Instrumental variable approaches to identifying the causal effect of educational attainment on dementia risk
Instrumental variable approaches to identifying the causal effect of educational attainment on dementia risk
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DOI：
10.1016/j.annepidem.2015.10.006
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发表时间：
2016-01-01
影响因子：
5.6
通讯作者：
Glymour, M. Maria
中科院分区：
文献类型：
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作者：
Nguyen, Thu T.;Tchetgen, Eric J. Tchetgen;Glymour, M. Maria
目的：教育是老年人认知状态的既定相关因素，但考虑到先前因果推理研究的局限性，扩大教育机会是否会改善认知功能仍不清楚。因此，我们在该领域首次使用遗传变异作为工具以及州级学校政策，对教育与痴呆风险之间的关联进行了工具变量（IV）分析。方法：健康与退休研究队列（1998-2010）中的IV分析使用了两套工具：（1）由三个单核苷酸多态性（SNP；n = 7981）构建的遗传风险评分； (2) 义务教育法 (CSL) 和州立学校特征（学期长度、师生比例和支出；n = 10,955）。结果：使用遗传风险评分作为 IV，每年上学一年的痴呆症风险降低 1.1%（95% 置信区间，-2.4 至 0.02）。利用义务教育法和公立学校特征作为 IV，具有更大的保护效果（-9.5%；95% 置信区间，-14.8 至 -4.2）。评估 IV 假设合理性的分析表明，基于 CSL 的分析得出的估计值提供了对教育因果效应的最佳估计。结论：IV 分析表明，教育可以预防老年人患痴呆症的风险。 (C) 2016 Elsevier Inc. 保留所有权利。
Purpose: Education is an established correlate of cognitive status in older adulthood, but whether expanding educational opportunities would improve cognitive functioning remains unclear given limitations of prior studies for causal inference. Therefore, we conducted instrumental variable (IV) analyses of the association between education and dementia risk, using for the first time in this area, genetic variants as instruments as well as state-level school policies.Methods: IV analyses in the Health and Retirement Study cohort (1998-2010) used two sets of instruments: (1) a genetic risk score constructed from three single-nucleotide polymorphisms (SNPs; n = 7981); and (2) compulsory schooling laws (CSLs) and state school characteristics (term length, student teacher ratios, and expenditures; n = 10,955).Results: Using the genetic risk score as an IV, there was a 1.1% reduction in dementia risk per year of schooling (95% confidence interval, -2.4 to 0.02). Leveraging compulsory schooling laws and state school characteristics as IVs, there was a substantially larger protective effect (-9.5%; 95% confidence interval, -14.8 to -4.2). Analyses evaluating the plausibility of the IV assumptions indicated estimates derived from analyses relying on CSLs provide the best estimates of the causal effect of education.Conclusions: IV analyses suggest education is protective against risk of dementia in older adulthood. (C) 2016 Elsevier Inc. All rights reserved.