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Akbaş KE, Hark BD. Evaluation of quantitative bias analysis in epidemiological research: A systematic review from 2010 to mid-2023. J Eval Clin Pract 2024; 30:1413-1421. [PMID: 39031561 DOI: 10.1111/jep.14065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/17/2024] [Accepted: 06/03/2024] [Indexed: 07/22/2024]
Abstract
OBJECTIVE We aimed to demonstrate the use of quantitative bias analysis (QBA), which reveals the effects of systematic error, including confounding, misclassification and selection bias, on study results in epidemiological studies published in the period from 2010 to mid-23. METHOD The articles identified through a keyword search using Pubmed and Scopus were included in the study. The articles obtained from this search were eliminated according to the exclusion criteria, and the articles in which QBA analysis was applied were included in the detailed evaluation. RESULTS It can be said that the application of QBA analysis has gradually increased over the 13-year period. Accordingly, the number of articles in which simple is used as a method in QBA analysis is 9 (9.89%), the number of articles in which the multidimensional approach is used is 10 (10.99%), the number of articles in which the probabilistic approach is used is 60 (65.93%) and the number of articles in which the method is not specified is 12 (13.19%). The number of articles with misclassification bias model is 44 (48.35%), the number of articles with uncontrolled confounder(s) bias model is 32 (35.16%), the number of articles with selection bias model is 7 (7.69%) and the number of articles using more than one bias model is 8 (8.79%). Of the 49 (53.85%) articles in which the bias parameter source was specified, 19 (38.78%) used internal validation, 26 (53.06%) used external validation and 4 (8.16%) used educated guess, data constraints and hypothetical data. Probabilistic approach was used as a bias method in 60 (65.93%) of the articles, and mostly beta (8 [13.33%)], normal (9 [15.00%]) and uniform (8 [13.33%]) distributions were selected. CONCLUSION The application of QBA is rare in the literature but is increasing over time. Future researchers should include detailed analyzes such as QBA analysis to obtain inferences with higher evidence value, taking into account systematic errors.
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Affiliation(s)
- Kübra Elif Akbaş
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Fırat University, Elazig, Turkey
| | - Betül Dağoğlu Hark
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Fırat University, Elazig, Turkey
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2
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Howards PP, Johnson CY. A selection of challenges in addressing selection bias. Paediatr Perinat Epidemiol 2024; 38:638-640. [PMID: 38949320 DOI: 10.1111/ppe.13102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 06/09/2024] [Indexed: 07/02/2024]
Affiliation(s)
| | - Candice Y Johnson
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
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3
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Goodman JE, Espira LM, Zu K, Boon D. Quantitative recall bias analysis of the talc and ovarian cancer association. GLOBAL EPIDEMIOLOGY 2024; 7:100140. [PMID: 38510537 PMCID: PMC10951893 DOI: 10.1016/j.gloepi.2024.100140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/09/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024] Open
Affiliation(s)
- Julie E. Goodman
- Gradient, One Beacon Street, 17 Floor, Boston, MA 02108, United States of America
| | - Leon M. Espira
- Gradient, One Beacon Street, 17 Floor, Boston, MA 02108, United States of America
| | | | - Denali Boon
- Gradient, One Beacon Street, 17 Floor, Boston, MA 02108, United States of America
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4
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Rosen EM, Ritchey ME, Girman CJ. Can Weight of Evidence, Quantitative Bias, and Bounding Methods Evaluate Robustness of Real-world Evidence for Regulator and Health Technology Assessment Decisions on Medical Interventions? Clin Ther 2023; 45:1266-1276. [PMID: 37798219 DOI: 10.1016/j.clinthera.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 06/07/2023] [Accepted: 09/12/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE High-quality evidence is crucial for health care intervention decision-making. These decisions frequently use nonrandomized data, which can be more vulnerable to biases than randomized trials. Accordingly, methods to quantify biases and weigh available evidence could elucidate the robustness of findings, giving regulators more confidence in making approval and reimbursement decisions. METHODS We conducted an integrative literature review to identify methods for determining probability of causation, evaluating weight of evidence, and conducting quantitative bias analysis as related to health care interventions. Eligible studies were published from 2012 to 2021, applicable to pharmacoepidemiology, and presented a method that met our objective. FINDINGS Twenty-two eligible studies were classified into 4 categories: (1) quantitative bias analysis; (2) weight of evidence methods; (3) Bayesian networks; and (4) miscellaneous. All of the methods have strengths, limitations, and situations in which they are more well suited than others. Some methods seem to lend themselves more to applications of health care evidence on medical interventions than others. IMPLICATIONS To provide robust evidence for and improve confidence in regulatory or reimbursement decisions, we recommend applying multiple methods to triangulate associations of medical interventions, accounting for biases in different ways. This approach could lead to well-defined robustness assessments of study findings and appropriate science-driven decisions by regulators and payers for public health.
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Affiliation(s)
- Emma M Rosen
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA; CERobs Consulting, LLC, Wrightsville Beach, North Carolina, USA
| | - Mary E Ritchey
- CERobs Consulting, LLC, Wrightsville Beach, North Carolina, USA; Med Tech Epi, LLC; Philadelphia, Pennsylvania, USA; Center for Pharmacoepidemiology & Treatment Science, Rutgers University, New Brunswick, New Jersey, USA
| | - Cynthia J Girman
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA; CERobs Consulting, LLC, Wrightsville Beach, North Carolina, USA.
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Erly S, Campos L, Buskin S, Reuer J. Evaluating surveillance definitions of HIV viral suppression 2015-2019: Which definition best detected barriers to care? J Public Health Res 2023; 12:22799036231182031. [PMID: 37361236 PMCID: PMC10285601 DOI: 10.1177/22799036231182031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 04/28/2023] [Indexed: 06/28/2023] Open
Abstract
Background People living with HIV (PLWH) who have not achieved or maintained viral suppression post-diagnosis likely face multiple barriers to HIV care. To identify these barriers a universally accepted definition of viral suppression is needed. The most common definition, the Center for Disease Control and Prevention (CDC) definition, contains simplifying assumptions that may misclassify individuals and attenuate associations. In this study, we evaluated alternative definitions of viral suppression on their ability to identify barriers to care. Design and methods We used HIV surveillance data to classify participants of the 2015-2019 Washington Medical Monitoring Project (MMP) as virally suppressed or not using the CDC definition and two definitions that assess viral suppression over a longer period ("Enriched" and "Durable"). We identified barriers to suppression from literature (unstable housing, illicit drug use, poor mental health, heavy drinking, recent incarceration, racism, and poverty) and measured them using interview questions from MMP. We compared the rate ratios (RR) of being not virally suppressed using each definition for each barrier. Results There were 858 PLWH in our study. All viral suppression definitions classified a similar proportion of people as suppressed (85%-89%). The durable viral suppression definition consistently yielded the largest rate ratios (e.g. unstable housing: CDC RR = 1.3, 95% CI 0.9-1.8; Enriched 1.5, 95% CI 1.0-2.2; Durable 2.2, 95% CI 1.6-3.1) and reclassified 10% of the population relative to the CDC definition. Conclusions Longitudinal definitions for viral suppression may yield less misclassification and serve as superior tools for identifying and curtailing barriers to HIV care.
