Calculating control variables with age at onset data to adjust for conditions prior to exposure.
BACKGROUND
When assessing the association between a factor X and a subsequent outcome Y in observational studies, the question that arises is what are the variables to adjust for to reduce bias due to confounding for causal inference on the effect of X on Y. Disregarding such factors is often a source of overestimation because these variables may affect both X and Y. On the other hand, adjustment for such variables can also be a source of underestimation because such variables may be the causal consequence of X and part of the mechanism that leads from X to Y.


METHODS
In this paper, we present a simple method to compute control variables in the presence of age at onset data on both X and a set of other variables. Using these age at onset data, control variables are computed that adjust only for conditions that occur prior to X. This strategy can be used in prospective as well as in survival analysis. Our method is motivated by an argument based on the counterfactual model of a causal effect.


RESULTS
The procedure is exemplified by examining of the relation between panic attack and the subsequent incidence of MDD.


CONCLUSIONS
The results reveal that the adjustment for all other variables, irrespective of their temporal relation to X, can yield a false negative result (despite unconsidered confounders and other sources of bias).
Höfler
Michael
M
Clinical Psychology and Epidemiology, Max Planck Institute of Psychiatry, Kraepelinstr. 2-10, 80804 München, Germany. hoefler@mpipsykl.mpg.de
Brückl
Tanja
T
Brueck
Tanja
T
Lieb
Roselind
R
Wittchen
Hans-Ulrich
HU
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D015331:Cohort Studies; D003865:Major Depressive Disorder / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016584:Panic Disorder / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D012917:Social Adjustment; D019966:Substance-Related Disorders / Q000453:epidemiology