Time-varying associations between an exposure history and a subsequent health outcome: a landmark approach to identify critical windows

Abstract Background Long-term behavioral and health risk factors constitute a primary focus of research on the etiology of chronic diseases. Yet, identifying critical time-windows during which risk factors have the strongest impact on disease risk is challenging. To assess the trajectory of associat...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Maude Wagner, Francine Grodstein, Karen Leffondre, Cécilia Samieri, Cécile Proust-Lima
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Landmarking Longitudinal outcome Measurement error Missing data Time-varying exposure Weighted cumulative index of exposure Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/e034b93a2c2e4678970b67fe6f423d1d
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:e034b93a2c2e4678970b67fe6f423d1d
record_format	dspace
spelling	oai:doaj.org-article:e034b93a2c2e4678970b67fe6f423d1d2021-11-28T12:38:49ZTime-varying associations between an exposure history and a subsequent health outcome: a landmark approach to identify critical windows10.1186/s12874-021-01403-w1471-2288https://doaj.org/article/e034b93a2c2e4678970b67fe6f423d1d2021-11-01T00:00:00Zhttps://doi.org/10.1186/s12874-021-01403-whttps://doaj.org/toc/1471-2288Abstract Background Long-term behavioral and health risk factors constitute a primary focus of research on the etiology of chronic diseases. Yet, identifying critical time-windows during which risk factors have the strongest impact on disease risk is challenging. To assess the trajectory of association of an exposure history with an outcome, the weighted cumulative exposure index (WCIE) has been proposed, with weights reflecting the relative importance of exposures at different times. However, WCIE is restricted to a complete observed error-free exposure whereas exposures are often measured with intermittent missingness and error. Moreover, it rarely explores exposure history that is very distant from the outcome as usually sought in life-course epidemiology. Methods We extend the WCIE methodology to (i) exposures that are intermittently measured with error, and (ii) contexts where the exposure time-window precedes the outcome time-window using a landmark approach. First, the individual exposure history up to the landmark time is estimated using a mixed model that handles missing data and error in exposure measurement, and the predicted complete error-free exposure history is derived. Then the WCIE methodology is applied to assess the trajectory of association between the predicted exposure history and the health outcome collected after the landmark time. In our context, the health outcome is a longitudinal marker analyzed using a mixed model. Results A simulation study first demonstrates the correct inference obtained with this approach. Then, applied to the Nurses’ Health Study (19,415 women) to investigate the association between body mass index history (collected from midlife) and subsequent cognitive decline (evaluated after age 70), the method identified two major critical windows of association: long before the first cognitive evaluation (roughly 24 to 12 years), higher levels of BMI were associated with poorer cognition. In contrast, adjusted for the whole history, higher levels of BMI became associated with better cognition in the last years prior to the first cognitive interview, thus reflecting reverse causation (changes in exposure due to underlying disease). Conclusions This approach, easy to implement, provides a flexible tool for studying complex dynamic relationships and identifying critical time windows while accounting for exposure measurement errors.Maude WagnerFrancine GrodsteinKaren LeffondreCécilia SamieriCécile Proust-LimaBMCarticleLandmarkingLongitudinal outcomeMeasurement errorMissing dataTime-varying exposureWeighted cumulative index of exposureMedicine (General)R5-920ENBMC Medical Research Methodology, Vol 21, Iss 1, Pp 1-15 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Landmarking Longitudinal outcome Measurement error Missing data Time-varying exposure Weighted cumulative index of exposure Medicine (General) R5-920
spellingShingle	Landmarking Longitudinal outcome Measurement error Missing data Time-varying exposure Weighted cumulative index of exposure Medicine (General) R5-920 Maude Wagner Francine Grodstein Karen Leffondre Cécilia Samieri Cécile Proust-Lima Time-varying associations between an exposure history and a subsequent health outcome: a landmark approach to identify critical windows
description	Abstract Background Long-term behavioral and health risk factors constitute a primary focus of research on the etiology of chronic diseases. Yet, identifying critical time-windows during which risk factors have the strongest impact on disease risk is challenging. To assess the trajectory of association of an exposure history with an outcome, the weighted cumulative exposure index (WCIE) has been proposed, with weights reflecting the relative importance of exposures at different times. However, WCIE is restricted to a complete observed error-free exposure whereas exposures are often measured with intermittent missingness and error. Moreover, it rarely explores exposure history that is very distant from the outcome as usually sought in life-course epidemiology. Methods We extend the WCIE methodology to (i) exposures that are intermittently measured with error, and (ii) contexts where the exposure time-window precedes the outcome time-window using a landmark approach. First, the individual exposure history up to the landmark time is estimated using a mixed model that handles missing data and error in exposure measurement, and the predicted complete error-free exposure history is derived. Then the WCIE methodology is applied to assess the trajectory of association between the predicted exposure history and the health outcome collected after the landmark time. In our context, the health outcome is a longitudinal marker analyzed using a mixed model. Results A simulation study first demonstrates the correct inference obtained with this approach. Then, applied to the Nurses’ Health Study (19,415 women) to investigate the association between body mass index history (collected from midlife) and subsequent cognitive decline (evaluated after age 70), the method identified two major critical windows of association: long before the first cognitive evaluation (roughly 24 to 12 years), higher levels of BMI were associated with poorer cognition. In contrast, adjusted for the whole history, higher levels of BMI became associated with better cognition in the last years prior to the first cognitive interview, thus reflecting reverse causation (changes in exposure due to underlying disease). Conclusions This approach, easy to implement, provides a flexible tool for studying complex dynamic relationships and identifying critical time windows while accounting for exposure measurement errors.
format	article
author	Maude Wagner Francine Grodstein Karen Leffondre Cécilia Samieri Cécile Proust-Lima
author_facet	Maude Wagner Francine Grodstein Karen Leffondre Cécilia Samieri Cécile Proust-Lima
author_sort	Maude Wagner
title	Time-varying associations between an exposure history and a subsequent health outcome: a landmark approach to identify critical windows
title_short	Time-varying associations between an exposure history and a subsequent health outcome: a landmark approach to identify critical windows
title_full	Time-varying associations between an exposure history and a subsequent health outcome: a landmark approach to identify critical windows
title_fullStr	Time-varying associations between an exposure history and a subsequent health outcome: a landmark approach to identify critical windows
title_full_unstemmed	Time-varying associations between an exposure history and a subsequent health outcome: a landmark approach to identify critical windows
title_sort	time-varying associations between an exposure history and a subsequent health outcome: a landmark approach to identify critical windows
publisher	BMC
publishDate	2021
url	https://doaj.org/article/e034b93a2c2e4678970b67fe6f423d1d
work_keys_str_mv	AT maudewagner timevaryingassociationsbetweenanexposurehistoryandasubsequenthealthoutcomealandmarkapproachtoidentifycriticalwindows AT francinegrodstein timevaryingassociationsbetweenanexposurehistoryandasubsequenthealthoutcomealandmarkapproachtoidentifycriticalwindows AT karenleffondre timevaryingassociationsbetweenanexposurehistoryandasubsequenthealthoutcomealandmarkapproachtoidentifycriticalwindows AT ceciliasamieri timevaryingassociationsbetweenanexposurehistoryandasubsequenthealthoutcomealandmarkapproachtoidentifycriticalwindows AT cecileproustlima timevaryingassociationsbetweenanexposurehistoryandasubsequenthealthoutcomealandmarkapproachtoidentifycriticalwindows
_version_	1718407862769680384

Time-varying associations between an exposure history and a subsequent health outcome: a landmark approach to identify critical windows

Ejemplares similares