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Affiliation(s)
- Steven Erly
- Washington State Department of Health, Division of Disease Control and Health Statistics, Olympia, WA, USA
- Department of Epidemiology, University of Washington, Olympia, WA, USA
| | - Leticia Campos
- Washington State Department of Health, Division of Disease Control and Health Statistics, Olympia, WA, USA
| | - Susan Buskin
- Department of Epidemiology, University of Washington, Olympia, WA, USA
- Public Health – Seattle & King County, Seattle, WA, USA
| | - Jennifer Reuer
- Washington State Department of Health, Division of Disease Control and Health Statistics, Olympia, WA, USA
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6
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Harlow AF, Stokes AC, Brooks DR, Benjamin EJ, Barrington-Trimis JL, Ross CS. e-Cigarette Use and Combustible Cigarette Smoking Initiation Among Youth: Accounting for Time-Varying Exposure and Time-Dependent Confounding. Epidemiology 2022; 33:523-532. [PMID: 35394965 PMCID: PMC9156560 DOI: 10.1097/ede.0000000000001491] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Youth e-cigarette use is associated with the initiation of combustible cigarette smoking, but prior studies have rarely accounted for time-varying measures of e-cigarette exposure or time-dependent confounding of e-cigarette use and smoking initiation. METHODS Using five waves of the Population Assessment of Tobacco and Health (2013-2019), we estimated marginal structural models with inverse probability of treatment and censoring weights to examine the association between time-varying e-cigarette initiation and subsequent cigarette smoking initiation among e-cigarette- and cigarette-naïve youth (12-17 years) at baseline. Time-dependent confounders used as predictors in inverse probability weights included tobacco-related attitudes or beliefs, mental health symptoms, substance use, and tobacco-marketing exposure. RESULTS Among 9,584 youth at baseline, those who initiated e-cigarettes were 2.4 times as likely to subsequently initiate cigarette smoking as youth who did not initiate e-cigarettes (risk ratio = 2.4, 95% confidence interval [CI] = 2.1, 2.7), after accounting for time-dependent confounding and selection bias. Among youth who initiated e-cigarettes, more frequent vaping was associated with greater risk of smoking initiation (risk ratio ≥3 days/month = 1.8, 95% CI = 1.4, 2.2; 1-2 days/month = 1.2; 95% CI = 0.93, 1.6 vs. 0 days/month). Weighted marginal structural model estimates were moderately attenuated compared with unweighted estimates adjusted for baseline-only confounders. At the US population level, we estimated over half a million youth initiated cigarette smoking because of prior e-cigarette use over follow-up. CONCLUSIONS The association between youth vaping and combustible cigarette smoking persisted after accounting for time-dependent confounding. We estimate that e-cigarette use accounts for a considerable share of cigarette initiation among US youth. See video abstract at, http://links.lww.com/EDE/B937.
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Affiliation(s)
- Alyssa F. Harlow
- University of Southern California, Department of Population and Public Health Sciences, Los Angeles, CA
- Boston University School of Public Health, Department of Epidemiology, Boston, MA
| | - Andrew C. Stokes
- Boston University School of Public Health, Department of Global Health, Boston, MA
| | - Daniel R. Brooks
- Boston University School of Public Health, Department of Epidemiology, Boston, MA
| | - Emelia J. Benjamin
- Boston University School of Public Health, Department of Epidemiology, Boston, MA
- Boston University School of Medicine, Department of Medicine, Boston, MA
| | | | - Craig S. Ross
- Boston University School of Public Health, Department of Epidemiology, Boston, MA
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Chen X, Chang J, Spiegelman D, Li F. A Bayesian approach for estimating the partial potential impact fraction with exposure measurement error under a main study/internal validation design. Stat Methods Med Res 2021; 31:404-418. [PMID: 34841964 DOI: 10.1177/09622802211060514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The partial potential impact fraction describes the proportion of disease cases that can be prevented if the distribution of modifiable continuous exposures is shifted in a population, while other risk factors are not modified. It is a useful quantity for evaluating the burden of disease in epidemiologic and public health studies. When exposures are measured with error, the partial potential impact fraction estimates may be biased, which necessitates methods to correct for the exposure measurement error. Motivated by the health professionals follow-up study, we develop a Bayesian approach to adjust for exposure measurement error when estimating the partial potential impact fraction under the main study/internal validation study design. We adopt the reclassification approach that leverages the strength of the main study/internal validation study design and clarifies transportability assumptions for valid inference. We assess the finite-sample performance of both the point and credible interval estimators via extensive simulations and apply the proposed approach in the health professionals follow-up study to estimate the partial potential impact fraction for colorectal cancer incidence under interventions exploring shifting the distributions of red meat, alcohol, and/or folate intake.
