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American Journal of Epidemiology
Journal Prestige (SJR): 2.713
Citation Impact (citeScore): 3
Number of Followers: 234  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9262 - ISSN (Online) 1476-6256
Published by Oxford University Press Homepage  [412 journals]
  • 2019 Articles of the Year, Reviewers of the Year, and Figure of the Year
    • Pages: 485 - 486
      Abstract: We are delighted to announce the 10 best articles published in 2019. We believe that all papers published in the Journal meet the standard of excellence. However, the 10 papers selected this year represent, in the editors’ opinions, the best in the field. The articles are listed below in the order of publication.
      PubDate: Wed, 01 Jul 2020 00:00:00 GMT
      DOI: 10.1093/aje/kwaa094
      Issue No: Vol. 189, No. 6 (2020)
       
  • Editorial: JUMBO, MRFIT, and the Making of Public Health Epidemiology
    • Authors: Morabia A.
      Pages: 487 - 490
      Abstract: Think: What are the main achievements of epidemiology that come immediately to your mind'
      PubDate: Wed, 15 Jan 2020 00:00:00 GMT
      DOI: 10.1093/aje/kwz271
      Issue No: Vol. 189, No. 6 (2020)
       
  • Estimating Risk Ratios and Risk Differences Using Regression
    • Authors: Naimi A; Whitcomb B.
      Pages: 508 - 510
      PubDate: Fri, 27 Mar 2020 00:00:00 GMT
      DOI: 10.1093/aje/kwaa044
      Issue No: Vol. 189, No. 6 (2020)
       
  • The Epidemiologic Toolbox: Identifying, Honing, and Using the Right Tools
           for the Job
    • Authors: Lesko C; Keil A, Edwards J.
      Pages: 511 - 517
      Abstract: AbstractThere has been much debate about the relative emphasis of the field of epidemiology on causal inference. We believe this debate does short shrift to the breadth of the field. Epidemiologists answer myriad questions that are not causal and hypothesize about and investigate causal relationships without estimating causal effects. Descriptive studies face significant and often overlooked inferential and interpretational challenges; we briefly articulate some of them and argue that a more detailed treatment of biases that affect single-sample estimation problems would benefit all types of epidemiologic studies. Lumping all questions about causality creates ambiguity about the utility of different conceptual models and causal frameworks; 2 distinct types of causal questions include 1) hypothesis generation and theorization about causal structures and 2) hypothesis-driven causal effect estimation. The potential outcomes framework and causal graph theory help efficiently and reliably guide epidemiologic studies designed to estimate a causal effect to best leverage prior data, avoid cognitive fallacies, minimize biases, and understand heterogeneity in treatment effects. Appropriate matching of theoretical frameworks to research questions can increase the rigor of epidemiologic research and increase the utility of such research to improve public health.
      PubDate: Tue, 24 Mar 2020 00:00:00 GMT
      DOI: 10.1093/aje/kwaa030
      Issue No: Vol. 189, No. 6 (2020)
       
  • Retaining Hispanics: Lessons From the Hispanic Community Health
           Study/Study of Latinos
    • Authors: Perreira K; Abreu M, Zhao B, et al.
      Pages: 518 - 531
      Abstract: AbstractWe aimed to examine the retention of Hispanics/Latinos participating in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a prospective cohort study of 16,415 adults in 4 US cities who were enrolled between 2008 and 2011. We summarized retention strategies and examined contact, response, and participation rates over 5 years of annual follow-up interviews. We then evaluated motivations for participation and satisfaction with retention efforts among participants who completed a second in-person interview approximately 6 years after their baseline interview. Finally, we conducted logistic regression analyses estimating associations of demographic, health, and interview characteristics at study visit 1 (baseline) with participation, high motivation, and high satisfaction at visit 2. Across 5 years, the HCHS/SOL maintained contact, response, and participation rates over 80%. The most difficult Hispanic/Latino populations to retain included young, single, US-born males with less than a high school education. At visit 2, we found high rates of motivation and satisfaction. HCHS/SOL participants primarily sought to help their community and learn more about their health. High rates of retention of Hispanics/Latinos can be facilitated through the employment of bilingual/bicultural staff and the development of culturally tailored retention materials.
      PubDate: Thu, 23 Jan 2020 00:00:00 GMT
      DOI: 10.1093/aje/kwaa003
      Issue No: Vol. 189, No. 6 (2020)
       
