Considering Questions Before Methods in Dementia Research With Competing Events and Causal Goals

Abstract Studying causal exposure effects on dementia is challenging when death is a competing event. Researchers often interpret death as a potential source of bias, although bias cannot be defined or assessed if the causal question is not explicitly specified. Here we discuss 2 possible notions of...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:American journal of epidemiology 2023-08, Vol.192 (8), p.1415-1423
Hauptverfasser: Rojas-Saunero, L Paloma, Young, Jessica G, Didelez, Vanessa, Ikram, M Arfan, Swanson, Sonja A
Format: Artikel
Sprache:eng
Schlagworte:
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page 1423
container_issue 8
container_start_page 1415
container_title American journal of epidemiology
container_volume 192
creator Rojas-Saunero, L Paloma
Young, Jessica G
Didelez, Vanessa
Ikram, M Arfan
Swanson, Sonja A
description Abstract Studying causal exposure effects on dementia is challenging when death is a competing event. Researchers often interpret death as a potential source of bias, although bias cannot be defined or assessed if the causal question is not explicitly specified. Here we discuss 2 possible notions of a causal effect on dementia risk: the “controlled direct effect” and the “total effect.” We provide definitions and discuss the “censoring” assumptions needed for identification in either case and their link to familiar statistical methods. We illustrate concepts in a hypothetical randomized trial on smoking cessation in late midlife, and emulate such a trial using observational data from the Rotterdam Study, the Netherlands, 1990–2015. We estimated a total effect of smoking cessation (compared with continued smoking) on 20-year dementia risk of 2.1 (95% confidence interval: −0.1, 4.2) percentage points and a controlled direct effect of smoking cessation on 20-year dementia risk had death been prevented of −2.7 (95% confidence interval: −6.1, 0.8) percentage points. Our study highlights how analyses corresponding to different causal questions can have different results, here with point estimates on opposite sides of the null. Having a clear causal question in view of the competing event and transparent and explicit assumptions are essential to interpreting results and potential bias.
doi_str_mv 10.1093/aje/kwad090
format Article
fullrecord <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10403306</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/aje/kwad090</oup_id><sourcerecordid>2809542340</sourcerecordid><originalsourceid>FETCH-LOGICAL-c441t-93935cc20be2ff8a3831d86757d2bf59b56244e252b8062e56e09133141c71e23</originalsourceid><addsrcrecordid>eNp9kc2L1EAQxRtR3HH05F0aBBEkbvVn0qdF47oKK6IoHttOUtnpMUmP3cmK_709zLioB08FVb961KtHyEMGzxkYceq2ePrth-vAwC2yYrLUheZK3yYrAOCF4ZqfkHspbQEYMwrukhNRMmFUBSvytQ5T8h1GP13RDwum2ecGfYl9iEjf4bwJXaJ-oq9wxGn2jn7EhC62G_rFzxtah3GH8375_DrPE3VTR2u3JDfQi-CGdJ_c6XPBB8e6Jp9fn3-q3xSX7y_e1i8ui1ZKNhdGGKHalkODvO8rJyrBukqXqux40yvTKM2lRK54U4HmqDSCYUIwydqSIRdrcnbQ3S3NiF2bj4lusLvoRxd_2uC8_Xsy-Y29CteWgQQhQGeFp0eFGL7vP2FHn1ocBjdhWJLlFRglucj4mjz-B92GJU7ZnxUgTea4LjP17EC1MaQUsb-5hoHdR2dzdPYYXaYf_Wnghv2dVQaeHICw7P6r9Au9CKIG</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3049095267</pqid></control><display><type>article</type><title>Considering Questions Before Methods in Dementia Research With Competing Events and Causal Goals</title><source>MEDLINE</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Rojas-Saunero, L Paloma ; Young, Jessica G ; Didelez, Vanessa ; Ikram, M Arfan ; Swanson, Sonja A</creator><creatorcontrib>Rojas-Saunero, L Paloma ; Young, Jessica G ; Didelez, Vanessa ; Ikram, M Arfan ; Swanson, Sonja A</creatorcontrib><description>Abstract Studying causal exposure effects on dementia is challenging when death is a competing event. Researchers often interpret death as a potential source of bias, although bias cannot be defined or assessed if the causal question is not explicitly specified. Here we discuss 2 possible notions of a causal effect on dementia risk: the “controlled direct effect” and the “total effect.” We provide definitions and discuss the “censoring” assumptions needed for identification in either case and their link to familiar statistical methods. We illustrate concepts in a hypothetical randomized trial on smoking cessation in late midlife, and emulate such a trial using observational data from the Rotterdam Study, the Netherlands, 1990–2015. We estimated a total effect of smoking cessation (compared with continued smoking) on 20-year dementia risk of 2.1 (95% confidence interval: −0.1, 4.2) percentage points and a controlled direct effect of smoking cessation on 20-year dementia risk had death been prevented of −2.7 (95% confidence interval: −6.1, 0.8) percentage points. Our study highlights how analyses corresponding to different causal questions can have different results, here with point estimates on opposite sides of the null. Having a clear causal question in view of the competing event and transparent and explicit assumptions are essential to interpreting results and potential bias.