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Affiliation(s)
- Xinyuan Chen
- Department of Mathematics and Statistics, 5547Mississippi State University, Mississippi State, MS, USA
| | - Joseph Chang
- Department of Statistics and Data Science, 5755Yale University, New Haven, CT, USA
| | - Donna Spiegelman
- Department of Statistics and Data Science, 5755Yale University, New Haven, CT, USA
- Department of Biostatistics, 50296Yale University School of Public Health, New Haven, CT, USA
- Center for Methods in Implementation and Preventive Science, 5755Yale University, New Haven, CT, USA
| | - Fan Li
- Department of Biostatistics, 50296Yale University School of Public Health, New Haven, CT, USA
- Center for Methods in Implementation and Preventive Science, 5755Yale University, New Haven, CT, USA
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Wong BHW, Lee J, Spiegelman D, Wang M. Estimation and inference for the population attributable risk in the presence of misclassification. Biostatistics 2021; 22:805-818. [PMID: 32112073 DOI: 10.1093/biostatistics/kxz067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/27/2019] [Accepted: 12/29/2019] [Indexed: 11/14/2022] Open
Abstract
Because it describes the proportion of disease cases that could be prevented if an exposure were entirely eliminated from a target population as a result of an intervention, estimation of the population attributable risk (PAR) has become an important goal of public health research. In epidemiologic studies, categorical covariates are often misclassified. We present methods for obtaining point and interval estimates of the PAR and the partial PAR (pPAR) in the presence of misclassification, filling an important existing gap in public health evaluation methods. We use a likelihood-based approach to estimate parameters in the models for the disease and for the misclassification process, under main study/internal validation study and main study/external validation study designs, and various plausible assumptions about transportability. We assessed the finite sample perf ormance of this method via a simulation study, and used it to obtain corrected point and interval estimates of the pPAR for high red meat intake and alcohol intake in relation to colorectal cancer incidence in the HPFS, where we found that the estimated pPAR for the two risk factors increased by up to 317% after correcting for bias due to misclassification.
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Affiliation(s)
- Benedict H W Wong
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Jooyoung Lee
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA and Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Donna Spiegelman
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA, Department of Epidemiology, Harvard T.H. Chan School of Public Health, 181 Longwood Ave, Boston, MA 02115, USA, Department of Nutrition and Global Health & Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA and Department of Biostatistics, Center on Methods in Implementation and Prevention Science, Yale School of Public Health, 60 College St, New Haven, CT 06510, USA
| | - Molin Wang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA, Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA and Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 181 Longwood Ave, Boston, MA 02115
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9
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Chilblains during lockdown are associated with household exposure to SARS-CoV-2: a multicentre case-control study. Clin Microbiol Infect 2021; 28:285-291. [PMID: 34619397 PMCID: PMC8489277 DOI: 10.1016/j.cmi.2021.09.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/13/2021] [Accepted: 09/26/2021] [Indexed: 11/30/2022]
Abstract
Objectives During the COVID-19 pandemic, numerous cases of chilblains have been reported. However, in most cases, RT-PCR or serology did not confirm SARS-CoV-2 infection. Hypotheses have been raised about an interferon-mediated immunological response to SARS-CoV-2, leading to effective clearance of the SARS-CoV-2 without the involvement of humoral immunity. Our objective was to explore the association between chilblains and exposure to SARS-CoV-2. Methods In this multicentre case–control study, cases were the 102 individuals referred to five referral hospitals for chilblains occurring during the first lockdown (March to May 2020). Controls were recruited from healthy volunteers' files held by the same hospitals. All members of their households were included, resulting in 77 case households (262 individuals) and 74 control households (230 individuals). Household exposure to SARS-CoV-2 during the first lockdown was categorized as high, intermediate or low, using a pre-established algorithm based on individual data on symptoms, high-risk contacts, activities outside the home and RT-PCR testing. Participants were offered a SARS-CoV-2 serological test. Results After adjustment for age, the association between chilblains and viral exposure was estimated at OR 3.3, 95% CI (1.4–7.3) for an intermediate household exposure, and 6.9 (2.5–19.5) for a high household exposure to SARS-CoV-2. Out of 57 case households tested, six (11%) had positive serology for SARS-CoV-2, whereas all control households tested (n = 50) were seronegative (p = 0.03). The effect of potential misclassification on exposure has been assessed in a bias analysis. Discussion This case–control study demonstrates the association between chilblains occurring during the lockdown and household exposure to SARS-CoV-2.
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10
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Alshihayb TS, Heaton B. Simulation of Random Differential Periodontitis Outcome Misclassification with Perfect Specificity. JDR Clin Trans Res 2021; 7:174-181. [PMID: 33899555 DOI: 10.1177/23800844211007145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Misclassification of clinical periodontitis can occur by partial-mouth protocols, particularly when tooth-based case definitions are applied. In these cases, the true prevalence of periodontal disease is underestimated, but specificity is perfect. In association studies of periodontal disease etiology, misclassification by this mechanism is independent of exposure status (i.e., nondifferential). Despite nondifferential mechanisms, differential misclassification may be realized by virtue of random errors. OBJECTIVES To gauge the amount of uncertainty around the expectation of differential periodontitis outcome misclassification due to random error only, we estimated the probability of differential outcome misclassification, its magnitude, and expected impacts via simulation methods using values from the periodontitis literature. METHODS We simulated data sets with a binary exposure and outcome that varied according to sample size (200, 1,000, 5,000, 10,000), exposure effect (risk ratio; 1.5, 2), exposure prevalence (0.1, 0.3), outcome incidence (0.1, 0.4), and outcome sensitivity (0.6, 0.8). Using a Bernoulli trial, we introduced misclassification by randomly sampling individuals with the outcome in each exposure group and repeated each scenario 10,000 times. RESULTS The probability of differential misclassification decreased as the simulation parameter values increased and occurred at least 37% of the time across the 10,000 repetitions. Across all scenarios, the risk ratio was biased, on average, toward the null when the sensitivity was higher among the unexposed and away from the null when it was higher among the exposed. The extent of bias for absolute sensitivity differences ≥0.04 ranged from 0.05 to 0.19 regardless of simulation parameters. However, similar trends were not observed for the odds ratio where the extent and direction of bias were dependent on the outcome incidence, sensitivity of classification, and effect size. CONCLUSIONS The results of this simulation provide helpful quantitative information to guide interpretation of findings in which nondifferential outcome misclassification mechanisms are known to be operational with perfect specificity. KNOWLEDGE TRANSFER STATEMENT Measurement of periodontitis can suffer from classification errors, such as when partial-mouth protocols are applied. In this case, specificity is perfect and sensitivity is expected to be nondifferential, leading to an expectation for no bias when studying periodontitis etiologies. Despite expectation, differential misclassification could occur from sources of random error, the effects of which are unknown. Proper scrutiny of research findings can occur when the probability and impact of random classification errors are known.