  • Smoking-Related Risks of Colorectal Cancer by Anatomical Subsite and Sex
    • Authors: Gram I; Park S, Wilkens L, et al.
      Pages: 543 - 553
      Abstract: AbstractThe purpose of this study was to examine whether the increased risk of colorectal cancer due to cigarette smoking differed by anatomical subsite or sex. We analyzed data from 188,052 participants aged 45–75 years (45% men) who were enrolled in the Multiethnic Cohort Study in 1993–1996. During a mean follow-up period of 16.7 years, we identified 4,879 incident cases of invasive colorectal adenocarcinoma. In multivariate Cox regression models, as compared with never smokers of the same sex, male ever smokers had a 39% higher risk (hazard ratio (HR) = 1.39, 95% confidence interval (CI): 1.16, 1.67) of cancer of the left (distal or descending) colon but not of the right (proximal or ascending) colon (HR = 1.03, 95% CI: 0.89, 1.18), while female ever smokers had a 20% higher risk (HR = 1.20, 95% CI: 1.06, 1.36) of cancer of the right colon but not of the left colon (HR = 0.96, 95% CI: 0.80, 1.15). Compared with male smokers, female smokers had a greater increase in risk of rectal cancer with number of pack-years of smoking (P for heterogeneity = 0.03). Our results suggest that male smokers are at increased risk of left colon cancer and female smokers are at increased risk of right colon cancer. Our study also suggests that females who smoke may have a higher risk of rectal cancer due to smoking than their male counterparts.
      PubDate: Thu, 23 Jan 2020 00:00:00 GMT
      DOI: 10.1093/aje/kwaa005
      Issue No: Vol. 189, No. 6 (2020)
       
  • Long-Term Exposure to Ambient Fine Particulate Matter and Mortality From
           Renal Failure: A Retrospective Cohort Study in Hong Kong, China
    • Authors: Ran J; Yang A, Sun S, et al.
      Pages: 602 - 612
      Abstract: AbstractNumerous studies have indicated that ambient particulate matter is closely associated with increased risk of cardiovascular disease, yet the evidence for its association with renal disease remains underrecognized. We aimed to estimate the association between long-term exposure to fine particulate matter, defined as particulate matter with an aerodynamic diameter less than or equal to 2.5 μm (PM2.5), and mortality from renal failure (RF) among participants in the Elderly Health Service Cohort in Hong Kong, China, from 1998 to 2010. PM2.5 concentration at the residential address of each participant was estimated based on a satellite-based spatiotemporal model. We used Cox proportional hazards regression to estimate risks of overall RF and cause-specific mortality associated with PM2.5. After excluding 5,373 subjects without information on residential address or relevant covariates, we included 61,447 participants in data analyses. We identified 443 RF deaths during the 10 years of follow-up. For an interquartile-range increase in PM2.5 concentration (3.22 μg/m3), hazard ratios for RF mortality were 1.23 (95% confidence interval: 1.06, 1.43) among all cohort participants and 1.42 (95% confidence interval: 1.16, 1.74) among patients with chronic kidney disease. Long-term exposure to atmospheric PM2.5 might be an important risk factor for RF mortality in the elderly, especially among persons with existing renal diseases.
      PubDate: Mon, 06 Jan 2020 00:00:00 GMT
      DOI: 10.1093/aje/kwz282
      Issue No: Vol. 189, No. 6 (2020)
       
  • RE: “PUBLIC TRANSPORTATION USE AND COGNITIVE FUNCTION IN OLDER AGE: A
           QUASIEXPERIMENTAL EVALUATION OF THE FREE BUS PASS POLICY IN THE UNITED
           KINGDOM”
    • Authors: Blakely T; Kavanagh A, Bentley R, et al.
      Pages: 623 - 623
      Abstract: In a recent article, Reinhard et al. (1) assessed the association between use of public transportation and cognitive performance among older people in the United Kingdom. They used data from the English Longitudinal Study of Ageing for the exposure (any public transportation use) and outcome (a range of cognitive function measures) variables. Their first analysis used fixed-effects (FE) models, removing all individual-level time-invariant confounding and examining the within-person time-varying association between any public transportation use and cognitive function—and found modest effect sizes (1%–3% of a standard deviation increase in cognitive function for use of public transportation; see Reinhard et al.’s Table 2 (1)). Because of legitimate concerns about residual bias (reverse causation whereby cognitive function affects public transportation use and the measurement error of confounders), they used an FE regression with an instrumental variable (IV) analysis: the effect of a policy of free public transportation among older people (upon reaching an age threshold) as the instrument on public transportation use. This IV FE analysis saw effect sizes increase 20- to 30-fold; that is, use of public transportation was associated with a 0.346 standard deviation (95% confidence interval: 0.017, 0.674) increase in total cognitive function. These IV FE results were reported as the main results by Reinhard et al. (1).
      PubDate: Wed, 05 Feb 2020 00:00:00 GMT
      DOI: 10.1093/aje/kwz273
      Issue No: Vol. 189, No. 6 (2020)
       
