Within- and between-group regression for improving the robustness of causal claims in cross-sectional analysis
Background: A major objective of environmental epidemiology is to elucidate exposure-health outcome associations. To increase the variance of observed exposure concentrations, researchers recruit individuals from different geographic areas. The common analytical approach uses multilevel analysis to...
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| Main Authors: | , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
10 July 2015
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| In: |
Environmental health
Year: 2015, Volume: 14 |
| ISSN: | 1476-069X |
| DOI: | 10.1186/s12940-015-0047-2 |
| Online Access: | Verlag, kostenfrei, Volltext: http://dx.doi.org/10.1186/s12940-015-0047-2 Verlag, kostenfrei, Volltext: https://doi.org/10.1186/s12940-015-0047-2 
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| Author Notes: | Bernd Genser, Carlos A. Teles, Mauricio L. Barreto and Joachim E. Fischer |
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| 520 | |a Background: A major objective of environmental epidemiology is to elucidate exposure-health outcome associations. To increase the variance of observed exposure concentrations, researchers recruit individuals from different geographic areas. The common analytical approach uses multilevel analysis to estimate individual-level associations adjusted for individual and area covariates. However, in cross-sectional data this approach does not differentiate between residual confounding at the individual level and at the area level. An approach allowing researchers to distinguish between within-group effects and between-group effects would improve the robustness of causal claims. Methods: We applied an extended multilevel approach to a large cross-sectional study aimed to elucidate the hypothesized link between drinking water pollution from perfluoroctanoic acid (PFOA) and plasma levels of C-reactive protein (CRP) or lymphocyte counts. Using within- and between-group regression of the individual PFOA serum concentrations, we partitioned the total effect into a within- and between-group effect by including the aggregated group average of the individual exposure concentrations as an additional predictor variable. Results: For both biomarkers, we observed a strong overall association with PFOA blood levels. However, for lymphocyte counts the extended multilevel approach revealed the absence of a between-group effect, suggesting that most of the observed total effect was due to individual level confounding. In contrast, for CRP we found consistent between- and within-group effects, which corroborates the causal claim for the association between PFOA blood levels and CRP. Conclusion: Between- and within-group regression modelling augments cross-sectional analysis of epidemiological data by supporting the unmasking of non-causal associations arising from hidden confounding at different levels. In the application example presented in this paper, the approach suggested individual confounding as a probable explanation for the first observed association and strengthened the robustness of the causal claim for the second one. | ||
| 650 | 4 | |a Causal claims | |
| 650 | 4 | |a Cross-sectional studies | |
| 650 | 4 | |a Ecological fallacy | |
| 650 | 4 | |a Ecological inference | |
| 650 | 4 | |a Multilevel modelling | |
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