Marginal Structural Models for Life-Course Theories and Social Epidemiology: Definitions, Sources of Bias, and Simulated Illustrations

Gilsanz, P (通讯作者),Kaiser Permanente Div Res, 2000 Broadway, Oakland, CA 94612 USA.
2022-1-24
Social epidemiology aims to identify social structural risk factors, thus informing targets and timing of interventions. Ascertaining which interventions will be most effective and when they should be implemented is challenging because social conditions vary across the life course and are subject to time-varying confounding. Marginal structural models (MSMs) may be useful but can present unique challenges when studying social epidemiologic exposures over the life course. We describe selected MSMs corresponding to common theoretical life-course models and identify key issues for consideration related to time-varying confounding and late study enrollment. Using simulated data mimicking a cohort study evaluating the effects of depression in early, mid-, and late life on late-life stroke risk, we examined whether and when specific study characteristics and analytical strategies may induce bias. In the context of time-varying confounding, inverse-probability-weighted estimation of correctly specified MSMs accurately estimated the target causal effects, while conventional regression models showed significant bias. When no measure of early-life depression was available, neither MSMs nor conventional models were unbiased, due to confounding by early-life depression. To inform interventions, researchers need to identify timing of effects and consider whether missing data regarding exposures earlier in life may lead to biased estimates.
AMERICAN JOURNAL OF EPIDEMIOLOGY
卷号:191|期号:2|页码:349-359
ISSN:0002-9262|收录类别:SCIE
语种
英语
来源机构
Kaiser Permanente; University of California System; University of California San Francisco; Harvard University; Harvard Medical School; Harvard Pilgrim Health Care; Harvard University; Harvard T.H. Chan School of Public Health; Harvard University; Harvard T.H. Chan School of Public Health; University of Pennsylvania; Harvard University; Harvard T.H. Chan School of Public Health
资助信息
This study was supported by the National Institutes of Health (grants R01AI104459, R01AI27271, RF1AG050782, RF1AG052132, RF1AG055486, R01AG065276, R01AG066132, R01CA222147, R01GM139926, R01MH101269, T32MH017119, and T32AG049663) and the Yerby Postdoctoral Fellowship Program.
被引频次(WOS)
2
被引频次(其他)
2
180天使用计数
3
2013以来使用计数
3
EISSN
1476-6256
出版年
2022-1-24
DOI
10.1093/aje/kwab253
WOS学科分类
Public, Environmental & Occupational Health
学科领域
循证公共卫生
关键词
bias confounding inverse probability weighting life course marginal structural models simulation social epidemiology
资助机构
National Institutes of Health(United States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA) Yerby Postdoctoral Fellowship Program