  • THE AUTHORS REPLY
    • Authors: Reinhard E; Carrino L, van Lenthe F, et al.
      Pages: 624 - 625
      Abstract: We thank Blakely et al. (1) for their observations. We welcome their stance that researchers conducting instrumental variable (IV)–fixed-effects (FE) analysis should be wary of potential violations of the exclusion restriction—in our study (2), the assumption that eligibility for the free bus pass only impacts cognitive function through the effect on public transportation use. The exclusion restriction is essentially untestable and must be supported by strong arguments. We argue that Blakely et al.’s concerns do not offer convincing evidence to conclude that the difference in magnitude between our FE estimates and our IV-FE estimates is due to an exclusion restriction violation.
      PubDate: Wed, 05 Feb 2020 00:00:00 GMT
      DOI: 10.1093/aje/kwz274
      Issue No: Vol. 189, No. 6 (2020)
       
  • The National Cooperative Trial on Multifactorial Prevention of First Heart
           Attacks and Coronary Mortality in Free-Living, High-Risk, Middle-Aged
           American Men, Also Known as JUMBO: A Short Story
    • Authors: Blackburn H.
      Pages: 491 - 498
      Abstract: AbstractThe concept of a multiple risk-factor intervention trial (MRFIT) originated in mid-20th century efforts to determine whether modifying the “risk factors” established by cardiovascular disease epidemiology would prevent heart attacks. The term “MRFIT” probably first appeared in the 1968 report to the National Heart Institute from investigators of the National Diet-Heart Feasibility Study. Based on their pilot experience, they recommended a trial of diet alone. Aware, however, that authorities might agree with the rationale but not the implementation of such a massive and risky undertaking, they also proposed an alternative: whether coronary heart disease was preventable at all by simultaneous intervention on several risk factors; that is, a multiple risk-factor intervention trial. After some years agonizing by serial expert committees, the National Heart Institute opted against an explanatory diet trial and for a pragmatic multiple risk-factor intervention, one designed by Institute staff and operated under contract. Meanwhile, an impatient community of investigators met together in the Makarska Conference, outlined a broad cardiovascular disease prevention policy, and submitted their idealized version of a multiple risk-factor trial, called JUMBO. But the National Heart Institute, because of the plan for its own trial, had no funds left for an investigator-initiated proposal. Hence, this background and story of the MRFIT that wasn’t.
      PubDate: Tue, 12 Nov 2019 00:00:00 GMT
      DOI: 10.1093/aje/kwz255
      Issue No: Vol. 189, No. 6 (2019)
       
  • Invited Commentary: Can You Do Trials of Behavioral Modification, Such as
           Diet or Exercise Intervention, With Hard Endpoints'
    • Authors: Kuller L.
      Pages: 499 - 502
      Abstract: AbstractBlackburn (Am J Epidemiol. 2020;189(6):491–498) describes the evolution from the Makarska Conference in 1968 to the planning of the JUMBO trial and the decision by the National Institutes of Health (NIH) to do the Multiple Risk Factor Intervention Trial. He attributes the failure of the Multiple Risk Factor Intervention Trial to show a significant reduction in coronary heart disease or total mortality to the design of the trial, the multiple centers involved, and continued bureaucracy. The paper is important in raising 3 issues of continued relevance: 1) What is the relationship of the NIH staff in both development and monitoring of large cooperative studies, especially clinical trials, outside of the walls of the NIH' 2) Can clinical trials that utilize individual randomization to intervention and comparison be successful in evaluating a common-source epidemic, such as diet and coronary heart disease, especially in populations with readily available foods and competing advertising, etc.' 3) How much information obtained from, e.g., observational studies, animal models, and genetic studies, is necessary given limits of human population clinical trials of behavioral intervention to develop recommendations for strong public health programs to reduce morbidity and mortality, and what is the measure of successful intervention'
      PubDate: Tue, 12 Nov 2019 00:00:00 GMT
      DOI: 10.1093/aje/kwz256
      Issue No: Vol. 189, No. 6 (2019)
       
