Toward a Clearer Definition of Selection Bias When Estimating Causal Effects

Lu, Haidong; Cole, Stephen R.; Howe, Chanelle J.; Westreich, Daniel

doi:10.1097/ede.0000000000001516

Cited by 66 publications

(77 citation statements)

References 49 publications

(98 reference statements)

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“…Last but not least, this study is cross-sectional, and our study may suffer from selection bias. It can only determine the association between depression, anxiety, and potential risk factors ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

The impact of COVID-19 on the mental health of pregnant women in Shanghai, China

Zhang¹,

Yuan²,

Xu³

et al. 2022

Front. Public Health

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BackgroundCOVID-19 has dramatically impacted people's health, especially mental health. This study aimed to compare the psychological status of pregnant women before and after the COVID-19 outbreak.MethodsParticipants were recruited (from September 29, 2019, to November 5, 2020) and screened by the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7). The study participants were categorized into three groups based on two turning-points: January 23, 2020, when China initiated a locked-down strategy, and May 11, 2020, when Shanghai started to ease the COVID-19 measures. Multivariable logistic regression was used to determine the factors associated with depression and anxiety in pregnant women. We used enter method for variable selection; only variables with P <0.10 were included in the final model.ResultsWe recruited 478 pregnant women. After the outbreak, the depression rate (PHQ-9 ≥ 5) increased by 12.3% (from 35.4 to 47.7%), and the anxiety rate (GAD-7 ≥ 5) was stable (13.3 vs. 16.2%). The multivariable logistic regression results further confirmed that the odds of depression in pregnant women increased 81% after the outbreak (aOR = 1.81, 95%CI: 1.16–2.84). However, the median depression scale score was still statistically higher after the pandemic situation was stable (5.0 vs. 4.0) compared to the outbreak period.ConclusionThe depression rate increased among pregnant women after the outbreak and was not recovered after the ease of COVID-19 measures in Shanghai. Health institutes should pay attention to the long-term influence of the pandemic.

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Section: Discussionmentioning

confidence: 99%

The impact of COVID-19 on the mental health of pregnant women in Shanghai, China

Zhang¹,

Yuan²,

Xu³

et al. 2022

Front. Public Health

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“…Moreover, although tobacco-speci c NNAL has a relatively long half-life compared with cotinine, it still only measures a person's recent exposure to tobacco and does not re ect long-term exposure to tobacco. In addition, the excluded people due to missing data (n = 112) and the included participants (n = 1,673) had ethnic, mental health, and lifestyle differences; therefore, selection bias may exist [33]. Last but not least, we may not have assessed all cognitive domains with only three cognitive tests.…”

Section: Discussionmentioning

confidence: 99%

Urinary Tobacco-specific Nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and Cognitive Functioning in Older Adults: The National Health and Nutrition Examination Survey 2013-2014

Song¹

2022

Preprint

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Introduction Tobacco and tobacco smoke contain a class of carcinogens called tobacco-specific nitrosamines. A metabolite of tobacco-specific nitrosamine is 4-(methylnitrosamino)-1-(3-pyridyl)-1-Butanol (NNAL). We aimed to examine the association between urinary tobacco-specific NNAL (free NNAL plus NNAL-glucuronide) and cognitive functioning among a nationally representative sample of U.S. older adults. Method A total of 1,673 older adults aged 60 and above from the National Health and Nutrition Examination Survey 2013–2014 were included. Urinary tobacco-specific NNAL was collected in mobile health centers and analyzed in the laboratory. Cognitive functioning was measured using the Consortium to Establish a Registry for Alzheimer’s Disease Word Learning subtest (CERAD-WL) immediate and delayed memory tests, the Animal Fluency test (AFT), and the Digit Symbol Substitution Test (DSST). Test-specific and global cognition z-scores were calculated based on means and standard deviations (SD) of the cognitive test scores. Multivariable linear regression models were constructed to examine the independent association between quantiles of urinary tobacco-specific NNAL (reference: the lowest quantile) and cognitive test-specific and global cognition z-scores controlling for age, race/ethnicity, education, depressive symptoms, smoking status, body mass index, prevalent coronary heart disease, stroke, and systolic blood pressure. Results About half of the participants (mean age 69.8 years, SD 6.8) were female (52.1%), non-Hispanic White (48.3%), and completed some college and above (49.7%). Multivariate linear regressions showed that higher quantiles of urinary tobacco-specific NNAL, compared with the lowest quantile, was significantly associated with lower AFT (beta [β] -0.16, 95% confidence interval [CI] -0.27, -0.04), DSST (β -0.25, 95% CI -0.35, -0.14), and global cognition (β -0.15, 95% CI -0.27, -0.04) z-scores controlling for the covariates. Conclusions Higher urinary tobacco-specific NNAL was associated with worse cognitive functioning in older adults. Prevention and reduction of active or passive exposure to tobacco in older adults may help protect their cognitive functioning.

