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Cited by 67Statistical Methods in EpidemiologyAdvanced Causal Inference TechniquesHistorical and modern epidemiology studies

Point: Incident Exposures, Prevalent Exposures, and Causal Inference: Does Limiting Studies to Persons Who Are Followed From First Exposure Onward Damage Epidemiology?

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Vandenbroucke, Jan, Pearce, Neil·2015·American Journal of Epidemiology
DOI 10.1093/aje/kwv225
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Abstract

The idea that epidemiologic studies should start from first exposure onward has been advocated in the past few years. The study of incident exposures is contrasted with studies of prevalent exposures in which follow-up may commence after first exposure. The former approach is seen as a hallmark of a good study and necessary for causal inference. We argue that studying incident exposures may be necessary in some situations, but it is not always necessary and is not the preferred option in many instances. Conducting a study involves decisions as to which person-time experience should be included. Although studies of prevalent exposures involve left truncation (missingness on the left), studies of incident exposures may involve right censoring (missingness on the right) and therefore may not be able to assess the long-term effects of exposure. These considerations have consequences for studies of dynamic (open) populations that involve a mixture of prevalent and incident exposures. We argue that studies with prevalent exposures will remain a necessity for epidemiology. The purpose of this paper is to restore the balance between the emphasis on first exposure cohorts and the richness of epidemiologic information obtained when studying prevalent exposures.

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  • The validity of bipolar disorder and schizophrenia diagnoses in primary care records has been established and the incidence of bipolar disorder and schizophrenia in THIN is similar to other European cohorts.

    “The validity of bipolar disorder and schizophrenia diagnoses in primary care records has been established and the incidence of bipolar disorder and schizophrenia in THIN is similar to other European cohorts.44,45”

    From Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000–2014 (2017) · cites this paper as [44]

    The paper’s “How generalizable is the problem?” section discusses hormone therapy and other outcomes, not psychiatric diagnoses. Searches for bipolar disorder and schizophrenia diagnosis validity, and for their incidence in THIN relative to European cohorts, found no passage addressing either claim. (LLM, conf=0.78)

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  • The exposure groups (bipolar disorder and schizophrenia) and the outcomes (mortality, CVD deaths, CVD, suicide and self-harm) have been well validated.

    “The exposure groups (bipolar disorder and schizophrenia)44,45 and the outcomes (mortality, CVD deaths, CVD, suicide and self-harm)46,47,50,51 have been well validated.”

    From Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000–2014 (2017) · cites this paper as [44]

    The paper’s ‘How generalizable is the problem?’ section discusses bias in studies of hormone therapy and several health outcomes, not validation of the cited exposure groups or outcome measures. Searches for bipolar disorder, schizophrenia, suicide, self-harm, and outcome validation found no passage addressing the claim; the paper’s References section does not establish it either. Page numbers were unavailable in our copy. (LLM, conf=0.78)

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Research works printed but not linked: 3

  1. Institute of Medicine. Ethical and Scientific Issues in Studying the Safety of Approved Drugs. Washington, DC: The National Academies Press; 2012.
  2. Robins JM. The analysis of randomized and non-randomized AIDS treatment trials using a new approach to causal inference in longitudinal studies. In: Sechrest L, Freeman L, Mulley A, eds. Health Services Research Methodology: a Focus on AIDS. Bethesda, MD: US Public Health Service, National Center for Health Services Research; 1989:113-159.
  3. Rothman KJ, Greenland S, Lash TL. Modern Epidemiology. 3rd ed. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2008.

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Authors
Vandenbroucke, J., & Pearce, N.
Affiliations
Leiden University Medical Center (NL)
Corresponding author
Vandenbroucke, Jan
ORCID
Venue
American Journal of Epidemiology
Publisher
Oxford University Press (OUP)
Published
2015-10-26
Volume
182
Issue
10
Pages
826-833
ISSN
  • 0002-9262 (ISSN-L)
  • 1476-6256
DOI
10.1093/aje/kwv225
OpenAlex
W2175123557
Cited by
67
References
53
Citations by year
2026: 4 · 2025: 8 · 2024: 3 · 2023: 7 · 2022: 3 · 2021: 6 · 2020: 6 · 2019: 12 · 2018: 7 · 2017: 4 · 2016: 4 · 2015: 3
FWCI
5.34
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • American Journal of Epidemiology (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
Funders
  • Wellcome Trust Institutional Strategic Support Fund (097834/Z/11/B)
  • Health Research Council of New Zealand
Topics
  • Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
  • Physical Sciences › Mathematics › Statistics and Probability › Advanced Causal Inference Techniques
  • Social Sciences › Sociology and Political Science › Historical and modern epidemiology studies
Keywords
left truncation, right censoring, causal inference, long-term exposure effects, research design
MeSH terms
Drug Combinations, Epidemiologic Methods, Estrogens, Female, Humans, Myocardial Infarction, Progestins, Research Design, Time Factors, Estrogen Replacement Therapy, Bias, Causality, Confounding Factors, Epidemiologic, Life Tables, Incidence, Prevalence, Proportional Hazards Models, Public Health Surveillance

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