identified COVID-19 infections. Associations of incident severe COVID-19 with continuous LE8, categorical LE8 (low [<50], moderate [50 to <80], and high [≥80] CVH), and individual LE8 components, were tested in adjusted cause-specific hazards models. RESULTS: Among 29 740 participants in 9 cohorts (mean age, 66±14 years; 61% women; 35% White race; 22% Black race; 34% Hispanic ethnicity), there were 681 severe COVID-19 cases between March 1, 2020, and February 28, 2023. There was a 20% lower hazard of severe COVID-19 per each 1-SD higher LE8 (adjusted hazard ratio [aHR], 0.80 [95% CI, 0.73-0.88]). Relative to low CVH, high CVH was associated with lower risk of severe COVID-19 (aHR, 0.54 [95% CI, 0.37-0.78]); this was not seen for moderate CVH (aHR, 0.81 [95% CI, 0.64-1.04]). Of LE8 components, better physical activity, body mass index, blood pressure, and sleep were associated with a lower hazard of severe COVID-19. CONCLUSIONS: Better CVH was associated with lower severe COVID-19 risk among cardiovascular disease-free adults. Whether CVH optimization could mitigate adverse risk from COVID-19 and other harmful viruses warrants further investigation.

  PublisherDOI

• Optimizing Blood Pressure Targets in Patients With Cardiovascular Disease: Rethinking Control in Terms of Time in Range

  Circulation Population Health and Outcomes · 2026-02-24 · 1 citations

  article1st authorCorresponding
  PublisherDOI

• Cardiovascular-Kidney-Metabolic Medication Eligibility Across National Survey, Community-Based, and Ambulatory Healthcare Samples

  JAMA Cardiology · 2026-01-28 · 2 citations

  articleOpen access

  Importance: The prevalence of obesity and cardiovascular-kidney-metabolic (CKM) syndrome continues to rise. Indications for novel CKM therapies, including glucagonlike peptide 1 receptor agonists (GLP-1RAs), sodium-glucose cotransporter-2 inhibitors (SGLT2is), and nonsteroidal mineralocorticoid antagonists (nsMRAs) continue to expand, yet the proportion of adults meeting expanded indications, including for multiple medications remains unclear. Objective: To examine proportion of adults meeting US Food and Drug Administration (FDA)-approved indications for GLP1-RAs, SGLT2is, and nsMRAs across national survey, community-based, and ambulatory health care samples. Design, Setting, and Participants: This study used a representative cross-sectional survey of US adults (National Health and Nutrition Examination Survey [NHANES], weighted 245 million; mean [SD] age, 47 [18] years; 126.8 million [52%] female), 5 pooled community-based cohort studies (the Framingham Heart Study, the Multi-Ethnic Study of Atherosclerosis, the Prevention of Renal and Vascular Endstage Disease Study, the Atherosclerosis Risk in Communities Study, and the Cardiovascular Health Study; n = 30 929; mean [SD] age, 63 [14] years; 16 749 [54%] female), and 2 ambulatory health care samples (the Beth Israel Deaconess Medical Center cohort [BIDMC], n = 84 714; mean [SD] age, 46 [17] years; 51 113 [60%] female] and the Mass General Brigham cohort [MGB], n = 362 485; mean [SD] age, 48 [17] years; 227 206 [61%] female). Data were analyzed from November 2024 to November 2025. Exposures: FDA-approved indications for GLP-1RAs, SGLT2is, and nsMRAs. Main Outcomes and Measures: Medication class eligibility within each study sample. Results: The proportion of individuals who met current FDA-approved indications for 1 or more CKM medication was 60% in NHANES (representing 148 million US adults), 61% in the pooled cohorts, 42% in the BIDMC ambulatory cohort, and 46% in the MGB ambulatory cohort. Eligibility for GLP-1RA therapy was most common, with 56% (representing 137.1 million US adults) in NHANES, 49% in the pooled cohorts, 41% in the BIDMC cohort, and 46% in the MGB cohort. This was followed by SGLT2i therapy (24% [57.9 million] in NHANES, 33% in the pooled cohorts, 14% for both BIDMC and MGB) and nsMRA (5% [11.7 million] in NHANES, 5% in the pooled cohorts, and 1% to 2% in ambulatory samples). Overlapping eligibility for multiple classes was common, with 12% to 17% for GLP1-RA and SGLT2i therapies and 1% to 5% for all 3 classes (an estimated 11.7 million US adults in NHANES). Conclusions and Relevance: This study found that up to 61% of adults met FDA-approved indications for at least 1 of 3 novel CKM therapy classes. This represents an estimated 148 million US adults, including 11.7 million US adults with potential FDA indications for triple therapy, highlighting the urgent need to optimize implementation and utilization of CKM syndrome therapies.

