Yu Xuexin, Zahodne Laura B, Gross Alden L, Needham Belinda L, Langa Kenneth M, Cho Tsai-Chin, Kobayashi Lindsay C
Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, United States.
Department of Psychology, University of Michigan, Ann Arbor, MI 48109, United States.
Am J Epidemiol. 2025 Mar 4;194(3):811-819. doi: 10.1093/aje/kwae186.
Gender is an observed effect modifier of the association between loneliness and memory aging. However, this effect modification may be a result of information bias due to differential loneliness underreporting by gender. We applied probabilistic bias analyses to examine whether effect modification of the loneliness-memory decline relationship by gender is retained under three simulation scenarios with various magnitudes of differential loneliness underreporting between men and women. Data were from biennial interviews with adults aged ≥ 50 years in the US Health and Retirement Study from 1996-2016 (5646 women and 3386 men). Loneliness status (yes vs no) was measured from 1996-2004 using the Center for Epidemiologic Studies Depression (CES-D) Scale loneliness item, and memory was measured from 2004-2016. Simulated sensitivity and specificity of the loneliness measure were informed by a validation study using the UCLA Loneliness Scale as a gold standard. The likelihood of observing effect modification by gender was higher than 90% in all simulations, although the likelihood reduced with an increasing difference in magnitude of the loneliness underreporting between men and women. The gender difference in loneliness underreporting did not meaningfully affect the observed effect modification by gender in our simulations. Our simulation approach may be promising to quantify potential information bias in effect modification analyses.
性别是孤独感与记忆老化之间关联的一个观察到的效应修饰因素。然而，这种效应修饰可能是由于性别差异导致孤独感报告不足而产生的信息偏差的结果。我们应用概率偏差分析来检验在男性和女性之间存在不同程度的孤独感报告不足的三种模拟情景下，性别对孤独感与记忆衰退关系的效应修饰是否依然存在。数据来自于1996年至2016年美国健康与退休研究中对年龄≥50岁成年人的两年一次访谈（5646名女性和3386名男性）。孤独感状态（是与否）在1996年至2004年期间使用流行病学研究中心抑郁量表（CES-D）中的孤独感项目进行测量，记忆在2004年至2016年期间进行测量。孤独感测量的模拟敏感性和特异性是根据一项以加州大学洛杉矶分校孤独感量表作为金标准的验证研究得出的。在所有模拟中，观察到性别效应修饰的可能性均高于90%，尽管随着男性和女性在孤独感报告不足程度上差异的增加，这种可能性会降低。在我们的模拟中，孤独感报告不足的性别差异并未对观察到的性别效应修饰产生显著影响。我们的模拟方法可能有望量化效应修饰分析中的潜在信息偏差。
