BMC Public Health (Sep 2024)
Do small effects matter more in vulnerable populations? an investigation using Environmental influences on Child Health Outcomes (ECHO) cohorts
- Janet L. Peacock,
- Susana Diaz Coto,
- Judy R. Rees,
- Odile Sauzet,
- Elizabeth T. Jensen,
- Raina Fichorova,
- Anne L. Dunlop,
- Nigel Paneth,
- Amy Padula,
- Tracey Woodruff,
- Rachel Morello-Frosch,
- Jessica Trowbridge,
- Dana Goin,
- Luis E. Maldonado,
- Zhongzheng Niu,
- Akhgar Ghassabian,
- Leonardo Transande,
- Assiamira Ferrara,
- Lisa A. Croen,
- Stacey Alexeeff,
- Carrie Breton,
- Augusto Litonjua,
- Thomas G. O’Connor,
- Kristen Lyall,
- Heather Volk,
- Akram Alshawabkeh,
- Justin Manjourides,
- Carlos A. Camargo,
- Dana Dabelea,
- Christine W. Hockett,
- Casper G. Bendixsen,
- Irva Hertz-Picciotto,
- Rebecca J. Schmidt,
- Alison E. Hipwell,
- Kate Keenan,
- Catherine Karr,
- Kaja Z. LeWinn,
- Barry Lester,
- Marie Camerota,
- Jody Ganiban,
- Cynthia McEvoy,
- Michael R. Elliott,
- Sheela Sathyanarayana,
- Nan Ji,
- Joseph M. Braun,
- Margaret R. Karagas,
- on behalf of Program Collaborators for Environmental influences on Child Health Outcomes
Affiliations
- Janet L. Peacock
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Dartmouth College
- Susana Diaz Coto
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Dartmouth College
- Judy R. Rees
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Dartmouth College
- Odile Sauzet
- Bielefeld School of Public Health and Department of Economy and Business Administration, Bielefeld University
- Elizabeth T. Jensen
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine
- Raina Fichorova
- Department of Gynecology and Reproductive Biology, Brigham and Women’s Hospital
- Anne L. Dunlop
- Emory University School of Medicine
- Nigel Paneth
- Department of Epidemiology and Biostatistics, Michigan State University
- Amy Padula
- Department of Reproductive Sciences, School of Medicine, University of California San Francisco
- Tracey Woodruff
- Department of Reproductive Sciences, School of Medicine, University of California San Francisco
- Rachel Morello-Frosch
- Department of Environmental Health Sciences, University of California
- Jessica Trowbridge
- Department of Reproductive Sciences, School of Medicine, University of California San Francisco
- Dana Goin
- Children’s Environmental Health Center, University of Illinois
- Luis E. Maldonado
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
- Zhongzheng Niu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
- Akhgar Ghassabian
- Harvard TH Chan School of Public Health, Harvard University
- Leonardo Transande
- Department of Pediatrics, NYU Grossman School of Medicine
- Assiamira Ferrara
- Kaiser Permanente Northern California Division of Research, Kaiser Permanente Northern California
- Lisa A. Croen
- Kaiser Permanente Northern California Division of Research, Kaiser Permanente Northern California
- Stacey Alexeeff
- Kaiser Permanente Northern California Division of Research, Kaiser Permanente Northern California
- Carrie Breton
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
- Augusto Litonjua
- University of Rochester Medical Center
- Thomas G. O’Connor
- University of Rochester Medical Center
- Kristen Lyall
- AJ Drexel Autism Institute, Drexel University
- Heather Volk
- Johns Hopkins Bloomberg School of Public Health
- Akram Alshawabkeh
- Department of Civil and Environmental Engineering, Northeastern University
- Justin Manjourides
- Department of Civil and Environmental Engineering, Northeastern University
- Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital
- Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus
- Christine W. Hockett
- Avera Research Institute
- Casper G. Bendixsen
- National Farm Medicine Center, Marshfield Clinic Research Institute
- Irva Hertz-Picciotto
- Department of Public Health Sciences, School of Medicine, The MIND Institute, University of California Davis
- Rebecca J. Schmidt
- Department of Public Health Sciences, School of Medicine, The MIND Institute, University of California Davis
- Alison E. Hipwell
- Department of Psychiatry, University of Pittsburgh
- Kate Keenan
- University of Chicago
- Catherine Karr
- Department of Pediatrics, University of Washington
- Kaja Z. LeWinn
- Department of Psychiatry and Behavioral Sciences, University of California
- Barry Lester
- Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Brown University
- Marie Camerota
- Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Brown University
- Jody Ganiban
- George Washington University
- Cynthia McEvoy
- Department of Pediatrics, School of Medicine, Oregan Health and Science University
- Michael R. Elliott
- University of Michigan School of Public Health and Institute for Social Research, University of Michigan
- Sheela Sathyanarayana
- Department of Pediatrics, Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute
- Nan Ji
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
- Joseph M. Braun
- Warren Alpert Medical School of Brown University, Brown University
- Margaret R. Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Dartmouth College
- on behalf of Program Collaborators for Environmental influences on Child Health Outcomes
- DOI
- https://doi.org/10.1186/s12889-024-20075-x
- Journal volume & issue
-
Vol. 24,
no. 1
pp. 1 – 13
Abstract
Abstract Background A major challenge in epidemiology is knowing when an exposure effect is large enough to be clinically important, in particular how to interpret a difference in mean outcome in unexposed/exposed groups. Where it can be calculated, the proportion/percentage beyond a suitable cut-point is useful in defining individuals at high risk to give a more meaningful outcome. In this simulation study we compute differences in outcome means and proportions that arise from hypothetical small effects in vulnerable sub-populations. Methods Data from over 28,000 mother/child pairs belonging to the Environmental influences on Child Health Outcomes Program were used to examine the impact of hypothetical environmental exposures on mean birthweight, and low birthweight (LBW) (birthweight < 2500g). We computed mean birthweight in unexposed/exposed groups by sociodemographic categories (maternal education, health insurance, race, ethnicity) using a range of hypothetical exposure effect sizes. We compared the difference in mean birthweight and the percentage LBW, calculated using a distributional approach. Results When the hypothetical mean exposure effect was fixed (at 50, 125, 167 or 250g), the absolute difference in % LBW (risk difference) was not constant but varied by socioeconomic categories. The risk differences were greater in sub-populations with the highest baseline percentages LBW: ranging from 3.1–5.3 percentage points for exposure effect of 125g. Similar patterns were seen for other mean exposure sizes simulated. Conclusions Vulnerable sub-populations with greater baseline percentages at high risk fare worse when exposed to a small insult compared to the general population. This illustrates another facet of health disparity in vulnerable individuals.
Keywords
- Pregnancy outcomes
- Child health outcome
- Health disparities
- Environmental exposure
- Social determinants of health