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Affiliation(s)
- T S Alshihayb
- Department of Health Policy and Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
- Department of Preventive Science, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - B Heaton
- Department of Health Policy and Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
- Department of Epidemiology, School of Public Health, Boston University
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11
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Petersen JM, Ranker LR, Barnard-Mayers R, MacLehose RF, Fox MP. A systematic review of quantitative bias analysis applied to epidemiological research. Int J Epidemiol 2021; 50:1708-1730. [PMID: 33880532 DOI: 10.1093/ije/dyab061] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Quantitative bias analysis (QBA) measures study errors in terms of direction, magnitude and uncertainty. This systematic review aimed to describe how QBA has been applied in epidemiological research in 2006-19. METHODS We searched PubMed for English peer-reviewed studies applying QBA to real-data applications. We also included studies citing selected sources or which were identified in a previous QBA review in pharmacoepidemiology. For each study, we extracted the rationale, methodology, bias-adjusted results and interpretation and assessed factors associated with reproducibility. RESULTS Of the 238 studies, the majority were embedded within papers whose main inferences were drawn from conventional approaches as secondary (sensitivity) analyses to quantity-specific biases (52%) or to assess the extent of bias required to shift the point estimate to the null (25%); 10% were standalone papers. The most common approach was probabilistic (57%). Misclassification was modelled in 57%, uncontrolled confounder(s) in 40% and selection bias in 17%. Most did not consider multiple biases or correlations between errors. When specified, bias parameters came from the literature (48%) more often than internal validation studies (29%). The majority (60%) of analyses resulted in >10% change from the conventional point estimate; however, most investigators (63%) did not alter their original interpretation. Degree of reproducibility related to inclusion of code, formulas, sensitivity analyses and supplementary materials, as well as the QBA rationale. CONCLUSIONS QBA applications were rare though increased over time. Future investigators should reference good practices and include details to promote transparency and to serve as a reference for other researchers.
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Affiliation(s)
- Julie M Petersen
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Lynsie R Ranker
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Ruby Barnard-Mayers
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Richard F MacLehose
- Division of Epidemiology and Community Health, University of Minnesota, School of Public Health, Minneapolis, MN, USA
| | - Matthew P Fox
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.,Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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12
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Newcomer SR, Xu S, Kulldorff M, Daley MF, Fireman B, Glanz JM. A primer on quantitative bias analysis with positive predictive values in research using electronic health data. J Am Med Inform Assoc 2021; 26:1664-1674. [PMID: 31365086 DOI: 10.1093/jamia/ocz094] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/12/2019] [Accepted: 05/17/2019] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE In health informatics, there have been concerns with reuse of electronic health data for research, including potential bias from incorrect or incomplete outcome ascertainment. In this tutorial, we provide a concise review of predictive value-based quantitative bias analysis (QBA), which comprises epidemiologic methods that use estimates of data quality accuracy to quantify the bias caused by outcome misclassification. TARGET AUDIENCE Health informaticians and investigators reusing large, electronic health data sources for research. SCOPE When electronic health data are reused for research, validation of outcome case definitions is recommended, and positive predictive values (PPVs) are the most commonly reported measure. Typically, case definitions with high PPVs are considered to be appropriate for use in research. However, in some studies, even small amounts of misclassification can cause bias. In this tutorial, we introduce methods for quantifying this bias that use predictive values as inputs. Using epidemiologic principles and examples, we first describe how multiple factors influence misclassification bias, including outcome misclassification levels, outcome prevalence, and whether outcome misclassification levels are the same or different by exposure. We then review 2 predictive value-based QBA methods and why outcome PPVs should be stratified by exposure for bias assessment. Using simulations, we apply and evaluate the methods in hypothetical electronic health record-based immunization schedule safety studies. By providing an overview of predictive value-based QBA, we hope to bridge the disciplines of health informatics and epidemiology to inform how the impact of data quality issues can be quantified in research using electronic health data sources.
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Affiliation(s)
- Sophia R Newcomer
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA.,Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Stan Xu
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA
| | - Martin Kulldorff
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew F Daley
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA.,Department of Pediatrics, School of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Bruce Fireman
- Division of Research, Vaccine Study Center, Kaiser Permanente Northern California, Oakland, California, USA
| | - Jason M Glanz
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, Colorado, USA.,Department of Epidemiology, School of Public Health, University of Colorado Denver, Aurora, Colorado, USA
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Rao A, MacNeill SJ, van de Luijtgaarden MWM, Chesnaye NC, Drechsler C, Wanner C, Torino C, Postorino M, Szymczak M, Evans M, Dekker FW, Jager KJ, Ben-Shlomo Y, Caskey FJ. Using datasets to ascertain the generalisability of clinical cohorts: the example of European QUALity Study on the treatment of advanced chronic kidney disease (EQUAL). Nephrol Dial Transplant 2021; 37:540-547. [PMID: 33426560 DOI: 10.1093/ndt/gfab002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Cohort studies are among the most robust of observational studies but have issues with external validity. This study assesses threats to external validity (generalisability) in the European QUALity (EQUAL) study, a cohort study of people over 65 years with stage 4/5 chronic kidney disease. METHODS Patients meeting the EQUAL inclusion criteria were identified in The Health Improvement Network database and stratified into those attending renal units (secondary care cohort-SCC) and not (primary care cohort-PCC). Survival, progression to renal replacement therapy (RRT), and hospitalisation were compared. RESULTS The analysis included 250, 633, and 2,464 patients in EQUAL, PCC, and SCC. EQUAL had a higher proportion of men in comparison to PCC and SCC (60.0% vs. 34.8% vs. 51.4%). Increasing age (≥85 years odds ratio (OR) 0.25 (95% confidence interval (CI) 0.15-0.40)) and comorbidity (Charlson Comorbidity Index ≥ 4 OR 0.69 (CI 0.52-0.91)) were associated with non-participation in EQUAL. EQUAL had a higher proportion of patients starting RRT at 1 year compared to SCC (8.1% vs. 2.1%%, p < 0.001). Patients in the PCC and SCC had increased risk of Hospitalisation (incidence rate ratio=1.76 (95% CI 1.27-2.47) & 2.13 (95% CI 1.59-2.86)) and mortality at one year (hazard ratio=3.48 (95% CI 2.1-5.7) & 1.7 (95% CI 1.1-2.7)) compared to EQUAL. CONCLUSIONS This study provides evidence of how participants in a cohort study can differ from the broader population of patients, which is essential when considering external validity and applying to local practice.