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“…In addition, the excluded people due to missing data and being current smokers (n = 769) and the included participants (n = 2703) had ethnic, mental health, and lifestyle differences. Therefore, selection bias is likely (Lu, Cole, Howe, & Westreich, 2022).…”

Section: Discussionmentioning

confidence: 99%

Higher Blood Cotinine Level is Associated with Worse Cognitive Functioning in Non-smoking Older Adults

Qiao

Song

2022

Preprint

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Introduction Secondhand smoke (SHS) is common in older adults; however, its cognitive effect is unclear. We aimed to examine the association between serum cotinine level and cognitive functioning among non-smoking older adults. Method A total of 2703 older adults aged 60 and above from the National Health and Nutrition Examination Survey 2011–2014 were included. Serum cotinine level was analyzed in the laboratory. A level ≤ 10 ng/mL and response of “no” to the question “Do you currently smoke?” were used to select non-smokers. Cognitive functioning was measured using the Consortium to Establish a Registry for Alzheimer’s Disease Word Learning subtest (CERAD-WL) immediate and delayed recall tests, the Animal Fluency test (AFT), and the Digit Symbol Substitution Test (DSST). Using means and standard deviations (SD) of the cognitive test scores, test-specific and global cognition z scores were calculated. Multivariable linear regression models were constructed to examine the association between serum cotinine level quartile and test-specific and global cognition z scores adjusting for age, race/ethnicity, education, depressive symptoms, body mass index, alcohol use, smoking history, prevalent coronary heart disease, stroke, and systolic blood pressure. Results About half of the participants (mean age 70.5 years) were female (53.6%), non-Hispanic White (48.3%), and completed some college and above (50.2%). Multivariate linear regressions showed that participants in the 1st quartile (highest) of serum cotinine level, compared with those in the 4th quantile (lowest), had lower immediate recall (β -0.16, 95% confidence interval [CI] -0.29, -0.03), AFT (β -0.19, 95% CI -0.33, -0.05), DSST (β -0.27, 95% CI -0.39, -0.15), and global cognition (β -0.26, 95% CI -0.39, -0.14) z scores. Participants in the 2nd quartile, compared with those in the 4th quartile, had lower immediate recall (β -0.16, 95% CI -0.30, -0.02) and global cognition (β -0.16, 95% CI -0.29, -0.02) z scores. Participants in the 3rd quartile, compared with those in the 4th quartile, had lower delayed recall z scores (β -0.16, 95% CI -0.29, -0.02). Conclusions Higher serum cotinine level was associated with worse cognitive functioning in non-smoking older adults. Prevention and reduction of SHS in older adults may help protect their cognitive functioning.

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Toward a Clearer Definition of Selection Bias When Estimating Causal Effects

Cited by 66 publications

References 49 publications

The impact of COVID-19 on the mental health of pregnant women in Shanghai, China

The impact of COVID-19 on the mental health of pregnant women in Shanghai, China

Urinary Tobacco-specific Nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) and Cognitive Functioning in Older Adults: The National Health and Nutrition Examination Survey 2013-2014

Higher Blood Cotinine Level is Associated with Worse Cognitive Functioning in Non-smoking Older Adults

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