American journal of epidemiology最新文献_第3页

Reallocation of 24-hour movement behaviour composition and mortality: exploring effect modification by sleep characteristics. 24小时运动行为构成与死亡率的再分配：探索睡眠特征对效果的影响。

IF 4.1 2区医学

American journal of epidemiology Pub Date : 2026-10-07 DOI: 10.1093/aje/kwag249

Wenxin Bian, Matthew N Ahmadi, John J Mitchell, Raaj Kishore Biswas, Nicholas A Koemel, Dorothea Dumuid, Sebastien F M Chastin, Joanna M Blodgett, Jean-Philippe Chaput, Mark Hamer, Emmanuel Stamatakis

{"title":"Reallocation of 24-hour movement behaviour composition and mortality: exploring effect modification by sleep characteristics.","authors":"Wenxin Bian, Matthew N Ahmadi, John J Mitchell, Raaj Kishore Biswas, Nicholas A Koemel, Dorothea Dumuid, Sebastien F M Chastin, Joanna M Blodgett, Jean-Philippe Chaput, Mark Hamer, Emmanuel Stamatakis","doi":"10.1093/aje/kwag249","DOIUrl":"https://doi.org/10.1093/aje/kwag249","url":null,"abstract":"Sleep, sedentary behaviour (SB), standing, light-intensity physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) compose the 24-hour day, and reallocating time between these behaviours is associated with premature mortality; however, whether these associations differ by sleep characteristics remains unclear. We examined associations between time reallocations across these device-measured behaviours and all-cause, cardiovascular disease (CVD) and physical activity-related cancer mortality, and potential effect modification by sleep duration and regularity. We conducted a population-based prospective cohort study among UK Biobank participants and applied compositional Cox regression. In 68 995 adults, 2668 deaths occurred over a mean follow-up of 8.0 years. Among participants meeting sleep duration guidelines, reallocating 30-minutes from sleep to standing, LPA or MVPA was favourably associated with all-cause mortality, with HRs of 0.85 (95%CI 0.79, 0.92), 0.87 (0.81, 0.94), and 0.80 (0.74, 0.87), respectively. Among short sleepers, reallocating 30-minutes from sleep to SB, standing or LPA was adversely associated with CVD mortality, with HRs of 1.18 (1.04, 1.34), 1.20 (1.04, 1.38), and 1.18 (1.03, 1.35), respectively. Beneficial associations of reallocating SB to sleep were evident among both regular sleepers and irregular sleepers. These observational findings suggest that associations between 24-hour behavioural reallocations and mortality may vary according to sleep characteristics.","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Leveraging electronic health record data to evidence collider stratification bias and inform clinical epidemiology: obesity, diabetes, and rotator cuff tears. 利用电子健康记录数据来证明碰撞分层偏差并告知临床流行病学：肥胖、糖尿病和肩袖撕裂。

IF 4.1 2区医学

American journal of epidemiology Pub Date : 2026-10-07 DOI: 10.1093/aje/kwag117

Simone D Ueland, Til B Basnet, Wenting Liu, Henry H Ong, Srushti Gangreddi, Wei-Qi Wei, Wanqing Wen, Katherine E Hartmann, Nitin B Jain, Ayush Giri