  • Invited Commentary: Learning From Our Past to Build on Our Future—
           Lessons Learned From MRFIT and JUMBO
    • Authors: Odoms-Young A; Thorpe R, Jr..
      Pages: 503 - 507
      Abstract: AbstractWe propose that Blackburn (Am J Epidemiol. 2020;189(6):491–498) ignores several important issues that need to be considered in the context of a historical reflection of the National Heart Institute’s landmark study, the Multiple Risk Factor Intervention Trial (MRFIT), and the alternative proposal, the “JUMBO” trial, submitted to the National Heart Institute by an experienced team of extramural investigators but never funded. A key focus of this commentary is to offer an alternative perspective on both studies using our current understanding of the impact of social and structural determinants of health; evidence that policy, systems, and environmental interventions are needed to support behavior change at the individual level; and the significance of examining research from a racial/socioeconomic equity lens. While we strongly agree with Blackburn’s conclusion urging the National Institutes of Health to invest in prevention research at a level consistent with its social and economic impact, we encourage the author to move beyond simply underscoring the methodological limitations and failure of the findings of MRFIT compared with the potential of the proposed JUMBO trial to consider the contribution of MRFIT to our current understanding of chronic disease prevention and treatment.
      PubDate: Tue, 17 Dec 2019 00:00:00 GMT
      DOI: 10.1093/aje/kwz269
      Issue No: Vol. 189, No. 6 (2019)
       
  • Serum Retinol and Risk of Overall and Site-Specific Cancer in the ATBC
           Study
    • Authors: Hada M; Mondul A, Weinstein S, et al.
      Pages: 532 - 542
      Abstract: AbstractRetinol, the most biologically active form of vitamin A, might influence cancer-related biological pathways. However, results from observational studies of serum retinol and cancer risk have been mixed. We prospectively examined serum retinol and risk of overall and site-specific cancer in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study (n = 29,104 men), conducted in 1985–1993, with follow-up through 2012. Serum retinol concentration was measured using reverse-phase high-performance liquid chromatography. Cox proportional hazards models estimated the association between baseline serum retinol quintile and overall and site-specific cancer risk in 10,789 cases. After multivariable adjustment, higher serum retinol was not associated with overall cancer risk (highest vs. lowest quintile: hazard ratio (HR) = 0.97, 95% confidence interval (CI): 0.91, 1.03; P for trend = 0.43). Higher retinol concentrations were, however, associated with increased risk of prostate cancer (highest vs. lowest quintile: HR = 1.28, 95% CI: 1.13, 1.45; P for trend < 0.0001) and lower risk of both liver and lung cancers (highest vs. lowest quintile: for liver, HR = 0.62, 95% CI: 0.42, 0.91; P for trend = 0.004; and for lung, HR = 0.80, 95% CI: 0.72, 0.88; P for trend < 0.0001). No associations with other cancers were observed. Understanding the mechanisms that underlie these associations might provide insight into the role of vitamin A in cancer etiology.
      PubDate: Tue, 15 Oct 2019 00:00:00 GMT
      DOI: 10.1093/aje/kwz226
      Issue No: Vol. 189, No. 6 (2019)
       
  • Association Between Chronic Hepatitis C Virus Infection and Myocardial
           Infarction Among People Living With HIV in the United States
    • Authors: Williams-Nguyen J; Hawes S, Nance R, et al.
      Pages: 554 - 563
      Abstract: AbstractHepatitis C virus (HCV) infection is common among people living with human immunodeficiency virus (PLWH). Extrahepatic manifestations of HCV, including myocardial infarction (MI), are a topic of active research. MI is classified into types, predominantly atheroembolic type 1 MI (T1MI) and supply-demand mismatch type 2 MI (T2MI). We examined the association between HCV and MI among patients in the Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems, a US multicenter clinical cohort of PLWH. MIs were centrally adjudicated and categorized by type using the Third Universal Definition of Myocardial Infarction. We estimated the association between chronic HCV (RNA+) and time to MI while adjusting for demographic characteristics, cardiovascular risk factors, clinical characteristics, and history of injecting drug use. Among 23,407 PLWH aged ≥18 years, there were 336 T1MIs and 330 T2MIs during a median of 4.7 years of follow-up between 1998 and 2016. HCV was associated with a 46% greater risk of T2MI (adjusted hazard ratio (aHR) = 1.46, 95% confidence interval (CI): 1.09, 1.97) but not T1MI (aHR = 0.87, 95% CI: 0.58, 1.29). In an exploratory cause-specific analysis of T2MI, HCV was associated with a 2-fold greater risk of T2MI attributed to sepsis (aHR = 2.01, 95% CI: 1.25, 3.24). Extrahepatic manifestations of HCV in this high-risk population are an important area for continued research.
      PubDate: Tue, 12 Nov 2019 00:00:00 GMT
      DOI: 10.1093/aje/kwz236
      Issue No: Vol. 189, No. 6 (2019)
       
