Journal article
The Effects of Reverse Causality and Selective Attrition on the Relationship Between Body Mass Index and Mortality in Postmenopausal Women
American journal of epidemiology, Vol.188(10), pp.1838-1848
10/01/2019
DOI: 10.1093/aje/kwz160
PMCID: PMC6768808
PMID: 31274146
Abstract
Concerns about reverse causality and selection bias complicate the interpretation of studies of body mass index (BMI, calculated as weight (kg)/height (m)(2)) and mortality in older adults. The objective of this study was to investigate methodological explanations for the apparent attenuation of obesity-related risks in older adults. We used data from 68,132 participants in the Women's Health Initiative (WHI) clinical trial for this analysis. All of the participants were postmenopausal women aged 50-79 years at baseline (1993-1998). To examine reverse causality and selective attrition, we compared rate ratios from inverse probability of treatment- and censoring-weighted Poisson marginal structural models with results from an unweighted adjusted Poisson regression model. The estimated mortality rate ratios and 95% confidence intervals for BMIs of 30.0-34.9, 35.0-39.9 and >= 40.0 were 0.86 (95% confidence interval (CI): 0.77, 0.96), 0.85 (95% CI: 0.72, 0.99), and 0.88 (95% CI: 0.72, 1.07), respectively, in the unweighted model. The corresponding mortality rate ratios were 0.96 (95% CI: 0.86, 1.07), 1.12 (95% CI: 0.97, 1.29), and 1.31 95% CI: (1.08, 1.57), respectively, in the marginal structural model. Results from the inverse probability of treatment- and censoring-weighted marginal structural model were attenuated in low BMI categories and increased in high BMI categories. The results demonstrate the importance of accounting for reverse causality and selective attrition in studies of older adults.
Details
- Title: Subtitle
- The Effects of Reverse Causality and Selective Attrition on the Relationship Between Body Mass Index and Mortality in Postmenopausal Women
- Creators
- Hailey R. Banack - Buffalo State UniversityJennifer W. Bea - University of ArizonaJay S. Kaufman - McGill UniversityAndrew Stokes - Boston UniversityCandyce H. Kroenke - Kaiser PermanenteMarcia L. Stefanick - Stanford UniversityShirley A. Beresford - University of WashingtonChloe E. Bird - RAND CorporationLorena Garcia - University of California, DavisRobert Wallace - University of IowaRobert A. Wild - University of OklahomaBette Caan - Kaiser PermanenteJean Wactawski-Wende - Buffalo State University
- Resource Type
- Journal article
- Publication Details
- American journal of epidemiology, Vol.188(10), pp.1838-1848
- DOI
- 10.1093/aje/kwz160
- PMID
- 31274146
- PMCID
- PMC6768808
- NLM abbreviation
- Am J Epidemiol
- ISSN
- 0002-9262
- eISSN
- 1476-6256
- Publisher
- Oxford Univ Press
- Number of pages
- 11
- Grant note
- Banting Postdoctoral Fellowship Program from the Canadian Institute of Health Research; Canadian Institutes of Health Research (CIHR) HHSN268201600018C; HHSN268201600001C; HHSN268201600002C; HHSN268201600003C; HHSN268201600004C / National Heart, Lung, and Blood Institute of the National Institutes of Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI)
- Language
- English
- Date published
- 10/01/2019
- Academic Unit
- Epidemiology; Injury Prevention Research Center; Internal Medicine
- Record Identifier
- 9984364420502771
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