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Affiliation(s)
- Anirudh Rao
- Department of Nephrology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Moniek W M van de Luijtgaarden
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicholas C Chesnaye
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | - Christiane Drechsler
- Department of Internal Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Chistoph Wanner
- Department of Internal Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Claudia Torino
- Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, CNR-IFC, Reggio Calabria, Italy
| | - Maurizio Postorino
- Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, CNR-IFC, Reggio Calabria, Italy
| | - Maciej Szymczak
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Poland
| | - Marie Evans
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Friedo W Dekker
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Fergus J Caskey
- Population Health Sciences, University of Bristol, Bristol.,North Bristol NHS Trust, Bristol
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Characterizing Bias Due to Differential Exposure Ascertainment in Electronic Health Record Data. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2021; 21:309-323. [PMID: 34366704 DOI: 10.1007/s10742-020-00235-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Data derived from electronic health records (EHR) are heterogeneous with availability of specific measures dependent on the type and timing of patients' healthcare interactions. This creates a challenge for research using EHR-derived exposures because gold-standard exposure data, determined by a definitive assessment, may only be available for a subset of the population. Alternative approaches to exposure ascertainment in this case include restricting the analytic sample to only those patients with gold-standard exposure data available (exclusion); using gold-standard data, when available, and using a proxy exposure measure when the gold standard is unavailable (best available); or using a proxy exposure measure for everyone (common data). Exclusion may induce selection bias in outcome/exposure association estimates, while incorporating information from a proxy exposure via either the best available or common data approaches may result in information bias due to measurement error. The objective of this paper was to explore the bias and efficiency of these three analytic approaches across a broad range of scenarios motivated by a study of the association between chronic hyperglycemia and five-year mortality in an EHR-derived cohort of colon cancer survivors. We found that the best available approach tended to mitigate inefficiency and selection bias resulting from exclusion while suffering from less information bias than the common data approach. However, bias in all three approaches can be severe, particularly when both selection bias and information bias are present. When risk of either of these biases is judged to be more than moderate, EHR-based analyses may lead to erroneous conclusions.
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15
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Saddiki H, Fayosse A, Cognat E, Sabia S, Engelborghs S, Wallon D, Alexopoulos P, Blennow K, Zetterberg H, Parnetti L, Zerr I, Hermann P, Gabelle A, Boada M, Orellana A, de Rojas I, Lilamand M, Bjerke M, Van Broeckhoven C, Farotti L, Salvadori N, Diehl-Schmid J, Grimmer T, Hourregue C, Dugravot A, Nicolas G, Laplanche JL, Lehmann S, Bouaziz-Amar E, Hugon J, Tzourio C, Singh-Manoux A, Paquet C, Dumurgier J. Age and the association between apolipoprotein E genotype and Alzheimer disease: A cerebrospinal fluid biomarker-based case-control study. PLoS Med 2020; 17:e1003289. [PMID: 32817639 PMCID: PMC7446786 DOI: 10.1371/journal.pmed.1003289] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 07/22/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The ε4 allele of apolipoprotein E (APOE) gene and increasing age are two of the most important known risk factors for developing Alzheimer disease (AD). The diagnosis of AD based on clinical symptoms alone is known to have poor specificity; recently developed diagnostic criteria based on biomarkers that reflect underlying AD neuropathology allow better assessment of the strength of the associations of risk factors with AD. Accordingly, we examined the global and age-specific association between APOE genotype and AD by using the A/T/N classification, relying on the cerebrospinal fluid (CSF) levels of β-amyloid peptide (A, β-amyloid deposition), phosphorylated tau (T, pathologic tau), and total tau (N, neurodegeneration) to identify patients with AD. METHODS AND FINDINGS This case-control study included 1,593 white AD cases (55.4% women; mean age 72.8 [range = 44-96] years) with abnormal values of CSF biomarkers from nine European memory clinics and the American Alzheimer's Disease Neuroimaging Initiative (ADNI) study. A total of 11,723 dementia-free controls (47.1% women; mean age 65.6 [range = 44-94] years) were drawn from two longitudinal cohort studies (Whitehall II and Three-City), in which incident cases of dementia over the follow-up were excluded from the control population. Odds ratio (OR) and population attributable fraction (PAF) for AD associated with APOE genotypes were determined, overall and by 5-year age categories. In total, 63.4% of patients with AD and 22.6% of population controls carried at least one APOE ε4 allele. Compared with non-ε4 carriers, heterozygous ε4 carriers had a 4.6 (95% confidence interval 4.1-5.2; p < 0.001) and ε4/ε4 homozygotes a 25.4 (20.4-31.2; p < 0.001) higher OR of AD in unadjusted analysis. This association was modified by age (p for interaction < 0.001). The PAF associated with carrying at least one ε4 allele was greatest in the 65-70 age group (69.7%) and weaker before 55 years (14.2%) and after 85 years (22.6%). The protective effect of APOE ε2 allele for AD was unaffected by age. Main study limitations are that analyses were based on white individuals and AD cases were drawn from memory centers, which may not be representative of the general population of patients with AD. CONCLUSIONS In this study, we found that AD diagnosis based on biomarkers was associated with APOE ε4 carrier status, with a higher OR than previously reported from studies based on only clinical AD criteria. This association differs according to age, with the strongest effect at 65-70 years. These findings highlight the need for early interventions for dementia prevention to mitigate the effect of APOE ε4 at the population level.
