Heterogeneous Exposure Associations in Observational Cohort Studies: The Example of Blood Pressure in Older Adults.

TitleHeterogeneous Exposure Associations in Observational Cohort Studies: The Example of Blood Pressure in Older Adults.
Publication TypeJournal Article
Year of Publication2020
AuthorsOdden, MC, Rawlings, AM, Khodadadi, A, Fern, X, Shlipak, MG, Bibbins-Domingo, K, Covinsky, K, Kanaya, AM, Lee, A, Haan, MN, Newman, AB, Psaty, BM, Peralta, CA
JournalAm J Epidemiol
Volume189
Issue1
Pagination55-67
Date Published2020 Jan 31
ISSN1476-6256
KeywordsAged, Algorithms, Blood Pressure, Blood Pressure Determination, Cohort Studies, Data Interpretation, Statistical, Epidemiologic Methods, Female, Humans, Hypertension, Male, Nutrition Surveys, Observational Studies as Topic, Proportional Hazards Models
Abstract

Heterogeneous exposure associations (HEAs) can be defined as differences in the association of an exposure with an outcome among subgroups that differ by a set of characteristics. In this article, we intend to foster discussion of HEAs in the epidemiologic literature and present a variant of the random forest algorithm that can be used to identify HEAs. We demonstrate the use of this algorithm in the setting of the association between systolic blood pressure and death in older adults. The training set included pooled data from the baseline examination of the Cardiovascular Health Study (1989-1993), the Health, Aging, and Body Composition Study (1997-1998), and the Sacramento Area Latino Study on Aging (1998-1999). The test set included data from the National Health and Nutrition Examination Survey (1999-2002). The hazard ratios ranged from 1.25 (95% confidence interval: 1.13, 1.37) per 10-mm Hg increase in systolic blood pressure among men aged ≤67 years with diastolic blood pressure greater than 80 mm Hg to 1.00 (95% confidence interval: 0.96, 1.03) among women with creatinine concentration ≤0.7 mg/dL and a history of hypertension. HEAs have the potential to improve our understanding of disease mechanisms in diverse populations and guide the design of randomized controlled trials to control exposures in heterogeneous populations.

DOI10.1093/aje/kwz218
Alternate JournalAm J Epidemiol
PubMed ID31595960
PubMed Central IDPMC7119301
Grant ListU01 HL080295 / HL / NHLBI NIH HHS / United States
U01 HL130114 / HL / NHLBI NIH HHS / United States
HHSN268200800007C / HL / NHLBI NIH HHS / United States
N01HC55222 / HL / NHLBI NIH HHS / United States
R01 AG028050 / AG / NIA NIH HHS / United States
N01HC85083 / HL / NHLBI NIH HHS / United States
N01HC85080 / HL / NHLBI NIH HHS / United States
R01 AG046206 / AG / NIA NIH HHS / United States
N01HC85081 / HL / NHLBI NIH HHS / United States
R01 NR012459 / NR / NINR NIH HHS / United States
N01HC85086 / HL / NHLBI NIH HHS / United States
HHSN268201200036C / HL / NHLBI NIH HHS / United States
HHSN268201800001C / HL / NHLBI NIH HHS / United States
R01 AG012975 / AG / NIA NIH HHS / United States
N01HC85082 / HL / NHLBI NIH HHS / United States
N01HC85079 / HL / NHLBI NIH HHS / United States
R01 AG023629 / AG / NIA NIH HHS / United States