{"title":"Leveraging electronic health record data to evidence collider stratification bias and inform clinical epidemiology: obesity, diabetes, and rotator cuff tears.","authors":"Simone D Ueland, Til B Basnet, Wenting Liu, Henry H Ong, Srushti Gangreddi, Wei-Qi Wei, Wanqing Wen, Katherine E Hartmann, Nitin B Jain, Ayush Giri","doi":"10.1093/aje/kwag117","DOIUrl":"10.1093/aje/kwag117","url":null,"abstract":"Electronic health record (EHR) data are increasingly used for case-control investigations. Using multiple control groups in de-identified EHR data, we evidence how conditioning on imaging (descendant of a collider: symptomatology) can perturb exposure estimations enough to reverse conclusions. Because imaging is often required for rotator cuff tear diagnosis, some argue imaging should be required for control selection. We constructed 2 control groups (with vs without imaging) to evaluate selection bias through collider stratification involving metabolic exposures-body mass index (BMI), type 1 diabetes (T1D), and type 2 diabetes (T2D)-and rotator cuff tears. Cases and controls were identified using validated algorithms. We compared baseline characteristics and performed multivariable logistic regression across designs. Cases were older and more likely to have arthritis (57%), ligamentous disease (9%), and prior shoulder injury (99%) than controls. Controls requiring imaging more closely resembled cases than controls not requiring imaging, with more arthritis (9% vs 1%), ligamentous disease (6% vs 2%), and prior shoulder injury (54% vs 7%). T1D prevalence was 3% in cases, 4% in controls with imaging, and 1% in controls without, compared to ~1% nationally. T1D was positively associated with tears using controls without imaging (aOR = 1.78; 95% CI, 1.64-1.92), but inversely using controls with imaging (aOR = 0.75; 0.57-0.97).","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":"2592-2601"},"PeriodicalIF":4.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148136488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Age-period-cohort analysis of low birth weight, early-term delivery, induction, and cesarean-section, US births 1990-2019. 1990-2019年美国出生低出生体重、早产、引产和剖宫产的年龄-时期队列分析

IF 4.1 2区医学

American journal of epidemiology Pub Date : 2026-10-07 DOI: 10.1093/aje/kwag147

Chloe A Teasdale, Sean Locke, Zachary Shahn, Saskia Rueda, Elizabeth A Kelly, Francisco Bolumar, Heidi E Jones

{"title":"Age-period-cohort analysis of low birth weight, early-term delivery, induction, and cesarean-section, US births 1990-2019.","authors":"Chloe A Teasdale, Sean Locke, Zachary Shahn, Saskia Rueda, Elizabeth A Kelly, Francisco Bolumar, Heidi E Jones","doi":"10.1093/aje/kwag147","DOIUrl":"10.1093/aje/kwag147","url":null,"abstract":"We conducted an age-period-cohort (APC) analysis to distinguish age, period, and cohort effects underlying temporal trends in low birth weight (LBW: <2500 g), early-term deliveries (ETD: 37-38 weeks), induction, and cesarean-section (c-section) using US birth records from 1994-2019 for all singleton, first, full-term (37-44 weeks gestation) births (n = 8 194 523). Using the APC-interaction method, we estimated age, period, and cohort effects as odds ratios with 95% CI. Age and period effects were observed for all outcomes. Pregnant women/people aged 40-44 years had increased odds of LBW (OR 1.23, 95% CI, 1.19-1.26), ETD (OR 1.24, 95% CI, 1.23-1.26), induction (OR 1.05, 95% CI, 1.04-1.06), and c-section (OR 2.28, 95% CI, 2.26-2.30) compared to the total population. Odds of LBW (OR 1.14, 95% CI, 1.13-1.16), ETD (OR 1.11, 95% CI, 1.10-1.12), and induction (OR 1.71, 95%,CI, 1.70-1.72) were higher in 2019 compared to the study period average. Cohort effects not explained by age and period effects were observed for women aged 40-44 years in 2019 indicated by higher odds of ETD (OR 1.08, 95% CI, 1.05-1.10), induction (1.10, 95% CI, 1.07-1.12), and c-section (OR 1.09, 95% CI, 1.06-1.11). These findings suggest obstetric management of pregnant women ≥40 years changed in recent decades in ways not expected based on age and temporal trends alone.","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":"2640-2647"},"PeriodicalIF":4.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642371/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148306665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Shifting burden of childhood cancer mortality in the United States: progress and persistent inequities. 转移美国儿童癌症死亡率的负担：进步和持续的不平等。

IF 4.1 2区医学

American journal of epidemiology Pub Date : 2026-10-07 DOI: 10.1093/aje/kwag169

Jessica L Baedke, Qi Liu, Shizue Izumi, Tomoko Yoshida, Nishan Lamichhane, Sahar Aliabadi, José Miguel Martinez, I-Chan Huang, Gregory T Armstrong, Yutaka Yasui

