American Journal of Epidemiology Advance Access originally published online on November 23, 2005
American Journal of Epidemiology 2006 163(1):84-96; doi:10.1093/aje/kwj003
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Practice of Epidemiology |
Statistical Issues in Life Course Epidemiology
1 Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
2 MRC National Survey of Health and Development, Department of Epidemiology, Royal Free and University College Medical School, London, United Kingdom
3 Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, London, United Kingdom
Correspondence to Dr. Bianca L. De Stavola, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom (e-mail: bianca.destavola{at}lshtm.ac.uk).
There is growing recognition that the risk of many diseases in later life, such as type 2 diabetes or breast cancer, is affected by adult as well as early-life variables, including those operating prior to conception and during the prenatal period. Most of these risk factors are correlated because of common biologic and/or social pathways, while some are intrinsically ordered over time. The study of how they jointly influence later ("distal") disease outcomes is referred to as life course epidemiology. This area of research raises several issues relevant to the current debate on causal inference in epidemiology. The authors give a brief overview of the main analytical and practical problems and consider a range of modeling approaches, their differences determined by the degree with which associations present (or presumed) among the correlated explanatory variables are explicitly acknowledged. Standard multiple regression (i.e., conditional) models are compared with joint models where more than one outcome is specified. Issues arising from measurement error and missing data are addressed. Examples from two cohorts in the United Kingdom are used to illustrate alternative modeling strategies. The authors conclude that more than one analytical approach should be adopted to gain more insight into the underlying mechanisms.
correlation; lifetime; path analysis; regression; structural equation model
Abbreviations: G0, grandparents; G1, study participants; G2, study participants' offspring
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