  • The Population Impact of Late Presentation With Advanced HIV Disease and
           Delayed Antiretroviral Therapy in Adults Receiving HIV Care in Latin
           America
    • Authors: Belaunzarán-Zamudio P; Caro-Vega Y, Shepherd B, et al.
      Pages: 564 - 572
      Abstract: AbstractLate presentation to care and antiretroviral therapy (ART) initiation with advanced human immunodeficiency virus (HIV) disease are common in Latin America. We estimated the impact of these conditions on mortality in the region. We included adults enrolled during 2001–2014 at HIV care clinics. We estimated the adjusted attributable risk (AR) and population attributable fraction (PAF) for all-cause mortality of presentation to care with advanced HIV disease (advanced LP), ART initiation with advanced HIV disease, and not initiating ART. Advanced HIV disease was defined as CD4 of <200 cells/μL or acquired immune deficiency syndrome. AR and PAF were derived using marginal structural models. Of 9,229 patients, 56% presented with advanced HIV disease. ARs of death for advanced LP were 86%, 71%, and 58%, and PAFs were 78%, 58%, and 43% at 1, 5, and 10 years after enrollment. Among people without advanced LP, ARs of death for delaying ART were 39%, 32%, and 37% at 1, 5, and 10 years post-enrollment and PAFs were 20%, 14%, and 15%. Among people with advanced LP, ART decreased the hazard of death by 63% in the first year after enrollment, but 93% of these started ART; thus universal ART among them would reduce mortality by only 10%. Earlier presentation to care and earlier ART initiation would prevent most HIV deaths in Latin America.
      PubDate: Tue, 29 Oct 2019 00:00:00 GMT
      DOI: 10.1093/aje/kwz252
      Issue No: Vol. 189, No. 6 (2019)
       
  • Prepregnancy Diabetes and Perinatal Mental Illness: A Population-Based
           Latent Class Analysis
    • Authors: Brown H; Cairncross Z, Lipscombe L, et al.
      Pages: 573 - 582
      Abstract: AbstractWe examined the risk of any perinatal mental illness associated with prepregnancy diabetes and identified how diabetes duration, complexity, and intensity of care affect this risk. We performed a population-based study of women aged 15–49 years with (n = 14,186) and without (n = 843,818) prepregnancy diabetes who had a singleton livebirth (Ontario, Canada, 2005–2015) and no recent mental illness. Modified Poisson regression estimated perinatal mental illness risk between conception and 1 year postpartum in women with versus without diabetes and in diabetes groups, defined by a latent class analysis of diabetes duration, complexity, and intensity-of-care variables, versus women without diabetes. Women with diabetes were more likely than those without to develop perinatal mental illness (18.1% vs. 16.0%; adjusted relative risk = 1.11, 95% confidence interval: 1.07, 1.15). Latent classes of women with diabetes were: uncomplicated and not receiving regular care (59.7%); complicated, with longstanding diabetes, and receiving regular care (16.4%); and recently diagnosed, with comorbidities, and receiving regular care (23.9%). Perinatal mental illness risk was elevated in all classes versus women without diabetes (adjusted relative risks: 1.09–1.12), but results for class 2 were nonsignificant after adjustment. Women with diabetes could benefit from preconception and perinatal strategies to reduce their mental illness risk.
      PubDate: Tue, 12 Nov 2019 00:00:00 GMT
      DOI: 10.1093/aje/kwz254
      Issue No: Vol. 189, No. 6 (2019)
       
