The inverse association between cancer history and incident cognitive impairment: Addressing attrition bias

作者：Michelle Shardell, Alan M. Rathbun, Ann L. Gruber‐Baldini, Alice S. Ryan, Jack M. Guralnik, Dimitrios Kapogiannis, Eleanor M. Simonsick · 发表于：Alzheimer s & Dementia · 年份：2024 · DOI：10.1002/alz.14268 · 被引用次数：5 · 研究领域：Cancer-related cognitive impairment studies、Dementia and Cognitive Impairment Research、Brain Metastases and Treatment

INTRODUCTION: Cancer is inversely associated with cognitive impairment. Whether this is due to statistical handling of attrition (death and censoring) is unknown. METHODS: We quantified associations between cancer history and incident cognitive impairment among Health, Aging, and Body Composition Study participants without baseline cognitive impairment or stroke (n = 2604) using multiple competing-risks models and their corresponding estimands: cause-specific, subdistribution, and marginal hazards, plus composite-outcome (cognitive impairment or all-cause mortality) hazards. All-cause mortality was also modeled. RESULTS: After covariate adjustment (demographics, apolipoprotein E ε4, lifestyle, health conditions), cause-specific and marginal hazard ratios (HRs) were similar to each other (≈ 0.84; P values < 0.05). The subdistribution HR was 0.764 (95% confidence interval [CI] = 0.645-0.906), and composite-outcome Cox model HR was 1.149 (95% CI = 1.016-1.299). Cancer history was positively associated with all-cause mortality (HR = 1.813; 95% CI = 1.525-2.156). DISCUSSION: Cause-specific, subdistribution, and marginal hazards models produced inverse associations between cancer and cognitive impairment. Competing risk models answer slightly different questions, and estimand choice influenced findings here. HIGHLIGHTS: Cancer history is inversely associated with incident cognitive impairment. Findings were robust to handling of competing risks of death. All models also addressed p...