</description><identifier>ISSN: 0002-9262</identifier><identifier>EISSN: 1476-6256</identifier><identifier>DOI: 10.1093/aje/kwad090</identifier><identifier>PMID: 37139580</identifier><language>eng</language><publisher>United States: Oxford University Press</publisher><subject>Bias ; Causality ; Cigarette smoking ; Confidence intervals ; Death ; Dementia ; Dementia - epidemiology ; Dementia disorders ; Drug addiction ; Goals ; Humans ; Mortality ; Practice of Epidemiology ; Questions ; Risk management ; Smoking ; Smoking - adverse effects ; Smoking - epidemiology ; Smoking cessation ; Smoking Cessation - methods ; Statistical analysis ; Statistical methods</subject><ispartof>American journal of epidemiology, 2023-08, Vol.192 (8), p.1415-1423</ispartof><rights>The Author(s) 2023. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. 2023</rights><rights>The Author(s) 2023. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c441t-93935cc20be2ff8a3831d86757d2bf59b56244e252b8062e56e09133141c71e23</citedby><cites>FETCH-LOGICAL-c441t-93935cc20be2ff8a3831d86757d2bf59b56244e252b8062e56e09133141c71e23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37139580$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rojas-Saunero, L Paloma</creatorcontrib><creatorcontrib>Young, Jessica G</creatorcontrib><creatorcontrib>Didelez, Vanessa</creatorcontrib><creatorcontrib>Ikram, M Arfan</creatorcontrib><creatorcontrib>Swanson, Sonja A</creatorcontrib><title>Considering Questions Before Methods in Dementia Research With Competing Events and Causal Goals</title><title>American journal of epidemiology</title><addtitle>Am J Epidemiol</addtitle><description>Abstract Studying causal exposure effects on dementia is challenging when death is a competing event. Researchers often interpret death as a potential source of bias, although bias cannot be defined or assessed if the causal question is not explicitly specified. Here we discuss 2 possible notions of a causal effect on dementia risk: the “controlled direct effect” and the “total effect.” We provide definitions and discuss the “censoring” assumptions needed for identification in either case and their link to familiar statistical methods. We illustrate concepts in a hypothetical randomized trial on smoking cessation in late midlife, and emulate such a trial using observational data from the Rotterdam Study, the Netherlands, 1990–2015. We estimated a total effect of smoking cessation (compared with continued smoking) on 20-year dementia risk of 2.1 (95% confidence interval: −0.1, 4.2) percentage points and a controlled direct effect of smoking cessation on 20-year dementia risk had death been prevented of −2.7 (95% confidence interval: −6.1, 0.8) percentage points. Our study highlights how analyses corresponding to different causal questions can have different results, here with point estimates on opposite sides of the null. Having a clear causal question in view of the competing event and transparent and explicit assumptions are essential to interpreting results and potential bias.</description><subject>Bias</subject><subject>Causality</subject><subject>Cigarette smoking</subject><subject>Confidence intervals</subject><subject>Death</subject><subject>Dementia</subject><subject>Dementia - epidemiology</subject><subject>Dementia disorders</subject><subject>Drug addiction</subject><subject>Goals</subject><subject>Humans</subject><subject>Mortality</subject><subject>Practice of Epidemiology</subject><subject>Questions</subject><subject>Risk management</subject><subject>Smoking</subject><subject>Smoking - adverse effects</subject><subject>Smoking - epidemiology</subject><subject>Smoking cessation</subject><subject>Smoking Cessation - methods</subject><subject>Statistical analysis</subject><subject>Statistical methods</subject><issn>0002-9262</issn><issn>1476-6256</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><sourceid>EIF</sourceid><recordid>eNp9kc2L1EAQxRtR3HH05F0aBBEkbvVn0qdF47oKK6IoHttOUtnpMUmP3cmK_709zLioB08FVb961KtHyEMGzxkYceq2ePrth-vAwC2yYrLUheZK3yYrAOCF4ZqfkHspbQEYMwrukhNRMmFUBSvytQ5T8h1GP13RDwum2ecGfYl9iEjf4bwJXaJ-oq9wxGn2jn7EhC62G_rFzxtah3GH8375_DrPE3VTR2u3JDfQi-CGdJ_c6XPBB8e6Jp9fn3-q3xSX7y_e1i8ui1ZKNhdGGKHalkODvO8rJyrBukqXqux40yvTKM2lRK54U4HmqDSCYUIwydqSIRdrcnbQ3S3NiF2bj4lusLvoRxd_2uC8_Xsy-Y29CteWgQQhQGeFp0eFGL7vP2FHn1ocBjdhWJLlFRglucj4mjz-B92GJU7ZnxUgTea4LjP17EC1MaQUsb-5hoHdR2dzdPYYXaYf_Wnghv2dVQaeHICw7P6r9Au9CKIG</recordid><startdate>20230804</startdate><enddate>20230804</enddate><creator>Rojas-Saunero, L Paloma</creator><creator>Young, Jessica G</creator><creator>Didelez, Vanessa</creator><creator>Ikram, M Arfan</creator><creator>Swanson, Sonja A</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>TOX</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7T2</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20230804</creationdate><title>Considering Questions Before Methods in