ArticleAmerican journal of epidemiology2023
Considering Questions Before Methods in Dementia Research With Competing Events and Causal Goals.
Article in American journal of epidemiology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
41 citing papers in PubMed, 56 citations in OpenAlex.
- Depressive and insomnia symptoms and incident dementia risk: A 12-year study in U.S. older adults.Journal of affective disorders · 2026Article
- Dementia risk across distinct metabolic profiles in the UK Biobank.GeroScience · 2026Article
- Streetview greenspace types and dementia risk in older adults: the Multi-Ethnic Study of Atherosclerosis.American journal of epidemiology · 2026Article
- Survival as a source of confounding, selection bias, and effect modification.International journal of epidemiology · 2026Article
- Long-term risk of death after tuberculosis diagnosis and treatment.Nature medicine · 2026Article
- Meat Consumption and Cognitive Health by APOE Genotype.JAMA network open · 2026Article
- Dementia Risk According to Indices of Insulin Sensitivity and Beta-Cell Function in Individuals With Newly Diagnosed Type 2 Diabetes: A Cohort Study.European journal of neurology · 2026Article
- Treating Hearing Loss With Hearing Aids for the Prevention of Cognitive Decline and Dementia.Neurology · 2026Observational
- Associations between joint air pollution exposure, mental health, and physical health and dementia incidence in an aging U.S. cohort.The journals of gerontology. Series B, Psychological sciences and social sciences · 2026Article
- Social isolation and functional impairment trajectories in a diverse cohort of middle-aged and older adults in Northern California.The journals of gerontology. Series A, Biological sciences and medical sciences · 2026Observational
- Investigating the dynamic association of multiple risk factors on cognitive impairment in older people: a retrospective cohort study in Baisha Town, Hepu County, China.BMC geriatrics · 2026Article
- Methodological innovations in studying marginalized populations in research on neurodegeneration and ageing.Frontiers in aging neuroscience · 2026Review
- Routine health checkups and cognitive resilience among older survivors of the 2011 Japan Tsunami.npj natural hazards · 2026Article
- Estimating cognitive decline in longitudinal studies with high mortality and a long interwave period: A comparison of approaches and considerations around integrating end-of-life interview data.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2025Article
- Continuation Versus Discontinuation of Sodium-Glucose Cotransporter-2 Inhibitors and Cardiorenal Outcomes Among Patients With Type 2 Diabetes and Chronic Kidney Disease: A Nationwide Cohort Study With a Target Trial Emulation Framework.Clinical and translational science · 2025Article
- Long-term cancer risk in users of GLP-1 agonists in Denmark: a nationwide emulated trial.The Lancet regional health. Europe · 2025Article
- Multi-dimensional sleep health and dementia risk: a prospective study in the UK Biobank.BMC medicine · 2025Article
- Hazards Constitute Key Quantities for Analyzing, Interpreting and Understanding Time-to-Event Data.Biometrical journal. Biometrische Zeitschrift · 2025Review
- Integrating Exposome into Lifecourse Understanding of Cognitive Ageing and Dementia: Current Evidence, Methodological Challenges, and Future Directions.International journal of environmental research and public health · 2025Article
- Mediators of educational differences in dementia risk later in life: evidence from the HUNT study.BMC public health · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Studying causal exposure effects on dementia is challenging when death is a competing event. Researchers often interpret death as a potential source of bias, although bias cannot be defined or assessed if the causal question is not explicitly specified. Here we discuss 2 possible notions of a causal effect on dementia risk: the "controlled direct effect" and the "total effect." We provide definitions and discuss the "censoring" assumptions needed for identification in either case and their link to familiar statistical methods. We illustrate concepts in a hypothetical randomized trial on smoking cessation in late midlife, and emulate such a trial using observational data from the Rotterdam Study, the Netherlands, 1990-2015. We estimated a total effect of smoking cessation (compared with continued smoking) on 20-year dementia risk of 2.1 (95% confidence interval: -0.1, 4.2) percentage points and a controlled direct effect of smoking cessation on 20-year dementia risk had death been prevented of -2.7 (95% confidence interval: -6.1, 0.8) percentage points. Our study highlights how analyses corresponding to different causal questions can have different results, here with point estimates on opposite sides of the null. Having a clear causal question in view of the competing event and transparent and explicit assumptions are essential to interpreting results and potential bias.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.