  • The Dynamic Relationship Between Asthma and Obesity in Schoolchildren
    • Authors: Zhang Y; Chen Z, Berhane K, et al.
      Pages: 583 - 591
      Abstract: AbstractAsthma and obesity are among the most prevalent chronic health conditions in children. Although there has been compelling evidence of co-occurrence of asthma and obesity, it is uncertain whether asthma contributes to the development of obesity or obesity contributes to the onset of asthma or both. In this study, we used a joint transition modeling approach with cross-lagged structure to understand how asthma and obesity influence each other dynamically over time. Subjects for this study included 5,193 kindergarten and first-grade students enrolled from 13 communities in 2002–2003 in the Southern California Children’s Health Study, with up to 10 years of follow-up. We found that nonobese children with diagnosed asthma at a study visit were at 37% higher odds of becoming obese by the next annual visit compared with children without asthma (odds ratio = 1.38; 95% credible interval: 1.12, 1.71). However, the presence of obesity at the current visit was not statistically significantly associated with asthma onset in the next visit (odds ratio = 1.25; 95% credible interval: 0.94, 1.62). In conclusion, childhood asthma appears to drive an increase in the onset of obesity among schoolchildren, while the onset of obesity does not necessarily imply the future onset of asthma, at least in the short term.
      PubDate: Tue, 12 Nov 2019 00:00:00 GMT
      DOI: 10.1093/aje/kwz257
      Issue No: Vol. 189, No. 6 (2019)
       
  • Observational Study of the Associations of Participation in High School
           Football With Self-Rated Health, Obesity, and Pain in Adulthood
    • Authors: Gaulton T; Deshpande S, Small D, et al.
      Pages: 592 - 601
      Abstract: AbstractAmerican football is the most popular high school sport in the United States, yet its association with health in adulthood has not been widely studied. We investigated the association between high school football and self-rated health, obesity, and pain in adulthood in a retrospective cohort study of data from the Wisconsin Longitudinal Study (1957–2004). We matched 925 males who played varsity football in high school with 1,521 males who did not play football. After matching, playing football was not associated with poor or fair self-rated health (odds ratio (OR) = 0.88, 95% confidence interval (CI): 0.63, 1.24; P = 0.48) or pain that limited activities (OR = 0.86, 95% CI: 0.59, 1.25; P = 0.42) at age 65 years. Football was associated with obesity (body mass index (weight (kg)height (m)2) ≥30) in adulthood (OR = 1.32, 95% CI: 1.06, 1.64; P = 0.01). The findings suggest that playing football in high school was not significantly associated with poor or fair self-related health at age 65 years, but it was associated with the risk of being obese as an adult in comparison with not playing football in high school. Our findings provide needed information about the risk of playing football with regard to a broader set of health outcomes.
      PubDate: Fri, 29 Nov 2019 00:00:00 GMT
      DOI: 10.1093/aje/kwz260
      Issue No: Vol. 189, No. 6 (2019)
       
  • Evaluating the Utility of Coarsened Exact Matching for
           Pharmacoepidemiology Using Real and Simulated Claims Data
    • Authors: Ripollone J; Huybrechts K, Rothman K, et al.
      Pages: 613 - 622
      Abstract: AbstractCoarsened exact matching (CEM) is a matching method proposed as an alternative to other techniques commonly used to control confounding. We compared CEM with 3 techniques that have been used in pharmacoepidemiology: propensity score matching, Mahalanobis distance matching, and fine stratification by propensity score (FS). We evaluated confounding control and effect-estimate precision using insurance claims data from the Pharmaceutical Assistance Contract for the Elderly (1999–2002) and Medicaid Analytic eXtract (2000–2007) databases (United States) and from simulated claims-based cohorts. CEM generally achieved the best covariate balance. However, it often led to high bias and low precision of the risk ratio due to extreme losses in study size and numbers of outcomes (i.e., sparse data bias)—especially with larger covariate sets. FS usually was optimal with respect to bias and precision and always created good covariate balance. Propensity score matching usually performed almost as well as FS, especially with higher index exposure prevalence. The performance of Mahalanobis distance matching was relatively poor. These findings suggest that CEM, although it achieves good covariate balance, might not be optimal for large claims-database studies with rich covariate information; it might be ideal if only a few (<10) strong confounders must be controlled.
      PubDate: Tue, 17 Dec 2019 00:00:00 GMT
      DOI: 10.1093/aje/kwz268
      Issue No: Vol. 189, No. 6 (2019)
       
 
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