{"title":"Shifting burden of childhood cancer mortality in the United States: progress and persistent inequities.","authors":"Jessica L Baedke, Qi Liu, Shizue Izumi, Tomoko Yoshida, Nishan Lamichhane, Sahar Aliabadi, José Miguel Martinez, I-Chan Huang, Gregory T Armstrong, Yutaka Yasui","doi":"10.1093/aje/kwag169","DOIUrl":"10.1093/aje/kwag169","url":null,"abstract":"While 5-year survival following childhood cancer rose greatly from ~60% in the mid-1970s to 85% today, inequities persist and conventional survival metrics obscure the true burden and shifting distribution of deaths. To address this, we used Surveillance, Epidemiology, and End Results registries to evaluate excess mortality rates and counts (AER and AEC), new metrics quantifying mortality attributable to childhood cancer, among 47 545 US children diagnosed before age 20 during 1975-2014, with follow-up through 2018. We quantified trends across subgroups and assessed modification by county-level income and rurality. AER declined across groups but at different magnitudes. From 1975-1979 to 2010-2014, declines were 75% in non-Hispanic White (NHW), 62% in non-Hispanic Black, and ~63% in Hispanic and Asian/Pacific Islander children. Among non-Hispanic American Indian/Alaska Native children, AER fell briefly with no clear improvement subsequently. Absolute burden shifted: AEC fell among NHW (8874 in 1990-1994 to 5134 in 2010-2014) but rose among other subgroups (4826 to 5213). By 2010-2014, non-NHW children accounted for more deaths despite >15 000 fewer diagnoses than NHW children. These findings show a shifting national burden: Despite overall survival gains, persistent and sometimes worsening inequities mean deaths are increasingly concentrated among non-NHW subgroups.","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":"2568-2575"},"PeriodicalIF":4.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Air pollution and healthy aging: a longitudinal inquire on the association of PM2.5 with intrinsic capacity and its domains. 大气污染与健康老龄化：PM2.5与内在容量及其域关联的纵向研究。

IF 4.1 2区医学

American journal of epidemiology Pub Date : 2026-10-07 DOI: 10.1093/aje/kwag160

Aarón Salinas-Rodríguez, Susana Román-Pérez, Mario Efraín Flores-Rodríguez, Betty Manrique-Espinoza

{"title":"Air pollution and healthy aging: a longitudinal inquire on the association of PM2.5 with intrinsic capacity and its domains.","authors":"Aarón Salinas-Rodríguez, Susana Román-Pérez, Mario Efraín Flores-Rodríguez, Betty Manrique-Espinoza","doi":"10.1093/aje/kwag160","DOIUrl":"10.1093/aje/kwag160","url":null,"abstract":"Air pollution constitutes a major challenge in achieving healthy aging. However, the association between PM2.5 and composite indicators of healthy aging (intrinsic capacity, IC) has not yet been explored. This study aimed to estimate the longitudinal association between long-term exposure to PM2.5 and IC and its domains in a sample of Mexican older people. We used data from 4 waves of the Study on Global Aging and Adult Health in Mexico (2009, 2014, 2017, and 2021). The annual PM2.5 concentration was calculated using satellite data. Longitudinal fixed-effects models were used to estimate the proposed associations. Higher levels of PM2.5 were significantly associated with a decline in IC and the sensory and locomotor domains. While higher PM2.5 values were significantly associated with lower values in the cognitive, vitality, and psychological domains; however, the scores in these domains did not decrease over time. Given that the global population is aging at an accelerated rate and urbanization continues to increase, addressing PM2.5 pollution is crucial for protecting the physical and mental well-being of older people.","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":"2509-2517"},"PeriodicalIF":4.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Including an infrequently measured time-varying error-prone covariate in survival analyses: a simulation-based comparison of methods. 在生存分析中包括不经常测量的时变易出错协变量：基于模拟的方法比较。

IF 4.1 2区医学

American journal of epidemiology Pub Date : 2026-10-07 DOI: 10.1093/aje/kwag059

Viviane Philipps, Laurence Freedman, Veronika Deffner, Catherine Helmer, Hélène Jacqmin-Gadda, Hendriek Boshuizen, Anne Cm Thiébaut, Cécile Proust-Lima