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Affiliation(s)
- Hana Saddiki
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Aurore Fayosse
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Emmanuel Cognat
- Cognitive Neurology Center, Lariboisiere—Fernand Widal Hospital, AP-HP, Université de Paris, Paris, France
| | - Séverine Sabia
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Sebastiaan Engelborghs
- Department of Neurology, Universitair Ziekenhuis Brussel, Center for Neurosciences, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Biomedical Sciences, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - David Wallon
- Inserm U1245, Rouen University Hospital, Department of Neurology and CNR-MAJ, Normandy Center for Genomic and Personalized Medicine, Rouen, France
| | - Panagiotis Alexopoulos
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, Institute of Neurology, University College London, UK Dementia Research Institute, London, United Kingdom
| | - Lucilla Parnetti
- Center for Memory Disturbances-Lab of Clinical Neurochemistry, Section of Neurology, University of Perugia, Italy
| | - Inga Zerr
- Department of Neurology, Clinical Dementia Center, University Medical Center Göttingen and German Center for Neurodegenerative Diseases, Göttingen, Germany
| | - Peter Hermann
- Department of Neurology, Clinical Dementia Center, University Medical Center Göttingen and German Center for Neurodegenerative Diseases, Göttingen, Germany
| | - Audrey Gabelle
- Department of Neurology, Memory Research and Resources Centre, University of Montpellier, Montpellier, France
| | - Mercè Boada
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurciències Aplicades, Universitat International de Catalunya, Barcelona, Spain
| | - Adelina Orellana
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurciències Aplicades, Universitat International de Catalunya, Barcelona, Spain
| | - Itziar de Rojas
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurciències Aplicades, Universitat International de Catalunya, Barcelona, Spain
| | - Matthieu Lilamand
- Cognitive Neurology Center, Lariboisiere—Fernand Widal Hospital, AP-HP, Université de Paris, Paris, France
| | - Maria Bjerke
- VIB Center for Molecular Neurology, Institute Born-Bunge and Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Christine Van Broeckhoven
- VIB Center for Molecular Neurology, Institute Born-Bunge and Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Lucia Farotti
- Center for Memory Disturbances-Lab of Clinical Neurochemistry, Section of Neurology, University of Perugia, Italy
| | - Nicola Salvadori
- Center for Memory Disturbances-Lab of Clinical Neurochemistry, Section of Neurology, University of Perugia, Italy
| | - Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Timo Grimmer
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Claire Hourregue
- Cognitive Neurology Center, Lariboisiere—Fernand Widal Hospital, AP-HP, Université de Paris, Paris, France
| | - Aline Dugravot
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
| | - Gaël Nicolas
- Inserm U1245, Rouen University Hospital, Department of Neurology and CNR-MAJ, Normandy Center for Genomic and Personalized Medicine, Rouen, France
| | - Jean-Louis Laplanche
- Department of Biochemistry and Molecular Biology, Lariboisière Hospital, APHP, Paris, France
| | - Sylvain Lehmann
- Department of Biochemistry, University of Montpellier, Montpellier, France
| | - Elodie Bouaziz-Amar
- Department of Biochemistry and Molecular Biology, Lariboisière Hospital, APHP, Paris, France
| | | | - Jacques Hugon
- Cognitive Neurology Center, Lariboisiere—Fernand Widal Hospital, AP-HP, Université de Paris, Paris, France
| | - Christophe Tzourio
- Bordeaux Population Health Research Center, Team HEALTHY, UMR1219, University of Bordeaux, Inserm, Bordeaux, France
| | - Archana Singh-Manoux
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Claire Paquet
- Cognitive Neurology Center, Lariboisiere—Fernand Widal Hospital, AP-HP, Université de Paris, Paris, France
| | - Julien Dumurgier
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative diseases, Paris, France
- Cognitive Neurology Center, Lariboisiere—Fernand Widal Hospital, AP-HP, Université de Paris, Paris, France
- * E-mail:
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Kondracki AJ, Hofferth SL. A gestational vulnerability window for smoking exposure and the increased risk of preterm birth: how timing and intensity of maternal smoking matter. Reprod Health 2019; 16:43. [PMID: 30992027 PMCID: PMC6469085 DOI: 10.1186/s12978-019-0705-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 04/01/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Reducing the incidence of preterm birth is a national priority. Maternal cigarette smoking is strongly and consistently associated with preterm birth. The objective of this study was to examine prenatal exposure based on combined measures of timing (by trimester) and intensity level (the number of cigarettes smoked per day) of maternal smoking to identify a pregnancy period with the highest risk of preterm birth. METHODS A sample of 2,485,743 singleton births was drawn from the 2010 National Center of Health Statistics (NCHS) linked birth/infant death file of US residents in 33 states that implemented the revised 2003 birth certificate. Nine mutually exclusive smoking status categories were created to assess prenatal exposure across pregnancy in association with preterm birth. Gestational age was based on the obstetric estimate. Multiple logistic regression analyses were conducted to compare the odds of preterm birth among women who smoked at different intensity levels in the second or third trimester with those who smoked only in the first trimester. RESULTS Overall, 7.95% of women had a preterm birth; 8.90% of low intensity (less than a pack/day) smokers in the first trimester only, 12.99% of low and 15.38% of high intensity (pack a day or more) smokers in the first two trimesters, and 10.56% of low and 11.35% of high intensity smokers in all three trimesters delivered preterm. First and second trimester high (aOR 1.85, 95% CI: 1.66, 2.06) and low intensity smokers (aOR 1.51, 95% CI: 1.41, 1.61) had higher odds of preterm birth compared to those who smoked less than a pack a day only in the first trimester, but the odds did not increase for all three trimester smokers relative to the first and second trimester smokers. In sensitivity analysis, adjustment for exposure misclassification error corrected data and testing for effect modification by maternal race/ethnicity found no significant interaction. CONCLUSIONS This study documented a biologically plausible vulnerability window for smoking exposure and the increased risk of preterm birth. For women who do not modify their smoking behavior preconception, preterm birth risk of smoking remains low until late in the first trimester.
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Affiliation(s)
- Anthony J. Kondracki
- School of Public Health, Department of Family Science, University of Maryland, 4200 Valley Drive, College Park, MD 20742 USA
| | - Sandra L. Hofferth
- School of Public Health, Department of Family Science, University of Maryland, 4200 Valley Drive, College Park, MD 20742 USA
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Johnson CY, Howards PP, Strickland MJ, Waller DK, Flanders WD. Multiple bias analysis using logistic regression: an example from the National Birth Defects Prevention Study. Ann Epidemiol 2018; 28:510-514. [PMID: 29936049 DOI: 10.1016/j.annepidem.2018.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 04/21/2018] [Accepted: 05/24/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Exposure misclassification, selection bias, and confounding are important biases in epidemiologic studies, yet only confounding is routinely addressed quantitatively. We describe how to combine two previously described methods and adjust for multiple biases using logistic regression. METHODS Weights were created from selection probabilities and predictive values for exposure classification and applied to multivariable logistic regression models in a case-control study of prepregnancy obesity (body mass index ≥30 vs. <30 kg/m2) and cleft lip with or without cleft palate (CL/P) using data from the National Birth Defects Prevention Study (2523 cases, 10,605 controls). RESULTS Adjusting for confounding by race/ethnicity, prepregnancy obesity, and CL/P were weakly associated (odds ratio [OR]: 1.10; 95% confidence interval: 0.98, 1.23). After weighting the data to account for exposure misclassification, missing exposure data, selection bias, and confounding, multiple bias-adjusted ORs ranged from 0.94 to 1.03 in nonprobabilistic bias analyses and median multiple bias-adjusted ORs ranged from 0.93 to 1.02 in probabilistic analyses. CONCLUSIONS This approach, adjusting for multiple biases using a logistic regression model, suggested that the observed association between obesity and CL/P could be due to the presence of bias.
