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Dose‐response analyses using restricted cubic spline functions in public health research

Desquilbet, Loic, Mariotti, François·2010·Statistics in Medicine

Abstract

Taking into account a continuous exposure in regression models by using categorization, when non‐linear dose‐response associations are expected, have been widely criticized. As one alternative, restricted cubic spline (RCS) functions are powerful tools (i) to characterize a dose‐response association between a continuous exposure and an outcome, (ii) to visually and/or statistically check the assumption of linearity of the association, and (iii) to minimize residual confounding when adjusting for a continuous exposure. Because their implementation with SAS® software is limited, we developed and present here an SAS macro that (i) creates an RCS function of continuous exposures, (ii) displays graphs showing the dose‐response association with 95 per cent confidence interval between one main continuous exposure and an outcome when performing linear, logistic, or Cox models, as well as linear and logistic‐generalized estimating equations, and (iii) provides statistical tests for overall and non‐linear associations. We illustrate the SAS macro using the third National Health and Nutrition Examination Survey data to investigate adjusted dose‐response associations (with different models) between calcium intake and bone mineral density (linear regression), folate intake and hyperhomocysteinemia (logistic regression), and serum high‐density lipoprotein cholesterol and cardiovascular mortality (Cox model). Copyright © 2010 John Wiley & Sons, Ltd.

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Metadata

Authors
Desquilbet, L., & Mariotti, F.
Venue
Statistics in Medicine
Publisher
Wiley
Published
2010-01-19
Volume
29
Issue
9
Pages
1037-1057
ISSN
  • 0277-6715 (ISSN-L)
  • 1097-0258
OpenAlex
W2150130690
Cited by
1,980
References
7
FWCI
22.08
Type
journal article
Language
en
Open access
closed

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Desquilbet, L., & Mariotti, F. (2010). Dose‐response analyses using restricted cubic spline functions in public health research. Statistics in Medicine. https://doi.org/10.1002/sim.3841

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