{"title":"Including an infrequently measured time-varying error-prone covariate in survival analyses: a simulation-based comparison of methods.","authors":"Viviane Philipps, Laurence Freedman, Veronika Deffner, Catherine Helmer, Hélène Jacqmin-Gadda, Hendriek Boshuizen, Anne Cm Thiébaut, Cécile Proust-Lima","doi":"10.1093/aje/kwag059","DOIUrl":"10.1093/aje/kwag059","url":null,"abstract":"Epidemiologic studies often evaluate the association between an exposure and an event risk. When time-varying, exposures are usually updated at discrete visits although changes are in continuous time and survival models require values to be constantly known. Moreover, exposures are likely measured with error, and their observation truncated at the event time. We aimed to quantify in a Cox regression the bias in the association resulting from intermittent measurements of an error-prone exposure. Using simulations under various scenarios, we compared five methods: last observation carried-forward (LOCF), classical two-stage regression calibration using measurements up to the event (RC) or also after (PE-RC), multiple imputation (MI) and joint modeling of the exposure and the event (JM). The LOCF, and to a lesser extent the classical RC, showed substantial bias in almost all 45 scenarios. The RC bias was avoided when considering post-event information. The MI performed relatively well, as did the JM. Illustrations exploring the association of Body Mass Index and Executive Functioning with dementia risk showed consistent conclusions. Accounting for measurement error and discrete updates is critical when studying time-varying exposures. MI and JM techniques may be applied in this context, while classical RC should be avoided due to the informative truncation.","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":"2622-2631"},"PeriodicalIF":4.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147442058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Temporal validation and extension of risk prediction model for pulmonary complications after head and neck surgeries. 头颈部手术后肺部并发症风险预测模型的时间验证与扩展。

IF 4.1 2区医学

American journal of epidemiology Pub Date : 2026-10-07 DOI: 10.1093/aje/kwag098

Mohammad Al-Tamimi, Belinda Nicolau, Harsimran Singh Kapoor, Nicholas Maroun Makhoul, Sreenath Madathil

{"title":"Temporal validation and extension of risk prediction model for pulmonary complications after head and neck surgeries.","authors":"Mohammad Al-Tamimi, Belinda Nicolau, Harsimran Singh Kapoor, Nicholas Maroun Makhoul, Sreenath Madathil","doi":"10.1093/aje/kwag098","DOIUrl":"10.1093/aje/kwag098","url":null,"abstract":"Postoperative pulmonary complications (PPCs) are common following head and neck surgeries (HNS), leading to extended hospital stays and increased morbidity. Existing PPC risk prediction models developed for general surgery patients underperform for HNS. This study validates an existing risk prediction model for PPC and extends it for HNS. We assessed the performance of original Gupta model, developed using 2007 ACS-NSQIP (American College of Surgeons-National Surgical Quality Improvement) data, by validating it on 2019 ACS-NSQIP HNS data. We recalibrated, refitted, and extended the model with HNS-specific predictors, followed by temporal validation. Model performance was assessed using scaled Brier score, Nagelkerke's R 2, discrimination (receiver operating characteristic area under the curve, ROC-AUC), and calibration. The extended model showed improved predictive performance compared to original Gupta model, with scaled Brier score of 0.024 vs -0.056 and R 2 of 0.144 vs -0.196. The ROC-AUC increased from 0.72 to 0.82, and calibration improved from 0.94 to 0.98. Among HNS patients, the extended model showed better performance, discrimination, and calibration in predicting PPC compared to original model. This model could aid clinicians in risk stratification and implement risk reduction strategies. Further validation in external HNS populations is necessary to confirm its generalizability and clinical utility.","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":"2562-2567"},"PeriodicalIF":4.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Building process improvement capacity in epidemiologic research operations: the Nurses' Health Studies experience. 流行病学研究业务流程改进能力建设：护士健康研究经验。

IF 4.1 2区医学

American journal of epidemiology Pub Date : 2026-10-07 DOI: 10.1093/aje/kwag074

Leanna Bassett, Vedika Vilas Patankar, Cizz-L N Lockhart, Matt B Mahoney, Janine Neville-Golden, Tanya L Palmer, Nicole Romero, Jacqueline R Starr

