Inference for environmental intervention studies using principal stratification.
Stat Med
; 33(28): 4919-33, 2014 Dec 10.
Article
em En
| MEDLINE
| ID: mdl-25164949
ABSTRACT
Previous research has found evidence of an association between indoor air pollution and asthma morbidity in children. Environmental intervention studies have been performed to examine the role of household environmental interventions in altering indoor air pollution concentrations and improving health. Previous environmental intervention studies have found only modest effects on health outcomes and it is unclear if the health benefits provided by environmental modification are comparable with those provided by medication. Traditionally, the statistical analysis of environmental intervention studies has involved performing two intention-to-treat analyses that separately estimate the effect of the environmental intervention on health and the effect of the environmental intervention on indoor air pollution concentrations. We propose a principal stratification approach to examine the extent to which an environmental intervention's effect on health outcomes coincides with its effect on indoor air pollution. We apply this approach to data from a randomized air cleaner intervention trial conducted in a population of asthmatic children living in Baltimore, Maryland, USA. We find that among children for whom the air cleaner reduced indoor particulate matter concentrations, the intervention resulted in a meaningful improvement of asthma symptoms with an effect generally larger than previous studies have shown. A key benefit of using principal stratification in environmental intervention studies is that it allows investigators to estimate causal effects of the intervention for sub-groups defined by changes in the indoor air pollution concentration.
Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Asma
/
Interpretação Estatística de Dados
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Modelos Estatísticos
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Poluição do Ar em Ambientes Fechados
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Material Particulado
Tipo de estudo:
Clinical_trials
/
Health_economic_evaluation
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Child
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Female
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Humans
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Male
País como assunto:
America do norte
Idioma:
En
Ano de publicação:
2014
Tipo de documento:
Article