A flexible hierarchical framework for improving inference in area-referenced environmental health studies
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Published version
Author(s)
Pirani, Monica
Mason, Alexina
Hansell, Anna
Richardson, Sylvia
Blangiardo, Marta
Type
Journal Article
Abstract
Study designs where data have been aggregated by geographical areas are popular in environmental epi-demiology. These studies are commonly based on administrative databases and, providing a completespatial coverage, are particularly appealing to make inference on the entire population. However, the re-sulting estimates are often biased and difficult to interpret due to unmeasured confounders, which typicallyare not available from routinely collected data. We propose a framework to improve inference drawn fromsuch studies exploiting information derived from individual-level survey data. The latter are summarized inan area-level scalar score by mimicking at ecological-level the well-known propensity score methodology.The literature on propensity score for confounding adjustment is mainly based on individual-level studiesand assumes a binary exposure variable. Here we generalize its use to cope with area-referenced stud-ies characterized by a continuous exposure. Our approach is based upon Bayesian hierarchical structuresspecified into a two-stage design: (i) geolocated individual-level data from survey samples are up-scaled atecological-level, then the latter are used to estimate a generalizedecological propensity score(EPS) in thein-sample areas; (ii) the generalized EPS is imputed in the out-of-sample areas under different assumptionsabout the missingness mechanisms, then it is included into the ecological regression, linking the exposureof interest to the health outcome. This delivers area-level risk estimates which allow a fuller adjustment forconfounding than traditional areal studies. The methodology is illustrated by using simulations and a casestudy investigating the risk of lung cancer mortality associated with nitrogen dioxide in England (UK).
Date Issued
2020-11
Date Acceptance
2020-02-19
Citation
Biometrical Journal: journal of mathematical methods in biosciences, 2020, 62 (7), pp.1650-1669
ISSN
0323-3847
Publisher
Wiley-VCH Verlag
Start Page
1650
End Page
1669
Journal / Book Title
Biometrical Journal: journal of mathematical methods in biosciences
Volume
62
Issue
7
Copyright Statement
© 2020 The Authors. Biometrical Journal published by WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
License URL
Sponsor
Medical Research Council
Identifier
https://onlinelibrary.wiley.com/doi/10.1002/bimj.201900241
Grant Number
MR/M025195/1
Subjects
Science & Technology
Life Sciences & Biomedicine
Physical Sciences
Mathematical & Computational Biology
Statistics & Probability
Mathematics
area-referenced studies
Bayesian inference
data integration
missing data
uncertainty
PROPENSITY SCORE
AIR-POLLUTION
MISSING CONFOUNDERS
NITROGEN-DIOXIDE
LUNG-CANCER
MORTALITY
MODEL
BIAS
EXPOSURE
RISKS
Bayesian inference
area-referenced studies
data integration
missing data
uncertainty
Statistics & Probability
0104 Statistics
Publication Status
Published
Date Publish Online
2020-06-22