Methods to Address Self-Selection and Reverse Causation in Studies of Neighborhood Environments and Brain Health

Besser, Lilah M.; Brenowitz, Willa D.; Meyer, Oanh L.; Hoermann, Serena; Renne, John L.

doi:10.3390/ijerph18126484

Cited by 32 publications

(23 citation statements)

References 84 publications

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“… 39 , 40 To account for this, only longitudinal studies were included. 41 For dementia as an outcome, studies were restricted to dementia‐free participants at baseline, and an additional meta‐analysis was conducted restricting each main model (Figure 3A–E ) to studies with ≥10 years of follow‐up (Figure S4 A–E). This was not possible for cognitive decline as most studies had <10 years of follow‐up.…”

Section: Methodsmentioning

confidence: 99%

Periodontal health, cognitive decline, and dementia: A systematic review and meta‐analysis of longitudinal studies

Asher

Stephen

Mäntylä

et al. 2022

J American Geriatrics Society

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Background Emerging evidence indicates that poor periodontal health adversely impacts cognition. This review examined the available longitudinal evidence concerning the effect of poor periodontal health on cognitive decline and dementia. Methods Comprehensive literature search was conducted on five electronic databases for relevant studies published until April 2022. Longitudinal studies having periodontal health as exposure and cognitive decline and/or dementia as outcomes were considered. Random effects pooled estimates and 95% confidence intervals were generated (pooled odds ratio for cognitive decline and hazards ratio for dementia) to assess whether poor periodontal health increases the risk of cognitive decline and dementia. Heterogeneity between studies was estimated by I2 and the quality of available evidence was assessed through quality assessment criteria. Results Adopted search strategy produced 2132 studies for cognitive decline and 2023 for dementia, from which 47 studies (24 for cognitive decline and 23 for dementia) were included in this review. Poor periodontal health (reflected by having periodontitis, tooth loss, deep periodontal pockets, or alveolar bone loss) was associated with both cognitive decline (OR = 1.23; 1.05–1.44) and dementia (HR = 1.21; 1.07–1.38). Further analysis, based on measures of periodontal assessment, found tooth loss to independently increase the risk of both cognitive decline (OR = 1.23; 1.09–1.39) and dementia (HR = 1.13; 1.04–1.23). Stratified analysis based on the extent of tooth loss indicated partial tooth loss to be important for cognitive decline (OR = 1.50; 1.02–2.23) and complete tooth loss for dementia (HR = 1.23; 1.05–1.45). However, the overall quality of evidence was low, and associations were at least partly due to reverse causality. Conclusions Poor periodontal health and tooth loss appear to increase the risk of both cognitive decline and dementia. However, the available evidence is limited (e.g., highly heterogenous, lacking robust methodology) to draw firm conclusions. Further well‐designed studies involving standardized periodontal and cognitive health assessment and addressing reverse causality are highly warranted.

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Section: Methodsmentioning

confidence: 99%

Periodontal health, cognitive decline, and dementia: A systematic review and meta‐analysis of longitudinal studies

Asher

Stephen

Mäntylä

et al. 2022

J American Geriatrics Society

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“…However, the approach chosen by Vaughan et al (2015) relied on several key assumptions, some of which were not tested or may not hold in the studied context. Moreover, observational studies are not only prone to residual confounding but also reverse causation ( Haycock et al, 2016 ; Besser et al, 2021 ). In contrast, Mendelian randomization (MR) uses genetic markers to draw causal conclusions on the association between an exposure (e.g., AAM) and an outcome (e.g., depression) of interest by exploiting the fact that genotypes are not generally associated with confounders in the population and randomly assigned at conception, analogous to randomization in clinical trials.…”

Section: Introductionmentioning

confidence: 99%

Causal Effect of Age at Menarche on the Risk for Depression: Results From a Two-Sample Multivariable Mendelian Randomization Study

et al. 2022

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A fair number of epidemiological studies suggest that age at menarche (AAM) is associated with depression, but the reported effect sizes are small, and there is evidence of residual confounding. Moreover, previous Mendelian randomization (MR) studies to avoid inferential problems inherent to epidemiological studies have provided mixed findings. To clarify the causal relationship between age at menarche and broadly defined depression risk, we used 360 genome-wide significantly AAM-related single-nucleotide polymorphisms (SNPs) as instrumental variable and data from the latest GWAS for the broadly defined depression risk on 807,553 individuals (246,363 cases and 561,190 controls). Multiple methods to account for heterogeneity of the instrumental variable (penalized weighted median, MR Lasso, and contamination mixture method), systematic and idiosyncratic pleiotropy (MR RAPS), and horizontal pleiotropy (MR PRESSO and multivariable MR using three methods) were used. Body mass index, education attainment, and total white blood count were considered pleiotropic phenotypes in the multivariable MR analysis. In the univariable [inverse-variance weighted (IVW): OR = 0.96, 95% confidence interval = 0.94–0.98, p = 0.0003] and multivariable MR analysis (IVW: OR = 0.96, 95% confidence interval = 0.94–0.99, p = 0.007), there was a significant causal effect of AAM on depression risk. Thus, the present study supports conclusions from previous epidemiological studies implicating AAM in depression without the pitfalls of residual confounding and reverse causation. Considering the adverse consequences of an earlier AAM on mental health, this finding should foster efforts to address risk factors that promote an earlier AAM.

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“…13,14 Furthermore, neighborhood and community characteristics in the form of higher density housing and lower walkability are associated with poorer cognitive performance in older adult samples. 15,16 In addition to cognitive and brain health, recent evidence suggests that SDoH also play an important role in instrumental activities of daily living (IADLs). 17 IADLs encompass a wide array of complex functional tasks (e.g., managing finances, completing household chores) and are essential for living independently.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Associations between social determinants of health and 10‐year change in everyday functioning within Black/African American and White older adults enrolled in ACTIVE

Clark

Weigand

Clay

et al. 2022

Alz & Dem Diag Ass & Dis Mo

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Introduction Given prior work showing racial differences on baseline social determinants of health (SDoH) and 10‐year trajectories of everyday functioning, we examined associations between SDoH and longitudinal everyday functioning performance in Black/African American and White older adults. Methods Participants were 2505 older adults (M age = 73.5; 28% Black/African American) without dementia. SDoH included economic stability/status, education access/quality, health‐care access, neighborhood/built environment, and social/community contexts. The Observed Tasks of Daily Living (OTDL) measured everyday functioning and was administered at baseline and 1‐, 2‐, 3‐, 5‐, and 10‐year visits. Results Across the sample, social and community context and economic stability/status were associated with steeper age‐related OTDL declines (βs = 0.05 to 0.07, P s < 0.001). Lower levels of social and community context (β = 0.08, P = 0.002) and economic stability/status (β = 0.07, P = 0.04) were associated with OTDL linear age declines in Black/African American participants, but not in White participants ( P s > 0.30). Discussion Inequities across SDoH accelerate age‐related declines in everyday functioning among Black/African American older adults.

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Methods to Address Self-Selection and Reverse Causation in Studies of Neighborhood Environments and Brain Health

Cited by 32 publications

References 84 publications

Periodontal health, cognitive decline, and dementia: A systematic review and meta‐analysis of longitudinal studies

Periodontal health, cognitive decline, and dementia: A systematic review and meta‐analysis of longitudinal studies

Causal Effect of Age at Menarche on the Risk for Depression: Results From a Two-Sample Multivariable Mendelian Randomization Study

Associations between social determinants of health and 10‐year change in everyday functioning within Black/African American and White older adults enrolled in ACTIVE

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