When exposure affects subgroup membership: Framing relevant causal questions in perinatal epidemiology and beyond
当暴露影响子群成员资格：围产期流行病学及其他情境中的因果问题AI 解读 ↓
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当暴露影响子群成员资格：围产期流行病学及其他情境中的因果问题
- 研究问题
- 当暴露改变哪些人会产下活婴以及生育时点时，如何定义婴儿结局的因果效应，并区分经由活产过程产生的影响？
- 方法与思路
- 作者提出条件总效应和条件随机直接效应，后者通过假想干预从指定分布抽取中介值，并以SEARCH研究中的HIV传播为例。
- 材料陈述的贡献
- 摘要称两类目标量分别涵盖或排除经由活产过程的影响，为暴露会改变子群成员资格的研究提供更明确的因果问题表述。
- 阅读关注点
- 应核对条件化的目标人群、中介干预分布及效应定义，并检查识别所需条件、活产选择的处理和应用中实际估计的目标量。
- 阅读边界
- 这是预印本，同行评审及期刊接收未获核验。摘要未说明识别假设、估计程序或效应数值，不能据此判断这些目标量在具体数据中可识别。
原文摘要
Perinatal epidemiology often aims to evaluate exposures on infant outcomes. When the exposure affects the composition of people who give birth to live infants (e.g., by affecting fertility, behavior, or birth outcomes), this "live birth process" mediates the exposure effect on infant outcomes. Causal estimands previously proposed for this setting include the total exposure effect on composite birth and infant outcomes, controlled direct effects (e.g., enforcing birth), and principal stratum direct effects. Using perinatal HIV transmission in the SEARCH Study as a motivating example, we present two alternative causal estimands: 1) conditional total effects; and 2) conditional stochastic direct effects, formulated under a hypothetical intervention to draw mediator values from some distribution (possibly conditional on covariates). The proposed conditional total effect includes impacts of an intervention that operate by changing the types of people who have a live birth and the timing of births. The proposed conditional stochastic direct effects isolate the effect of an exposure on infant outcomes excluding any impacts through this live birth process. In SEARCH, this approach quantifies the impact of a universal testing and treatment intervention on infant HIV-free survival absent any effect of the intervention on the live birth process, within a clearly defined target population of women of reproductive age with HIV at study baseline. Our approach has implications for the evaluation of intervention effects in perinatal epidemiology broadly, and whenever causal effects within a subgroup are of interest and exposure affects membership in the subgroup.