Do small effects matter more in vulnerable populations? an investigation using Environmental influences on Child Health Outcomes (ECHO) cohorts

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2024年9月28日

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Janet L. Peacock,
Susana Diaz Coto,
Judy R. Rees,
Odile Sauzet,
Elizabeth T. Jensen,
Raina Fichorova,
Anne L. Dunlop,
Nigel Paneth,
Amy Padula,
Tracey Woodruff,
Rachel Morello-Frosch,
Jessica Trowbridge,
Dana Goin,
Luis E. Maldonado,
Zhongzheng Niu,
Akhgar Ghassabian,
Leonardo Transande,
Assiamira Ferrara,
Lisa A. Croen,
Stacey Alexeeff,
Carrie Breton,
Augusto Litonjua,
Thomas G. O’Connor,
Kristen Lyall,
Heather Volk,
Akram Alshawabkeh,
Justin Manjourides,
Carlos A. Camargo Jr,
Dana Dabelea,
Christine W. Hockett,
Casper G. Bendixsen,
Irva Hertz-Picciotto,
Rebecca J. Schmidt,
Alison E. Hipwell,
Kate Keenan,
Catherine Karr,
Kaja Z. LeWinn,
Barry Lester,
Marie Camerota,
Jody Ganiban,
Cynthia McEvoy,
Michael R. Elliott,
Sheela Sathyanarayana,
Nan Ji,
Joseph M. Braun,
Margaret R. Karagas,
P.B. Smith,
L.K. Newby,
L.P. Jacobson,
D.J. Catellier,
R. Gershon,
D. Cella,
J. Cordero,
J. Meeker,
L. Gatzke-Kopp,
M. Swingler,
J.M. Mansbach,
J.M. Spergel,
M.E. Samuels-Kalow,
M. D. Stevenson,
C. S. Bauer,
D. Koinis Mitchell,
S. Deoni,
V D.’Sa,
C. S. Duarte,
C. Monk,
J. Posner,
G. Canino,
A. J. Elliott,
J. Gern,
R. Miller,
E. Zoratti,
C. Seroogy,
D. Jackson,
L. Bacharier,
M. Kattan,
R. Wood,
K. Rivera-Spoljaric,
G. Hershey,
T. Hartert,
C. Johnson,
D. Ownby,
A. Singh,
T. Bastain,
S. Farzan,
R. Habre,
F. Tylavsky,
A. Mason,
Q. Zhao,
N. Bush,
K. Z. LeWinn,
B. Carter,
S. Pastyrnak,
C. Neal,
L. Smith,
J. Helderman,
L. Leve,
J. Neiderhiser,
S. T. Weiss,
G. O.Connor,
R. Zeiger,
R. Tepper,
R. Landa,
S. Ozonoff,
S. Dager,
R. Schultz,
J. Piven,
H. Simhan,
C. Buss,
P. Wadhwa,
K. Huff,
R. K. Miller,
E. Oken,
J. M. Kerver,
C. Barone,
C. Fussman,
M. Elliott,
D. Ruden,
J. Herbstman,
S. Schantz,
J. Stanford,
C. Porucznik,
A. Giardino,
R. J. Wright,
M. Bosquet-Enlow,
K. Huddleston,
R. Nguyen,
E. Barrett,
S. Swan,
F. Perera

摘要

Background

A major challenge in epidemiology is knowing when an exposure effect is large enough to be clinically important, in particular how to interpret a difference in mean outcome in unexposed/exposed groups. Where it can be calculated, the proportion/percentage beyond a suitable cut-point is useful in defining individuals at high risk to give a more meaningful outcome. In this simulation study we compute differences in outcome means and proportions that arise from hypothetical small effects in vulnerable sub-populations.

Methods

Data from over 28,000 mother/child pairs belonging to the Environmental influences on Child Health Outcomes Program were used to examine the impact of hypothetical environmental exposures on mean birthweight, and low birthweight (LBW) (birthweight < 2500g). We computed mean birthweight in unexposed/exposed groups by sociodemographic categories (maternal education, health insurance, race, ethnicity) using a range of hypothetical exposure effect sizes. We compared the difference in mean birthweight and the percentage LBW, calculated using a distributional approach.

Results

When the hypothetical mean exposure effect was fixed (at 50, 125, 167 or 250g), the absolute difference in % LBW (risk difference) was not constant but varied by socioeconomic categories. The risk differences were greater in sub-populations with the highest baseline percentages LBW: ranging from 3.1–5.3 percentage points for exposure effect of 125g. Similar patterns were seen for other mean exposure sizes simulated.

Conclusions

Vulnerable sub-populations with greater baseline percentages at high risk fare worse when exposed to a small insult compared to the general population. This illustrates another facet of health disparity in vulnerable individuals.