ArticleEnvironmental epidemiology (Philadelphia, Pa.)2021
Environmental hazards, social inequality, and fetal loss: Implications of live-birth bias for estimation of disparities in birth outcomes.
Article in Environmental epidemiology (Philadelphia, Pa.), 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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Who cites it
19 citing papers in PubMed, 24 citations in OpenAlex.
- School-age outcomes among IVF-conceived children: A population-wide cohort study.PLoS medicine · 2023Trial
- Developing a Hierarchical Algorithm to Identify Pregnancies and Determine Gestational Age from Nationwide Linked Health Data in Taiwan.Drug safety · 2026Article
- Relative risk and excess fraction of preterm birth across maternal occupation and industry: a Danish nationwide register-based cohort study of employed pregnant women.Scandinavian journal of work, environment & health · 2026Article
- Prenatal fluoride exposure and pregnancy outcomes in two US pregnancy cohorts.International journal of epidemiology · 2026Article
- High ambient temperature during pregnancy and offspring cerebral palsy: A population-based case-control study in California.Environmental research · 2026Article
- Prenatal Care and Perinatal Regionalization for Congenital Heart Defects.JAMA network open · 2025Article
- Association of PMPaediatric and perinatal epidemiology · 2025Article
- The Camp fire and perinatal health: an example of the generalized synthetic control method to identify susceptible windows of exposure.American journal of epidemiology · 2025Article
- Hurricane Harvey and the risk of spontaneous preterm and early-term birth.Environmental epidemiology (Philadelphia, Pa.) · 2024Article
- Water Fluoridation and Birth Outcomes in California.Environmental health perspectives · 2024Article
- Toxic metal mixtures in private well water and increased risk for preterm birth in North Carolina.Environmental health : a global access science source · 2023Article
- Susceptible windows of exposure to fine particulate matter and fetal growth trajectories in the Spanish INMA (INfancia y Medio Ambiente) birth cohort.Environmental research · 2023Article
- Bias in the association between advanced maternal age and stillbirth using left truncated data.Scientific reports · 2022Article
- Birth outcomes following unexpected job loss: a matched-sibling design.International journal of epidemiology · 2022Article
- Maternal tobacco smoking and offspring autism spectrum disorder or traits in ECHO cohorts.Autism research : official journal of the International Society for Autism Research · 2022Article
- Hyper-localized measures of air pollution and risk of preterm birth in Oakland and San Jose, California.International journal of epidemiology · 2022Article
- Exposure toEnvironmental health perspectives · 2022Article
- Residential proximity to hydraulically fractured oil and gas wells and adverse birth outcomes in urban and rural communities in California (2006-2015).Environmental epidemiology (Philadelphia, Pa.) · 2021Article
- Occurrence of fatal police violence during pregnancy and hazard of preterm birth in California.Paediatric and perinatal epidemiology · 2021Article
Corrections and comments
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Authors and funding
5 authors at 4 institutions in 1 country.
Funding
Abstract
Restricting to live births can induce bias in studies of pregnancy and developmental outcomes, but whether this live-birth bias results in underestimating disparities is unknown. Bias may arise from collider stratification due to an unmeasured common cause of fetal loss and the outcome of interest, or depletion of susceptibles, where exposure differentially causes fetal loss among those with underlying susceptibility.
methodsWe conducted a simulation study to examine the magnitude of live-birth bias in a population parameterized to resemble one year of conceptions in California (N = 625,000). We simulated exposure to a non-time-varying environmental hazard, risk of spontaneous abortion, and time to live birth using 1000 Monte Carlo simulations. Our outcome of interest was preterm birth. We included a social vulnerability factor to represent social disadvantage, and estimated overall risk differences for exposure and preterm birth using linear probability models and stratified by the social vulnerability factor. We calculated how often confidence intervals included the true point estimate (CI coverage probabilities) to illustrate whether effect estimates differed qualitatively from the truth.
resultsDepletion of susceptibles resulted in a larger magnitude of bias compared with collider stratification, with larger bias among the socially vulnerable group. Coverage probabilities were not adversely affected by bias due to collider stratification. Depletion of susceptibles reduced coverage, especially among the socially vulnerable (coverage among socially vulnerable = 46%, coverage among nonsocially vulnerable = 91% in the most extreme scenario).
conclusionsIn simulations, hazardous environmental exposures induced live-birth bias and the bias was larger for socially vulnerable women.
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Registered trials
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