  PublisherOA PDFDOI

• Premature Menopause and Lifetime Risk of Coronary Heart Disease

  JAMA Cardiology · 2026-03-18 · 2 citations

  articleOpen access

  Importance: Premature onset of menopause is associated with increased short-term risk of coronary heart disease (CHD), but the associated long-term CHD risk and whether this differs by self-identified race are not known. Objective: To calculate lifetime risk estimates of incident CHD and to estimate years lived free of and with CHD by premature menopause status stratified by self-identified race. Design, Setting, and Participants: This prospective population-based cohort study was conducted with 163 600 person-years of follow-up, from 1964 to 2018. Individual-level data from postmenopausal women (aged 55-69 years) who self-identified their race as Black or White across 6 US cohorts were included. All participants were free of CHD at baseline and had data on menopausal status and CHD outcomes. Individuals who self-reported surgically induced menopause were excluded. Exposure: Premature onset of natural menopause (age <40 years). Main Outcome and Measures: The primary outcome was CHD (fatal and nonfatal myocardial infarction). The following analyses were performed: (1) modified Kaplan-Meier analysis to estimate lifetime risks, (2) adjusted competing Cox models to estimate joint cumulative risks for CHD or non-CHD death, and (3) Irwin restricted mean survival time to estimate mean years lived free of CHD and with CHD. Results: Of the 3522 Black women and 6514 White women included, mean (SD) age at baseline was 61.2 (4.3) years and 60.0 (4.4) years, respectively. Premature natural menopause occurred more frequently in Black women (545 [15.5%]) compared with White women (313 [4.8%]). Premature menopause was associated with a higher lifetime risk of incident CHD, with hazard ratios of 1.41 (95% CI, 1.04-1.90) for Black women and 1.39 (95% CI, 1.03-1.87) for White women. Mean years lived free of CHD were 18.2 years (95% CI, 17.5-18.9) for Black women with premature menopause compared to 19.1 years (95% CI, 18.8-19.4) for Black women without premature menopause; a similar pattern was seen in White women with and without premature menopause, but neither met statistical significance. Conclusions and Relevance: In this cohort study, premature menopause was associated with 40% higher lifetime risk of CHD in Black and White women. This suggests that premature onset of menopause is an important risk-enhancing factor for lifetime risk and should be routinely assessed in clinical practice to consider intensification of preventive efforts.

  PublisherOA PDFDOI

• PREVENT Equations in Young Adults

  Journal of the American College of Cardiology · 2026-02-04 · 1 citations

  article
  PublisherDOI

• Health Equity Perspective on Data‐Driven Treatment Decisions in Cardiovascular Care: Risk Assessments Versus Individualized Treatment Rules

  Journal of the American Heart Association · 2026-03-04

  articleOpen access

  Background Medical treatment decisions are often based on estimated global risk scores. When heterogeneity in treatment effects exists, assigning treatment according to estimated individualized treatment rules (ITRs) instead has the potential to improve mean outcomes. This article aims to investigate racial and ethnic group differences in treatment rates when comparing antihypertensive medication recommendations from an estimated ITR with a risk score approach. Methods Data were simulated to emulate observational data with underlying treatment effect heterogeneity in survival times. An ITR and risk score approach were compared to illustrate how the resulting recommendations may disagree. An ITR for prescribing antihypertensives was estimated from 3281 adults from MESA (Multi‐Ethnic Study of Atherosclerosis), an observational longitudinal cohort study, and compared with the risk‐based approach recommended by cardiovascular care guidelines. Hypothetical treatment rates under each “rule” were computed. In the simulation study, the proportion of individuals treated optimally under each rule was calculated. Using MESA, a Chi‐square test of independence was performed to determine whether treatment rates differed across racial and ethnic groups. Results Two benefits of ITRs were shown: they (1) maximize expected survival times and (2) may mitigate racial disparities when treatment effect heterogeneity is expected. Using MESA, the ITR recommended treatment to more participants than the risk score approach across all racial and ethnic groups. A Chi‐square test suggested that treatment rates for different “rules” differed significantly across racial and ethnic groups ( P &lt;0.001). Conclusions Treatment recommendations varied substantially when assigning treatment using an ITR versus a risk‐based approach.

