We revisit the well-known but often misunderstood issue of (non)collapsibility of effect measures in regression models for binary and time-to-event outcomes. We describe an existing simple but largely ignored procedure for marginalizing estimates of conditional odds ratios and propose a similar procedure for marginalizing estimates of conditional hazard ratios (allowing for right censoring), demonstrating its performance in simulation studies and in a reanalysis of data from a small randomized trial in primary biliary cirrhosis patients. In addition, we aim to provide an educational summary of issues surrounding (non)collapsibility from a causal inference perspective and to promote the idea that the words conditional and adjusted (likewise marginal and unadjusted) should not be used interchangeably.
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http://dx.doi.org/10.1002/bimj.201900297 | DOI Listing |
J Clin Med
January 2025
School of Community Health and Policy, Morgan State University, Baltimore, MD 21251, USA.
: There is significant underrepresentation in clinical trials across diverse populations. Less is known about how health system-related factors, such as relationships and trust, mediate the motivation for clinical trial participation. We aimed to investigate whether health system-related factors explain the association between sociodemographic factors and motivation for participation.
View Article and Find Full Text PDFInt J Environ Res Public Health
January 2025
Faculty of Nursing, MacEwan University, Edmonton, AB T5J 4S2, Canada.
The human immunodeficiency virus (HIV) pandemic is a global public health and social justice issue. HIV continues to disproportionately affect marginalized populations, including immigrants and refugees living with HIV (IRLHIV). This study investigated and captured the experiences of IRLHIV using the social determinants of health framework.
View Article and Find Full Text PDFImplement Sci Commun
January 2025
IWK Health and Dalhousie University, Halifax, NS, Canada.
Background: Implementation Science research completed with equity-deserving populations is not well understood or explored. The current opioid epidemic challenges healthcare systems to improve existing practices through implementation of evidence-based interventions. Pregnant persons diagnosed with opioid use disorder (OUD) is an equity-deserving population that continues to experience stigmatization within our healthcare system.
View Article and Find Full Text PDFBMC Health Serv Res
January 2025
Centre for Gender and Sexual Health Equity, Faculty of Medicine, 1190 Hornby St., Vancouver, BC, V6Z 1Y6, Canada.
Background: Due to social-structural marginalization, sex workers experience health inequities including a high prevalence of sexually transmitted and blood-borne infections, mental health disorders, trauma, and substance use, alongside a multitude of barriers to HIV and substance use services. Given limited evidence on sex workers' broader primary healthcare access, we aimed to examine social-structural factors associated with primary care use among sex workers over 7 years.
Methods: Data were derived from An Evaluation of Sex Workers Health Access (AESHA), a community-based open prospective cohort of women (cis and trans) sex workers in Metro Vancouver, from 2014 to 2021.
Health Justice
January 2025
Burnet Institute, Melbourne, Australia.
Background: During the COVID-19 pandemic, governments worldwide introduced law enforcement measures to deter and punish breaches of emergency public health orders. For example, in Victoria, Australia, discretionary fines of A$1,652 were issued for breaching stay-at-home orders, and A$4,957 fines for 'unlawful gatherings'; to date, approximately 30,000 fines remain outstanding or not paid in full. Studies globally have revealed how the expansion of policing powers produced significant collateral damage for marginalized populations, including people from low-income neighboorhoods, Indigenous Peoples, sex workers, and people from culturally diverse backgrounds.
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