Risk factors relate to the variability of health outcomes as well as the mean: A GAMLSS tutorial.
Elife
; 112022 01 05.
Article
en En
| MEDLINE
| ID: mdl-34985412
ABSTRACT
Background:
Risk factors or interventions may affect the variability as well as the mean of health outcomes. Understanding this can aid aetiological understanding and public health translation, in that interventions which shift the outcome mean and reduce variability are typically preferable to those which affect only the mean. However, most commonly used statistical tools do not test for differences in variability. Tools that do have few epidemiological applications to date, and fewer applications still have attempted to explain their resulting findings. We thus provide a tutorial for investigating this using GAMLSS (Generalised Additive Models for Location, Scale and Shape).Methods:
The 1970 British birth cohort study was used, with body mass index (BMI; N = 6007) and mental wellbeing (Warwick-Edinburgh Mental Wellbeing Scale; N = 7104) measured in midlife (42-46 years) as outcomes. We used GAMLSS to investigate how multiple risk factors (sex, childhood social class, and midlife physical inactivity) related to differences in health outcome mean and variability.Results:
Risk factors were related to sizable differences in outcome variability-for example males had marginally higher mean BMI yet 28% lower variability; lower social class and physical inactivity were each associated with higher mean and higher variability (6.1% and 13.5% higher variability, respectively). For mental wellbeing, gender was not associated with the mean while males had lower variability (-3.9%); lower social class and physical inactivity were each associated with lower mean yet higher variability (7.2% and 10.9% higher variability, respectively).Conclusions:
The results highlight how GAMLSS can be used to investigate how risk factors or interventions may influence the variability in health outcomes. This underutilised approach to the analysis of continuously distributed outcomes may have broader utility in epidemiologic, medical, and psychological sciences. A tutorial and replication syntax is provided online to facilitate this (https//osf.io/5tvz6/).Funding:
DB is supported by the Economic and Social Research Council (grant number ES/M001660/1), The Academy of Medical Sciences / Wellcome Trust ("Springboard Health of the Public in 2040" award HOP001/1025); DB and LW are supported by the Medical Research Council (MR/V002147/1). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Índice de Masa Corporal
/
Salud Mental
/
Factores de Riesgo
/
Evaluación de Resultado en la Atención de Salud
/
Cohorte de Nacimiento
Tipo de estudio:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Adult
/
Female
/
Humans
/
Male
/
Middle aged
País/Región como asunto:
Europa
Idioma:
En
Revista:
Elife
Año:
2022
Tipo del documento:
Article
País de afiliación:
Reino Unido