Effect of imbalanced sampling and missing data on associations between gender norms and risk of adolescent HIV
Summary: Background: Despite strides towards gender equality, inequalities persist or remain unstudied, due potentially to data gaps. Although mapped, the effects of key data gaps remain unknown. This study provides a framework to measure effects of gender- and age-imbalanced and missing covariate...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-08-01
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| Series: | EClinicalMedicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537022002437 |
| _version_ | 1811237725558276096 |
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| author | Ribhav Gupta Safa Abdalla Valerie Meausoone Nikitha Vicas Iván Mejía-Guevara Ann M. Weber Beniamino Cislaghi Gary L. Darmstadt |
| author_facet | Ribhav Gupta Safa Abdalla Valerie Meausoone Nikitha Vicas Iván Mejía-Guevara Ann M. Weber Beniamino Cislaghi Gary L. Darmstadt |
| author_sort | Ribhav Gupta |
| collection | DOAJ |
| description | Summary: Background: Despite strides towards gender equality, inequalities persist or remain unstudied, due potentially to data gaps. Although mapped, the effects of key data gaps remain unknown. This study provides a framework to measure effects of gender- and age-imbalanced and missing covariate data on gender-health research. The framework is demonstrated using a previously studied pathway for effects of pre-marital sex norms among adults on adolescent HIV risk. Methods: After identifying gender-age-imbalanced Demographic and Health Survey (DHS) datasets, we resampled responses and restricted covariate data from a relatively complete, balanced dataset derived from the 2007 Zambian DHS to replicate imbalanced gender-age sampling and covariate missingness. Differences in model outcomes due to sampling were measured using tests for interaction. Missing covariate effects were measured by comparing fully-adjusted and reduced model fitness. Findings: We simulated data from 25 DHS surveys across 20 countries from 2005-2014 on four sex-stratified models for pathways of adult attitude-behaviour discordance regarding pre-marital sex and adolescent risk of HIV. On average, across gender-age-imbalanced surveys, males comprised 29.6% of responses compared to 45.3% in the gender-balanced dataset. Gender-age-imbalanced sampling significantly affected regression coefficients in 40% of model-scenarios (N = 40 of 100) and biased relative-risk estimates away from gender-age-balanced sampling outcomes in 46% (N = 46) of model-scenarios. Model fitness was robust to covariate removal with minor effects on male HIV models. No consistent trends were observed between sampling distribution and risk of biased outcomes. Interpretation: Gender-health model outcomes may be affected by sampling gender-age-imbalanced data and less-so by missing covariates. Although occasionally attenuated, the effect magnitude of gender-age-imbalanced sampling is variable and may mask true associations, thus misinforming policy dialogue. We recommend future surveys improve balanced gender-age sampling to promote research reliability. Funding: Bill & Melinda Gates Foundation grant OPP1140262 to Stanford University. |
| first_indexed | 2024-04-12T12:29:23Z |
| format | Article |
| id | doaj.art-05288d5b46db42a6852b2a5d89c6dbfc |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-04-12T12:29:23Z |
| publishDate | 2022-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-05288d5b46db42a6852b2a5d89c6dbfc2022-12-22T03:33:05ZengElsevierEClinicalMedicine2589-53702022-08-0150101513Effect of imbalanced sampling and missing data on associations between gender norms and risk of adolescent HIVRibhav Gupta0Safa Abdalla1Valerie Meausoone2Nikitha Vicas3Iván Mejía-Guevara4Ann M. Weber5Beniamino Cislaghi6Gary L. Darmstadt7Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA; Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USAGlobal Center for Gender Equality, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USAProvider Network Data Science, Health Care Service Corporation (HCSC), Richardson, TX, USADepartment of Neuroscience, University of Texas – Dallas, Dallas, TX, USADepartment of Medicine - Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA; Stanford Aging and Ethnogeriatrics (SAGE) Research Center, Stanford University School of Medicine, Stanford, CA, USASchool of Public Health, University of Nevada, Reno, NV, USADepartment of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UKGlobal Center for Gender Equality, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA; Correspondig author at: Global Center for Gender Equality, Department of Pediatrics, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA 94304 USA.Summary: Background: Despite strides towards gender equality, inequalities persist or remain unstudied, due potentially to data gaps. Although mapped, the effects of key data gaps remain unknown. This study provides a framework to measure effects of gender- and age-imbalanced and missing covariate data on gender-health research. The framework is demonstrated using a previously studied pathway for effects of pre-marital sex norms among adults on adolescent HIV risk. Methods: After identifying gender-age-imbalanced Demographic and Health Survey (DHS) datasets, we resampled responses and restricted covariate data from a relatively complete, balanced dataset derived from the 2007 Zambian DHS to replicate imbalanced gender-age sampling and covariate missingness. Differences in model outcomes due to sampling were measured using tests for interaction. Missing covariate effects were measured by comparing fully-adjusted and reduced model fitness. Findings: We simulated data from 25 DHS surveys across 20 countries from 2005-2014 on four sex-stratified models for pathways of adult attitude-behaviour discordance regarding pre-marital sex and adolescent risk of HIV. On average, across gender-age-imbalanced surveys, males comprised 29.6% of responses compared to 45.3% in the gender-balanced dataset. Gender-age-imbalanced sampling significantly affected regression coefficients in 40% of model-scenarios (N = 40 of 100) and biased relative-risk estimates away from gender-age-balanced sampling outcomes in 46% (N = 46) of model-scenarios. Model fitness was robust to covariate removal with minor effects on male HIV models. No consistent trends were observed between sampling distribution and risk of biased outcomes. Interpretation: Gender-health model outcomes may be affected by sampling gender-age-imbalanced data and less-so by missing covariates. Although occasionally attenuated, the effect magnitude of gender-age-imbalanced sampling is variable and may mask true associations, thus misinforming policy dialogue. We recommend future surveys improve balanced gender-age sampling to promote research reliability. Funding: Bill & Melinda Gates Foundation grant OPP1140262 to Stanford University.http://www.sciencedirect.com/science/article/pii/S2589537022002437GenderBiasGender normsDemographic and health surveysHIVGlobal health |
| spellingShingle | Ribhav Gupta Safa Abdalla Valerie Meausoone Nikitha Vicas Iván Mejía-Guevara Ann M. Weber Beniamino Cislaghi Gary L. Darmstadt Effect of imbalanced sampling and missing data on associations between gender norms and risk of adolescent HIV EClinicalMedicine Gender Bias Gender norms Demographic and health surveys HIV Global health |
| title | Effect of imbalanced sampling and missing data on associations between gender norms and risk of adolescent HIV |
| title_full | Effect of imbalanced sampling and missing data on associations between gender norms and risk of adolescent HIV |
| title_fullStr | Effect of imbalanced sampling and missing data on associations between gender norms and risk of adolescent HIV |
| title_full_unstemmed | Effect of imbalanced sampling and missing data on associations between gender norms and risk of adolescent HIV |
| title_short | Effect of imbalanced sampling and missing data on associations between gender norms and risk of adolescent HIV |
| title_sort | effect of imbalanced sampling and missing data on associations between gender norms and risk of adolescent hiv |
| topic | Gender Bias Gender norms Demographic and health surveys HIV Global health |
| url | http://www.sciencedirect.com/science/article/pii/S2589537022002437 |
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