Polytomous Logistic Regression as a Tool for Exploring Heterogeneity across Birth Defect Subtypes: An Example Using Anencephaly and Spina Bifida
Polytomous Logistic Regression as a Tool for Exploring Heterogeneity across Birth Defect Subtypes: An Example Using Anencephaly and Spina Bifida
复制标题
DOI：
10.1002/bdra.20671
复制
发表时间：
2010-08-01
影响因子：
--
通讯作者：
Mitchel, Laura E.
中科院分区：
文献类型：
--
作者：
Lupo, Philip J.;Symanski, Elaine;Mitchel, Laura E.
背景技术背景：在出生缺陷流行病学中，表型亚组通常被组合成复合表型，以增加统计功效。尽管使用复合表型的有效性受到质疑，但尚未对组分表型间效应同质性的基本假设进行正式评估。采用多分类logistic回归分析评价几种公认的神经管缺陷（NTD）的效应异质性无脑畸形和脊柱裂的组成表型的风险因素。这些分析的数据来自国家出生缺陷预防研究。研究结果：复合表型的使用有可能掩盖特定于组成表型的关联，并且在某些情况下，变量的影响可能被错误地归因于复合表型。例如，婴儿性别与无脑畸形之间的关联（校正比值比[AOR]，1.5; 95%CI，1.1-1.9）（AOR，11; 95%CI，09 - 13），而与母体体重指数的相关性是脊柱裂特有的（AOR，19; 95%CI，16 - 2.4）归因于所有NTD（AOR，16; 95%CI，14 -2.0）。此外，基于临时比较而非正式评估得出的关于效应异质性的结论，可能容易受到相当大的主观性的影响，正如母亲的西班牙裔与脊柱裂相关的情况一样（AOR，1.4; 95%CI，12 - 18）和无脑畸形（AOR，2.0; 95% CI，1.5-28）结论：多分类逻辑回归提供了一个有用的工具，用于评估假定的危险因素，其中没有先验基础来假设组分表型之间的效应同质性。出生缺陷研究，（A部分）88701705，2010（C）2010 Wiley-Liss，Inc.
BACKGROUND: In birth defect epidemiology, phenotypic subgroups are often combined into a composite phenotype in an effort to increase statistical power Although the validity of using composite phenotypes has been questioned, formal evaluations of the underlying assumption of effect homogeneity across component phenotypes have not been conducted METHODS: Polytomous logistic regression was used to assess effect heterogeneity of several generally accepted neural tube defect (NTD) risk factors across the component phenotypes of anencephaly and spina bifida. Data for these analyses were obtained from the National Birth Defects Prevention Study. RESULTS: The use of a composite phenotype has the potential to mask associations specific to a component phenotype and in some cases the effect of a variable may be misattributed to the composite phenotype For example, an association between infant sex and anencephaly (adjusted odds ratio [AOR], 1 5; 95% Cl, 1.1-1.9) was masked when data from all NTDs were analyzed (AOR, 1 1; 95% Cl, 0 9-1 3), whereas an association with maternal body mass index that was specific to spina bifida (AOR, 1 9, 95% Cl, 1 6-2 4) was attributed to all NTDs (AOR, 1 6; 95% Cl, 1 4-2.0). Furthermore, conclusions regarding effect heterogeneity based on ad hoc comparisons, rather than some formal assessment, may be vulnerable to considerable subjectivity, as was the case for the association of maternal Hispanic ethnicity with spina bifida (AOR, 1.4; 95% Cl, 1 2-1 8) and anencephaly (AOR, 2.0; 95% Cl, 1.5-28) CONCLUSIONS: Polytomous logistic regression provides a useful tool for evaluating putative risk factors for which there is no a priori basis for assuming effect homogeneity across component phenotypes. Birth Defects Research, (Part A) 88701705, 2010 (C) 2010 Wiley-Liss, Inc.