DAGitty

Textor, Johannes; Hardt, Judith Nora; Knüppel, Sven

doi:10.1097/ede.0b013e318225c2be

Cited by 1,020 publications

(318 citation statements)

References 5 publications

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“…Based on all socio-demographic and contextual covariables mentioned above, we used the program DAGitty 2.0 [28], with a priori definition of the temporal direction of the events, to draw causal diagrams. The final adjusted model (model 2) included additional coefficients for sex, maternal education (less than/primary/secondary/university), residential neighborhood socioeconomic status, and air pollution exposure at home: The interactions between age and maternal education and socioeconomic status were unrelated to cognitive development ( p = 0.33) and were not included in the models.…”

Section: Methodsmentioning

confidence: 99%

Association between Traffic-Related Air Pollution in Schools and Cognitive Development in Primary School Children: A Prospective Cohort Study

et al. 2015

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BackgroundAir pollution is a suspected developmental neurotoxicant. Many schools are located in close proximity to busy roads, and traffic air pollution peaks when children are at school. We aimed to assess whether exposure of children in primary school to traffic-related air pollutants is associated with impaired cognitive development.Methods and FindingsWe conducted a prospective study of children (n = 2,715, aged 7 to 10 y) from 39 schools in Barcelona (Catalonia, Spain) exposed to high and low traffic-related air pollution, paired by school socioeconomic index; children were tested four times (i.e., to assess the 12-mo developmental trajectories) via computerized tests (n = 10,112). Chronic traffic air pollution (elemental carbon [EC], nitrogen dioxide [NO2], and ultrafine particle number [UFP; 10–700 nm]) was measured twice during 1-wk campaigns both in the courtyard (outdoor) and inside the classroom (indoor) simultaneously in each school pair. Cognitive development was assessed with the n-back and the attentional network tests, in particular, working memory (two-back detectability), superior working memory (three-back detectability), and inattentiveness (hit reaction time standard error). Linear mixed effects models were adjusted for age, sex, maternal education, socioeconomic status, and air pollution exposure at home.Children from highly polluted schools had a smaller growth in cognitive development than children from the paired lowly polluted schools, both in crude and adjusted models (e.g., 7.4% [95% CI 5.6%–8.8%] versus 11.5% [95% CI 8.9%–12.5%] improvement in working memory, p = 0.0024). Cogently, children attending schools with higher levels of EC, NO2, and UFP both indoors and outdoors experienced substantially smaller growth in all the cognitive measurements; for example, a change from the first to the fourth quartile in indoor EC reduced the gain in working memory by 13.0% (95% CI 4.2%–23.1%). Residual confounding for social class could not be discarded completely; however, the associations remained in stratified analyses (e.g., for type of school or high-/low-polluted area) and after additional adjustments (e.g., for commuting, educational quality, or smoking at home), contradicting a potential residual confounding explanation.ConclusionsChildren attending schools with higher traffic-related air pollution had a smaller improvement in cognitive development.

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Section: Methodsmentioning

confidence: 99%

Association between Traffic-Related Air Pollution in Schools and Cognitive Development in Primary School Children: A Prospective Cohort Study

et al. 2015

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“…We performed logistic regression with variable selection guided by an updated directed acyclic graph (DAG), in which BMI was depicted as an intermediate variable, developed using DAGitty version 2.0. 33,34 We adjusted for education and age and further adjusted for number of vaginal deliveries and hysterectomy status, based on past literature, which was permissible per the DAG. Regression diagnostics were checked for multicollinearity and influential observations.…”

