Journal Article

Causal Inference in Occupational Epidemiology: Accounting for the Healthy Worker Effect by Using Structural Nested Models

Ashley I. Naimi, David B. Richardson and Stephen R. Cole

in American Journal of Epidemiology

Published on behalf of Johns Hopkins Bloomberg School of Public Health

Volume 178, issue 12, pages 1681-1686
Published in print December 2013 | ISSN: 0002-9262
Published online September 2013 | e-ISSN: 1476-6256 | DOI: https://dx.doi.org/10.1093/aje/kwt215
Causal Inference in Occupational Epidemiology: Accounting for the Healthy Worker Effect by Using Structural Nested Models

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In a recent issue of the Journal, Kirkeleit et al. (Am J Epidemiol. 2013;177(11):1218–1224) provided empirical evidence for the potential of the healthy worker effect in a large cohort of Norwegian workers across a range of occupations. In this commentary, we provide some historical context, define the healthy worker effect by using causal diagrams, and use simulated data to illustrate how structural nested models can be used to estimate exposure effects while accounting for the healthy worker survivor effect in 4 simple steps. We provide technical details and annotated SAS software (SAS Institute, Inc., Cary, North Carolina) code corresponding to the example analysis in the Web Appendices, available at http://aje.oxfordjournals.org/.

Keywords: causal inference; healthy worker effect; marginal structural models; occupational epidemiology; structural nested models

Journal Article.  3970 words.  Illustrated.

Subjects: Public Health and Epidemiology

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