  PublisherDOI

• Exploring parental views and perceptions of cardiovascular health: a qualitative study

  BMC Public Health · 2025-12-17

  articleOpen accessSenior author

  BACKGROUND: Cardiovascular health (CVH) is a critical component of overall health and well-being; however, understanding parents' views and opinions on heart health remains underexplored. Insights from parents are essential for designing interventions that promote intergenerational heart health. The purpose of this study was to examine parental perceptions of CVH and gain a deeper understanding of their perspectives on achieving CVH and the role it plays in lifelong health. METHODS: We recruited participants and conducted semi-structured interviews with 21 parents of children under 18 and 4 children. Data were analyzed using thematic coding grounded in the constant comparative method to identify major themes and subthemes. Child interviews were analyzed separately. These interviews provided additional context for understanding how youth conceptualize CVH and insights into family communication on the topic. Thematic saturation was achieved, supporting the sample size's adequacy for qualitative analysis. RESULTS: Eight overarching themes emerged, including interest in participating in the study, parents' initial thoughts on CVH, definitions of heart health, information sources, family and community roles, heart health experiences, resources, and emotional health connections. Key findings revealed significant barriers to CVH, including limited access to fitness programs and healthy food due to cost and time constraints. While families supported CVH through shared activities, explicit discussions among family members were uncommon. Participants emphasized the impact of stress and negative emotions on heart health, highlighting a potential area for intervention. CONCLUSIONS: These findings highlight the need for flexible, community-based interventions that support CVH by engaging families and incorporating mental health promotion strategies. Effective strategies include enhancing community fitness and nutrition, programs to reduce cost barriers, offering flexible options to accommodate family schedules, and addressing emotional well-being. Healthcare providers can play a key role in these efforts by actively encouraging these strategies during patient interactions.

  PublisherDOI

• A health equity perspective on data-driven treatment decisions in cardiovascular care: risk assessments versus individualized treatment rules

  medRxiv · 2025-09-12

  preprintOpen access

  Abstract Background Medical treatment decisions are often based on estimated global risk scores. When heterogeneity in treatment effects exists, assigning treatment according to estimated individualized treatment rules (ITRs) instead has the potential to improve mean outcomes. To investigate racial and ethnic group differences in treatment rates when comparing antihypertensive medication recommendations from an estimated ITR with a risk score approach. Methods Data were simulated to emulate observational data with underlying treatment effect heterogeneity in survival times. An ITR and risk score approach were compared to illustrate how the resulting recommendations may disagree. An ITR for prescribing antihypertensives was estimated from 3,281 adults from the Multi-Ethnic Study of Atherosclerosis (MESA), an observational longitudinal cohort study, and compared to the risk-based approach recommended by cardiovascular care guidelines. Hypothetical treatment rates under each “rule” were computed. In the simulation study, the proportion of individuals treated optimally under each rule was calculated. Using MESA, a Chi-square test of independence was performed to determine whether treatment rates differed across racial and ethnic groups. Results Two benefits of ITRs were shown: they (1) maximize expected survival times and (2) may mitigate racial disparities when treatment effect heterogeneity is expected. Using MESA, the ITR recommended treatment to more participants than the risk score approach across all racial and ethnic groups. A Chi-square test suggested that treatment rates for different “rules” differed significantly across racial and ethnic groups (p &lt; .001). Conclusion Treatment recommendations varied substantially when assigning treatment using an ITR versus a risk-based approach.

  PublisherOA PDFDOI

Recent grants

• Dietary sodium, inflammation, and salt sensitivity of blood pressure

  NIH · $3.1M · 2019–2025

• NIH Grant R36HS016959

  NIH · $38k · 2009

• Favorable Cardiovascular Health and the Compression of Morbidity in Older Age

  NIH · $1.7M · 2014–2018

Frequent coauthors

• Donald M. Lloyd‐Jones

  Northwestern University

  425 shared

• Judith H. Lichtman

  358 shared

• Hongyan Ning

  Northwestern University

  185 shared

• Larry B. Goldstein

  182 shared

• Emi Watanabe

  176 shared

• Harlan M. Krumholz

  Yale New Haven Health System

  173 shared

• John A. Spertus

  University of Missouri–Kansas City

  170 shared

• Jared P. Reis

  National Heart Lung and Blood Institute

  134 shared