Section: Methodsmentioning

confidence: 99%

Lifetime physical activity and female stress urinary incontinence

Nygaard

Shaw

Bardsley

et al. 2015

American Journal of Obstetrics and Gynecology

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Objective To estimate whether moderate/severe stress urinary incontinence (SUI) in middle-aged women is associated with overall lifetime physical activity (including leisure, household, outdoor, and occupational), as well as lifetime leisure (recreational), lifetime strenuous and strenuous activity during the teen years. Study design Recruitment for this case-control study was conducted in primary care level family medicine and gynecology clinics. 1538 enrolled women ages 39–65 years underwent a Pelvic Organ Prolapse Quantification examination to assess vaginal support. Based on Incontinence Severity Index scores, cases had moderate/severe and controls no/mild SUI. We excluded 349 with vaginal descent at/below the hymen (pelvic organ prolapse), 194 who did not return questionnaires, and 110 with insufficient activity data for analysis. 213 cases were frequency-matched 1:1 by age group to controls. Physical activity was measured using the Lifetime Physical Activity Questionnaire, in which women recall activity from menarche to present. We created separate multivariable logistic regression models for activity measures. Results SUI odds increased slightly with overall lifetime activity (OR 1.20 per 70 additional MET-hrs/wk; 95% CI 1.02, 1.41), and were not associated with lifetime strenuous activity (OR 1.11; 95% CI 0.99, 1.25). In quintile analysis of lifetime leisure activity, which demonstrated a non-linear pattern, all quintiles incurred about half the odds of SUI compared to reference (2nd quintile; p=0.009). Greater strenuous activity in teen years modestly increased SUI odds (OR 1.37 per 7 additional hours/week; 95% CI 1.09, 1.71); OR 1.75; 95% CI 1.15, 2.66 in sensitivity analysis adjusting for measurement error. The predicted probability of SUI rose linearly in women exceeding 7.5 hours of strenuous activity/week during teen years. Teen strenuous activity had a similar effect on SUI odds when adjusted for subsequent strenuous activity during ages 21–65 years. Conclusion In middle-aged women, a slight increased odds of SUI was noted only after substantially increased overall lifetime physical activity. Increased lifetime leisure activity decreased and lifetime strenuous activity appeared unrelated to SUI odds. Greater strenuous activity during teen years modestly increased SUI odds.

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“…To estimate the impact of treatment, stage-specific MRRs were computed using a model adjusting for age, comorbidity, compartmentalization, depth, grade, histological type, location, and size. The adjustment covariates were selected based on a modified version (Figure 1) of a directed acyclic graph constructed by Maretty-Nielsen et al [36, 37] and included as seen in Tables 1 and 2. The proportional hazard assumption was assessed graphically using log-log plots.…”

Section: Methodsmentioning

confidence: 99%

Relative mortality in soft tissue sarcoma patients: a Danish population-based cohort study

et al. 2014

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BackgroundCancer-specific survival estimates rely on precise and correct data on the cause of death; however, these data can be difficult to acquire, particularly in elderly patients where comorbidity is common. Furthermore, while some deaths are directly related to cancer, others are more complex, with cancer merely contributing. Another, more precise, method is to assess the relative mortality, i.e., mortality in patients compared to the general population. The aims of this study were to describe the relative mortality in soft tissue sarcoma, and to compare the relative mortality with the cancer-specific mortality.MethodsWe included 1246 patients treated for soft tissue sarcoma and 6230 individually age- and sex-matched individuals from the general population. The relative mortality was estimated as rates, and rate ratios adjusted for comorbidity. Mortality rate ratios were computed using the Cox proportional hazard model for 0–5 years and 5–10 years, according to age, sex and level of comorbidity. The cancer-specific mortality was compared to the corresponding relative mortality.ResultsThe overall 5- and 10-year relative mortality was 32.8% and 36.0%. Patients with low-grade soft tissue sarcoma did not have increased mortality compared with the general population. Soft tissue sarcoma patients had a 4.4 times higher risk of dying within the first five years after diagnosis and a 1.6 times higher risk between five and ten years compared with the general comparison cohort. The relative mortality varied according to age, grade, stage at diagnosis, and level of comorbidity, being highest in younger patients and in patients without comorbidity. The overall 5- and 10-year cancer-specific mortality was underestimated by 1.5 and overestimated by 0.7 percentage points compared to the relative mortality, respectively. No statistical significant difference between the relative and the cancer-specific mortality was found.ConclusionThe relative mortality provides an unbiased and accurate method to differentiate between cancer-specific and non-cancer-specific deaths. However, when data on the cause of death is of a sufficient quality, there is no difference between relative mortality and disease-specific mortality based on death certificates.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2407-14-682) contains supplementary material, which is available to authorized users.

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DAGitty

Cited by 1,020 publications

References 5 publications

Association between Traffic-Related Air Pollution in Schools and Cognitive Development in Primary School Children: A Prospective Cohort Study

Association between Traffic-Related Air Pollution in Schools and Cognitive Development in Primary School Children: A Prospective Cohort Study

Lifetime physical activity and female stress urinary incontinence

Relative mortality in soft tissue sarcoma patients: a Danish population-based cohort study

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