A graphical method for assessing risk factor threshold values using the generalized additive model: The multi-ethnic study of atherosclerosis

Claude Messan Setodji, Maren Scheuner, James S. Pankow, Roger S. Blumenthal, Haiying Chen, Emmett Keeler

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Continuous variable dichotomization is a popular technique used in the estimation of the effect of risk factors on health outcomes in multivariate regression settings. Researchers follow this practice in order to simplify data analysis, which it unquestionably does. However thresholds used to dichotomize those variables are usually ad-hoc, based on expert opinions, or mean, median or quantile splits and can add bias to the effect of the risk factors on specific outcomes and underestimate such effect. In this paper, we suggest the use of a semi-parametric method and visualization for improvement of the threshold selection in variable dichotomization while accounting for mixture distributions in the outcome of interest and adjusting for covariates. For clinicians, these empirically based thresholds of risk factors, if they exist, could be informative in terms of the highest or lowest point of a risk factor beyond which no additional impact on the outcome should be expected.

Original languageEnglish (US)
Pages (from-to)62-79
Number of pages18
JournalHealth Services and Outcomes Research Methodology
Volume12
Issue number1
DOIs
StatePublished - Mar 1 2012

Keywords

  • Generalized additive model
  • Recycled prediction
  • Smearing estimates
  • Threshold detection

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