{"title":"Building process improvement capacity in epidemiologic research operations: the Nurses' Health Studies experience.","authors":"Leanna Bassett, Vedika Vilas Patankar, Cizz-L N Lockhart, Matt B Mahoney, Janine Neville-Golden, Tanya L Palmer, Nicole Romero, Jacqueline R Starr","doi":"10.1093/aje/kwag074","DOIUrl":"10.1093/aje/kwag074","url":null,"abstract":"With declining infrastructure funding for large-scale epidemiologic cohort studies, continuous process improvement is essential to sustain research quality and impact. The authors recently undertook a Lean Six Sigma (LSS) training initiative with operational staff of the Nurses' Health Studies (NHSs), among the longest-running and most productive cohort studies, to modernize operations and build internal capacity for process improvement. Twenty staff members across operational domains completed a structured LSS curriculum and 3 improvement projects: (1) reducing median turnaround time for medical record retrieval by 90%, (2) decreasing the proportion undeliverable questionnaires by 31%, and (3) cutting biweekly freezer maintenance time by 43 person-minutes per cycle, yielding an estimated 6.5 person-weeks annually. Staff reported substantial increases in understanding and confidence in applying process improvement methods. Fourteen trainees completed all requirements for LSS green-belt certification. Though some participants questioned the need to learn a specialized framework, most valued the collaborative, data-driven approach. This experience demonstrates that LSS can be successfully adapted to non-clinical trial epidemiologic research, improving efficiency and data quality. By improving data completeness and integrity, operational improvements reduced sources of bias in downstream analyses. The results support broader adoption of structured continuous improvement efforts to enhance the sustainability of epidemiologic research platforms.","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":"2608-2615"},"PeriodicalIF":4.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13519514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147589340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Intersection is interaction. 交集就是互动。

IF 4.1 2区医学

American journal of epidemiology Pub Date : 2026-10-07 DOI: 10.1093/aje/kwag187

Ali Al-Kassab-Córdova, Nasir Bashir

引用次数: 0

Coexposure confounding and amplification of bias-an exploration with practical interpretation and perspectives. 共同暴露、混淆和放大偏见——一种具有实际解释和观点的探索。

IF 4.1 2区医学

American journal of epidemiology Pub Date : 2026-10-07 DOI: 10.1093/aje/kwag183

Krista Y Christensen, Michael Leung, Elizabeth G Radke, J Michael Wright, Paige A Bommarito, Thomas F Bateson, Marc G Weisskopf

{"title":"Coexposure confounding and amplification of bias-an exploration with practical interpretation and perspectives.","authors":"Krista Y Christensen, Michael Leung, Elizabeth G Radke, J Michael Wright, Paige A Bommarito, Thomas F Bateson, Marc G Weisskopf","doi":"10.1093/aje/kwag183","DOIUrl":"10.1093/aje/kwag183","url":null,"abstract":"Epidemiologists increasingly estimate associations between mixtures of correlated coexposures and health outcomes. We propose an exploratory approach to help differentiate coexposure confounding from coexposure amplification of bias (CAB) for studies considering correlated coexposures using a case example and simulations based on observed relationships. Our example uses associations observed in published studies between co-occurring per- and polyfluoroalkyl substance (PFAS) biomarkers and tetanus antibody concentrations but could apply to any context where statistical modeling is performed with and without inclusion of correlated coexposures. Using directed acyclic graphs (DAGs), to define an assumed causal structure, and simulations of 3 PFAS predicting antibody titers, we show that if researchers can assume 1 component in the exposure mixture is correlated with the other components, but does not cause the outcome, then CAB can be detected by testing whether the estimate for the noncausal component in a multipollutant model is different from zero. In our simulation, the estimate for the noncausal component was zero (95% CI, -0.22, 0.25) when CAB was absent and -0.25 (95% CI, -0.48, 0.00) when present. These results illustrate a possible method to identify CAB and select statistical models that may produce less biased effect estimates if our assumed DAG is correct.","PeriodicalId":7472,"journal":{"name":"American journal of epidemiology","volume":" ","pages":"2585-2591"},"PeriodicalIF":4.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148597561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0