A structured approach to modelling the effects of binary exposure variables over the life course

Mishra, Gita; Nitsch, Dorothea; Black, Stephanie; De Stavola, Bianca; Kuh, Diana; Hardy, Rebecca

doi:10.1093/ije/dyn229

Cited by 219Health disparities and outcomesStatistical Methods in EpidemiologyBirth, Development, and Health

A structured approach to modelling the effects of binary exposure variables over the life course

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Mishra, Gita, Nitsch, Dorothea, Black, Stephanie, De Stavola, Bianca, Kuh, Diana, Hardy, Rebecca·2009·International Journal of Epidemiology

DOI 10.1093/ije/dyn229PMC PMC2663717

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Abstract

BACKGROUND: There is growing interest in the relationship between time spent in adverse circumstances across life course and increased risk of chronic disease and early mortality. This accumulation hypothesis is usually tested by summing indicators of binary variables across the life span to form an overall score that is then used as the exposure in regression models for health outcomes. This article highlights potential issues in the interpretation of results obtained from such an approach. METHODS: We propose a model-building framework that can be used to formally compare alternative hypotheses on the effect of multiple binary exposure measurements collected across the life course. The saturated model where the order and value of the binary variable at each time point influence the outcome of interest is compared with nested alternative specifications corresponding to the critical period, cumulative risk or hypotheses about the effect of changes in environment. This framework is illustrated with data on adult body mass index and socioeconomic position measured once in childhood and twice in adulthood from the Medical Research Council National Survey of Health and Development, using a series of liner regression models. RESULTS: We demonstrate how analyses that only consider the association of a cumulative score with a later outcome may produce misleading results. CONCLUSION: We recommend comparing a set of nested models-each corresponding to the accumulation, critical period and effect modification hypotheses-to an all-inclusive (saturated) model. This approach can provide a formal and clearer understanding of the relative merits of these alternative hypotheses.

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Comparing hypothesized models against a saturated model using an F-test cannot be extended to continuous exposures, as the required saturated model would have as many parameters as study participants.
“Other statistical methods applicable to the structured approach exist, such as comparing hypothesized models against a saturated model using an F-test.12 This cannot be extended to continuous exposures, as the required saturated model would have as many parameters as study participants.”
From A structured approach to hypotheses involving continuous exposures over the life course (2016) · cites this paper as [12]

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Model Selection of the Effect of Binary Exposures over the Life Course
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OP79 Extending the structured approach to hypotheses regarding life course associations to handle continuous exposures: birth cohort and simulation examples
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Self-citation

Authors: Mishra, G., Nitsch, D., Black, S., De Stavola, B., Kuh, D., & Hardy, R.
Affiliations: The Royal Free Hospital (GB)
London School of Hygiene & Tropical Medicine (GB)
Corresponding author: Mishra, Gita
ORCID: Mishra, Gita
Nitsch, Dorothea
Black, Stephanie
Kuh, Diana
Hardy, Rebecca
Venue: International Journal of Epidemiology
Publisher: Oxford University Press (OUP)
Published: 2008-11-21
Volume: 38
Issue: 2
Pages: 528-537
ISSN: 0300-5771 (ISSN-L)
1464-3685
DOI: 10.1093/ije/dyn229
PMC: PMC2663717
OpenAlex: W2121611632
Cited by: 218
References: 28
Citations by year: 2026: 5 · 2025: 5 · 2024: 17 · 2023: 20 · 2022: 11 · 2021: 16 · 2020: 9 · 2019: 18 · 2018: 11 · 2017: 14 · 2016: 13 · 2015: 20 · 2014: 23 · 2013: 9 · 2012: 11
FWCI: 5.67
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: International Journal of Epidemiology (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
UCL Discovery (University College London) (submittedVersion)
Funders: Medical Research Council
Topics: Social Sciences › Health › Health disparities and outcomes
Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Birth, Development, and Health
Keywords: life course exposure, nested model comparison, saturated models, critical period hypothesis, effect modification, body mass index, socioeconomic position, MRC National Survey of Health and Development
MeSH terms: Critical Period, Psychological, Female, Humans, Longitudinal Studies, Male, Middle Aged, Sex Factors, Social Mobility, Socioeconomic Factors, Models, Statistical, Body Mass Index

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A structured approach to modelling the effects of binary exposure variables over the life course

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