ArticleEpidemiology (Cambridge, Mass.)2018
Can Survival Bias Explain the Age Attenuation of Racial Inequalities in Stroke Incidence?: A Simulation Study.
Article in Epidemiology (Cambridge, Mass.), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Who cites it
21 citing papers in PubMed, 29 citations in OpenAlex.
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- Collider stratification bias II: magnitude of bias.American journal of epidemiology · 2025Article
- Selection Bias in Health Research: Quantifying, Eliminating, or Exacerbating Health Disparities?Current epidemiology reports · 2024Article
- Trends Over Time in Stroke Incidence by Race in the Greater Cincinnati Northern Kentucky Stroke Study.Neurology · 2024Article
- Recommendations for Using Causal Diagrams to Study Racial Health Disparities.American journal of epidemiology · 2022Article
- The limitations of large-scale volunteer databases to address inequalities and global challenges in health and aging.Nature aging · 2022Review
- Marginal Structural Models for Life-Course Theories and Social Epidemiology: Definitions, Sources of Bias, and Simulated Illustrations.American journal of epidemiology · 2022Article
- Monte Carlo Simulation Approaches for Quantitative Bias Analysis: A Tutorial.Epidemiologic reviews · 2022Review
- Biopsychosocial pathways in dementia inequalities: Introduction to the Michigan Cognitive Aging Project.The American psychologist · 2021Article
- Amyloid PET Imaging in Self-Identified Non-Hispanic Black Participants of the Anti-Amyloid in Asymptomatic Alzheimer's Disease (A4) Study.Neurology · 2021Article
- Evaluation of Selective Survival and Sex/Gender Differences in Dementia Incidence Using a Simulation Model.JAMA network open · 2021Article
- The competing risk of death and selective survival cannot fully explain the inverse cancer-dementia association.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2020Article
- Invited Commentary: Making Causal Inference More Social and (Social) Epidemiology More Causal.American journal of epidemiology · 2020Article
- It's Absolutely Relative: The Effect of Age on the BMI-Mortality Relationship in Postmenopausal Women.Obesity (Silver Spring, Md.) · 2020Article
- Does the Association of Diabetes With Stroke Risk Differ by Age, Race, and Sex? Results From the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study.Diabetes care · 2019Article
- The Effects of Reverse Causality and Selective Attrition on the Relationship Between Body Mass Index and Mortality in Postmenopausal Women.American journal of epidemiology · 2019Article
- Invited Commentary: Examining Sex/Gender Differences in Risk of Alzheimer Disease and Related Dementias-Challenges and Future Directions.American journal of epidemiology · 2019Article
Corrections and comments
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Authors and funding
7 authors at 5 institutions in 1 country.
Funding
Abstract
backgroundIn middle age, stroke incidence is higher among black than white Americans. For unknown reasons, this inequality decreases and reverses with age. We conducted simulations to evaluate whether selective survival could account for observed age patterning of black-white stroke inequalities.
methodsWe simulated birth cohorts of 20,000 blacks and 20,000 whites with survival distributions based on US life tables for the 1919-1921 birth cohort. We generated stroke incidence rates for ages 45-94 years using Reasons for Geographic and Racial Disparities in Stroke (REGARDS) study rates for whites and setting the effect of black race on stroke to incidence rate difference (IRD) = 20/10,000 person-years at all ages, the inequality observed at younger ages in REGARDS. We compared observed age-specific stroke incidence across scenarios, varying effects of U, representing unobserved factors influencing mortality and stroke risk.
resultsDespite a constant adverse effect of black race on stroke risk, the observed black-white inequality in stroke incidence attenuated at older age. When the hazard ratio for U on stroke was 1.5 for both blacks and whites, but U only directly influenced mortality for blacks (hazard ratio for U on mortality =1.5 for blacks; 1.0 for whites), stroke incidence rates in late life were lower among blacks (average observed IRD = -43/10,000 person-years at ages 85-94 years versus causal IRD = 20/10,000 person-years) and mirrored patterns observed in REGARDS.
conclusionsA relatively moderate unmeasured common cause of stroke and survival could fully account for observed age attenuation of racial inequalities in stroke.
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