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Arch Iran Med. 2023;26(10): 567-574.
doi: 10.34172/aim.2023.83
PMID: 38310413
PMCID: PMC10862089
Scopus ID: 85184096367
  Abstract View: 753
  PDF Download: 474

Original Article

Impact of Alcohol Consumption on Multiple Sclerosis Using Model-based Standardization and Misclassification Adjustment Via Probabilistic Bias Analysis

Pooneh Malekifar 1 ORCID logo, Saharnaz Nedjat 1, Ibrahim Abdollahpour 2, Maryam Nazemipour 1, Saeed Malekifar 3, Mohammad Ali Mansournia 1* ORCID logo

1 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
2 Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Science, Isfahan, Iran
3 Department of Computer Engineering, Iran University of Science and Technology, Tehran, Iran
*Corresponding Author: Mohammad Ali Mansournia, Email: mansournia_ma@yahoo.com

Abstract

Background: The etiology of multiple sclerosis (MS) is still not well-demonstrated, and assessment of some risk factors like alcohol consumption has problems like confounding and measurement bias. To determine the causal effect of alcohol consumption on MS after adjusting for alcohol consumption misclassification bias and confounders.

Methods: In a population-based incident case-control study, 547 patients with MS and 1057 healthy people were recruited. A minimally sufficient adjustment set of confounders was derived using the causal directed acyclic graph. The probabilistic bias analysis method (PBAM) using beta, logit-logistic, and triangular probability distributions for sensitivity/specificity to adjust for misclassification bias in self-reporting alcohol consumption and model-based standardization (MBS) to estimate the causal effect of alcohol consumption were used. Population attributable fraction (PAF) estimates with 95% Monte Carlo sensitivity analysis (MCSA) intervals were calculated using PBAM and MBS analysis. Bootstrap was used to deal with random errors.

Results: The adjusted risk ratio (95% MCSA interval) from the probabilistic bias analysis and MBS between alcohol consumption and MS using the three distribution was in the range of 1.93 (1.07 to 4.07) to 2.02 (1.15 to 4.69). The risk difference (RD) in all three scenarios was 0.0001 (0.0000 to 0.0005) and PAF was in the range of 0.15 (0.010 to 0.50) to 0.17 (0.001 to 0.47).

Conclusion: After adjusting for measurement bias, confounding, and random error alcohol consumption had a positive causal effect on the incidence of MS.


Cite this article as: Malekifar P, Nedjat S, Abdollahpour I, Nazemipour M, Malekifar S, Mansournia MA. Impact of alcohol consumption on multiple sclerosis using model-based standardization and misclassification adjustment via probabilistic bias analysis. Arch Iran Med. 2023;26(10):567-574. doi: 10.34172/aim.2023.83
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Submitted: 07 Feb 2023
Revision: 11 Jul 2023
Accepted: 06 Aug 2023
ePublished: 01 Oct 2023
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