Dementia Research With Competing Events and Causal Goals</title><author>Rojas-Saunero, L Paloma ; Young, Jessica G ; Didelez, Vanessa ; Ikram, M Arfan ; Swanson, Sonja A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c441t-93935cc20be2ff8a3831d86757d2bf59b56244e252b8062e56e09133141c71e23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Bias</topic><topic>Causality</topic><topic>Cigarette smoking</topic><topic>Confidence intervals</topic><topic>Death</topic><topic>Dementia</topic><topic>Dementia - epidemiology</topic><topic>Dementia disorders</topic><topic>Drug addiction</topic><topic>Goals</topic><topic>Humans</topic><topic>Mortality</topic><topic>Practice of Epidemiology</topic><topic>Questions</topic><topic>Risk management</topic><topic>Smoking</topic><topic>Smoking - adverse effects</topic><topic>Smoking - epidemiology</topic><topic>Smoking cessation</topic><topic>Smoking Cessation - methods</topic><topic>Statistical analysis</topic><topic>Statistical methods</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rojas-Saunero, L Paloma</creatorcontrib><creatorcontrib>Young, Jessica G</creatorcontrib><creatorcontrib>Didelez, Vanessa</creatorcontrib><creatorcontrib>Ikram, M Arfan</creatorcontrib><creatorcontrib>Swanson, Sonja A</creatorcontrib><collection>Oxford Journals Open Access Collection</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium &amp; Calcified Tissue Abstracts</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of epidemiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rojas-Saunero, L Paloma</au><au>Young, Jessica G</au><au>Didelez, Vanessa</au><au>Ikram, M Arfan</au><au>Swanson, Sonja A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Considering Questions Before Methods in Dementia Research With Competing Events and Causal Goals</atitle><jtitle>American journal of epidemiology</jtitle><addtitle>Am J Epidemiol</addtitle><date>2023-08-04</date><risdate>2023</risdate><volume>192</volume><issue>8</issue><spage>1415</spage><epage>1423</epage><pages>1415-1423</pages><issn>0002-9262</issn><eissn>1476-6256</eissn><abstract>Abstract Studying causal exposure effects on dementia is challenging when death is a competing event. Researchers often interpret death as a potential source of bias, although bias cannot be defined or assessed if the causal question is not explicitly specified. Here we discuss 2 possible notions of a causal effect on dementia risk: the “controlled direct effect” and the “total effect.” We provide definitions and discuss the “censoring” assumptions needed for identification in either case and their link to familiar statistical methods. We illustrate concepts in a hypothetical randomized trial on smoking cessation in late midlife, and emulate such a trial using observational data from the Rotterdam Study, the Netherlands, 1990–2015. We estimated a total effect of smoking cessation (compared with continued smoking) on 20-year dementia risk of 2.1 (95% confidence interval: −0.1, 4.2) percentage points and a controlled direct effect of smoking cessation on 20-year dementia risk had death been prevented of −2.7 (95% confidence interval: −6.1, 0.8) percentage points. Our study highlights how analyses corresponding to different causal questions can have different results, here with point estimates on opposite sides of the null. Having a clear causal question in view of the competing event and transparent and explicit assumptions are essential to interpreting results and potential bias.</abstract><cop>United States</cop><pub>Oxford University Press</pub><pmid>37139580</pmid><doi>10.1093/aje/kwad090</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 0002-9262
ispartof American journal of epidemiology, 2023-08, Vol.192 (8), p.1415-1423
issn 0002-9262
1476-6256
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10403306
source MEDLINE; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection
subjects Bias
Causality
Cigarette smoking
Confidence intervals
Death
Dementia
Dementia - epidemiology
Dementia disorders
Drug addiction
Goals
Humans
Mortality
Practice of Epidemiology
Questions
Risk management
Smoking
Smoking - adverse effects
Smoking - epidemiology
Smoking cessation
Smoking Cessation - methods
Statistical analysis
Statistical methods
title Considering Questions Before Methods in Dementia Research With Competing Events and Causal Goals
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-24T21%3A59%3A13IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Considering%20Questions%20Before%20Methods%20in%20Dementia%20Research%20With%20Competing%20Events%20and%20Causal%20Goals&rft.jtitle=American%20journal%20of%20epidemiology&rft.au=Rojas-Saunero,%20L%20Paloma&rft.date=2023-08-04&rft.volume=192&rft.issue=8&rft.spage=1415&rft.epage=1423&rft.pages=1415-1423&rft.issn=0002-9262&rft.eissn=1476-6256&rft_id=info:doi/10.1093/aje/kwad090&rft_dat=%3Cproquest_pubme%3E2809542340%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3049095267&rft_id=info:pmid/37139580&rft_oup_id=10.1093/aje/kwad090&rfr_iscdi=true