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Affiliation(s)
- Candice Y Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Penelope P Howards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | - D Kim Waller
- The University of Texas School of Public Health, Houston, TX
| | - W Dana Flanders
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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18
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Bayesian Correction for Misclassification in Multilevel Count Data Models. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2018; 2018:3212351. [PMID: 29681994 PMCID: PMC5845492 DOI: 10.1155/2018/3212351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/23/2018] [Accepted: 01/29/2018] [Indexed: 01/18/2023]
Abstract
Covariate misclassification is well known to yield biased estimates in single level regression models. The impact on hierarchical count models has been less studied. A fully Bayesian approach to modeling both the misclassified covariate and the hierarchical response is proposed. Models with a single diagnostic test and with multiple diagnostic tests are considered. Simulation studies show the ability of the proposed model to appropriately account for the misclassification by reducing bias and improving performance of interval estimators. A real data example further demonstrated the consequences of ignoring the misclassification. Ignoring misclassification yielded a model that indicated there was a significant, positive impact on the number of children of females who observed spousal abuse between their parents. When the misclassification was accounted for, the relationship switched to negative, but not significant. Ignoring misclassification in standard linear and generalized linear models is well known to lead to biased results. We provide an approach to extend misclassification modeling to the important area of hierarchical generalized linear models.
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19
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The Impact of Joint Misclassification of Exposures and Outcomes on the Results of Epidemiologic Research. CURR EPIDEMIOL REP 2018. [DOI: 10.1007/s40471-018-0147-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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McCarthy MM, Overton MW. Short communication: Model for metritis severity predicts that disease misclassification underestimates projected milk production losses. J Dairy Sci 2018; 101:5434-5438. [PMID: 29550133 DOI: 10.3168/jds.2017-14164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 02/02/2018] [Indexed: 11/19/2022]
Abstract
The objective of this research was to determine the effect of disease misclassification on the estimated effect of metritis on milk production. Misclassification introduces bias that usually results in an underestimation of the association between exposure (disease) and the outcome of interest (milk production). This distorted measure of association results from the comparison of an affected population (some of which may not truly be affected) to a nonaffected population (which often includes affected subjects that are unidentified). A convenience sample of DairyComp305 (Valley Agricultural Software, Tulare, CA) data representing 1 yr of calvings (n = 3,277) from 1 Midwestern Holstein herd was used. This herd was chosen because of its ongoing efforts to consistently and completely record all clinical diseases, including the incidence of both mild and severe metritis cases. Metritis was defined as the presence of a flaccid uterus containing fetid fluids or a foul watery discharge within 14 d of calving. Cows that appeared clinically normal other than the discharge were considered mild and those with systemic signs of disease were classified as severe. The original data set included metritis recorded as mild, severe, or not recorded (NR), where no metritis was observed, and was considered to contain the metritis true severity (TrS). First, to evaluate the effect of misclassification bias, we retrospectively randomized 45% of mild metritis to be classified as NR to simulate inconsistent disease recording (IR); then, in a separate model, all mild metritis cases were changed to NR to simulate a situation of very poor disease recording (PR), where only the most severe cases are recorded. The TrS, IR, and PR data sets were analyzed separately in JMP (SAS Institute Inc., Cary, NC). An ANOVA was conducted for second test 305-d mature-equivalent milk projection (2nd305ME), and nonsignificant variables were removed, but the variable metritis was forced into all models. Based upon the TrS model, adjusting for effects of lactation group, month of calving, dystocia, twins, retained placenta, early-lactation mastitis, displaced abomasum, and significant interactions, a case of mild metritis was associated with 384 kg less 2nd305ME and a case of severe metritis was associated with 847 kg less 2nd305ME compared with no metritis. For the IR model, a case of mild metritis was associated with 315 kg less 2nd305ME and a case of severe metritis was associated with 758 kg less 2nd305ME compared with no metritis. For the PR model, severe metritis was associated with 680 kg less 2nd305ME compared with NR. The IR and PR models underestimated 2nd305ME loss for severe metritis cases by 89 and 166 kg/cow, and resulted in 180,441 and 330,256 kg of total milk loss unaccounted for at the herd level, respectively, compared with TrS. Overall, misclassification of metritis cases results in greater bias and largely underestimates the true association between metritis and the consequence costs of the disease.
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Affiliation(s)
- M M McCarthy
- Elanco Animal Health, 2500 Innovation Way, Greenfield, IN 46140
| | - M W Overton
- Elanco Animal Health, 2500 Innovation Way, Greenfield, IN 46140.
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Newcomer SR, Kulldorff M, Xu S, Daley MF, Fireman B, Lewis E, Glanz JM. Bias from outcome misclassification in immunization schedule safety research. Pharmacoepidemiol Drug Saf 2018; 27:221-228. [PMID: 29292551 DOI: 10.1002/pds.4374] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/18/2017] [Accepted: 11/20/2017] [Indexed: 11/11/2022]
Abstract
PURPOSE The Institute of Medicine recommended conducting observational studies of childhood immunization schedule safety. Such studies could be biased by outcome misclassification, leading to incorrect inferences. Using simulations, we evaluated (1) outcome positive predictive values (PPVs) as indicators of bias of an exposure-outcome association, and (2) quantitative bias analyses (QBA) for bias correction. METHODS Simulations were conducted based on proposed or ongoing Vaccine Safety Datalink studies. We simulated 4 studies of 2 exposure groups (children with no vaccines or on alternative schedules) and 2 baseline outcome levels (100 and 1000/100 000 person-years), with 3 relative risk (RR) levels (RR = 0.50, 1.00, and 2.00), across 1000 replications using probabilistic modeling. We quantified bias from non-differential and differential outcome misclassification, based on levels previously measured in database research (sensitivity > 95%; specificity > 99%). We calculated median outcome PPVs, median observed RRs, Type 1 error, and bias-corrected RRs following QBA. RESULTS We observed PPVs from 34% to 98%. With non-differential misclassification and true RR = 2.00, median bias was toward the null, with severe bias (median observed RR = 1.33) with PPV = 34% and modest bias (median observed RR = 1.83) with PPV = 83%. With differential misclassification, PPVs did not reflect median bias, and there was Type 1 error of 100% with PPV = 90%. QBA was generally effective in correcting misclassification bias. CONCLUSIONS In immunization schedule studies, outcome misclassification may be non-differential or differential to exposure. Overall outcome PPVs do not reflect the distribution of false positives by exposure and are poor indicators of bias in individual studies. Our results support QBA for immunization schedule safety research.
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Affiliation(s)
- Sophia R Newcomer
- Kaiser Permanente Colorado, Institute for Health Research, Denver, CO, USA.,Colorado School of Public Health, Anschutz Medical Campus, Department of Epidemiology, Denver, CO, USA
| | - Martin Kulldorff
- Brigham and Women's Hospital and Harvard Medical School, Division of Pharmacoepidemiology and Pharmacoeconomics, Boston, MA, USA
| | - Stan Xu
- Kaiser Permanente Colorado, Institute for Health Research, Denver, CO, USA
| | - Matthew F Daley
- Kaiser Permanente Colorado, Institute for Health Research, Denver, CO, USA.,University of Colorado Denver, School of Medicine, Department of Pediatrics, Denver, CO, USA
| | - Bruce Fireman
- Kaiser Permanente Northern California, Division of Research, Vaccine Study Center, Oakland, CA, USA
| | - Edwin Lewis
- Kaiser Permanente Northern California, Division of Research, Vaccine Study Center, Oakland, CA, USA
| | - Jason M Glanz
- Kaiser Permanente Colorado, Institute for Health Research, Denver, CO, USA.,Colorado School of Public Health, Anschutz Medical Campus, Department of Epidemiology, Denver, CO, USA
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Arfè A, Nicotra F, Ghirardi A, Simonetti M, Lapi F, Sturkenboom M, Corrao G. A probabilistic bias analysis for misclassified categorical exposures, with application to oral anti-hyperglycaemic drugs. Pharmacoepidemiol Drug Saf 2016; 25:1443-1450. [PMID: 27594547 DOI: 10.1002/pds.4093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 06/26/2016] [Accepted: 08/10/2016] [Indexed: 11/09/2022]
Abstract
PURPOSE The effect of drug exposure misclassification generally receives little attention in pharmacoepidemiological research. In this paper, we illustrate a probabilistic bias analysis approach for misclassified categorical exposures and apply it in a database study of oral anti-hyperglycaemic drugs (OADs). METHODS A cohort study based on the Health Search Database general-practice database was carried out by including 12 640 adult (≥40 years) patients newly treated with OADs during 2003-2010. The proportion of days covered by OADs prescriptions during the first year of follow-up was evaluated for each individual, either by means of the prescribed daily dose or the defined daily dose. The effect of misclassification on hypothetical OAD-outcome association profiles was assessed through the proposed probabilistic bias analysis approach, taking advantage of available exposure validation data. RESULTS During the first year of follow-up, the average (SD) number of months with OADs available was 7 (4) months and 5 (3) months according to the prescribed daily dose and defined daily dose metrics, respectively. Probabilistic bias analysis results based on validation data suggest that the effect of misclassification is complex, as conventional exposure-outcome association estimates may be of greater or lower magnitude than their misclassification-adjusted values. CONCLUSIONS Misclassification should be taken into account in database studies on the safety of prescribed medications. To this aim, investigators should take advantage of external exposure validation data in sensitivity analysis approaches such as ours. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Andrea Arfè
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Federica Nicotra
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Arianna Ghirardi
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Monica Simonetti
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Miriam Sturkenboom
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Giovanni Corrao
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
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Doepker C, Lieberman HR, Smith AP, Peck JD, El-Sohemy A, Welsh BT. Caffeine: Friend or Foe? Annu Rev Food Sci Technol 2016; 7:117-37. [PMID: 26735800 DOI: 10.1146/annurev-food-041715-033243] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The debate on the safety of and regulatory approaches for caffeine continues among various stakeholders and regulatory authorities. This decision-making process comes with significant challenges, particularly when considering the complexities of the available scientific data, making the formulation of clear science-based regulatory guidance more difficult. To allow for discussions of a number of key issues, the North American Branch of the International Life Sciences Institute (ILSI) convened a panel of subject matter experts for a caffeine-focused session entitled "Caffeine: Friend or Foe?," which was held during the 2015 ILSI Annual Meeting. The panelists' expertise covered topics ranging from the natural occurrence of caffeine in plants and interindividual metabolism of caffeine in humans to specific behavioral, reproductive, and cardiovascular effects related to caffeine consumption. Each presentation highlighted the potential risks, benefits, and challenges that inform whether caffeine exposure warrants concern. This paper aims to summarize the key topics discussed during the session.
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Affiliation(s)
| | - Harris R Lieberman
- US Army Research Institute of Environmental Medicine, Natick, Massachusetts 01760;
| | - Andrew Paul Smith
- Centre for Occupational and Health Psychology, School of Psychology, Cardiff University, Cardiff CF10 3AS, United Kingdom;
| | - Jennifer D Peck
- Department of Biostatistics & Epidemiology, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104;
| | - Ahmed El-Sohemy
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario M5S 3E2, Canada;
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Association of miR-146a rs2910164 polymorphism with cardio-cerebrovascular diseases: A systematic review and meta-analysis. Gene 2015; 565:171-9. [PMID: 25865299 DOI: 10.1016/j.gene.2015.04.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 04/01/2015] [Accepted: 04/05/2015] [Indexed: 01/08/2023]
Abstract
The microRNA146a rs2910164 polymorphism has been associated with the development of cardio-cerebrovascular diseases (CCDs); however, the results were inconsistent among different studies. The present report was aimed to investigate the association between rs2910164 G/C polymorphism and the risk of CCDs. Based on the data extracted from 12 eligible studies with a total of 5433 CCD cases and 6278 controls, we performed a meta-analysis to assess the diseases risk of rs2910164 G/C polymorphism under allelic contrast (C vs. G), homozygote comparisons (CC vs. GG), heterozygote comparisons (GC vs. GG), dominant model (CC+GC vs. GG) and recessive models (CC vs. GC+GG) in fixed or random effects models. We also conducted pathway enrichment analyses using the putative and validated miR-146a interacting targets to explore the functional impacts of rs2910164. The current meta-analysis results showed that rs2910164 CC genotype has a decreased risk with overall cardiovascular diseases and the specific coronary artery disease. Stratified analysis based on ethnicity showed that the CC genotype has a decreased risk with CCDs in Chinese population, but has an increased risk with CCDs in Korean and Indian populations. The results from pathway enrichment analysis also revealed the association of rs2910164 G allele with heart function and disease related pathways. Our findings suggested that miR-146a CC genotype might be a protective factor for cardiovascular diseases in Chinese population, but a risk factor in Korean and Indian populations.
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