The Use of Multiple Outcomes Analysis in Neurotoxicity: An Example from the New Zealand Study of Offspring of Mothers Exposed to Methyl Mercury

Neurotoxicity has become an important area in the study of the risk to children of noncarcinogens. Many of the tests used to evaluate neurotoxic effects in neurotoxic studies are psychometric tests to assess cognitive, motor, and perceptual performance in individuals in order to determine the presence of psychological problems, impaired educational achievement, or neurological abnormalities. The underlying assumption of these procedures are that a test performance deficit is indicative of a neurological disability, and that such disability derives from the prenatal exposure to an offending substance. The usual analytic paradigm for discerning environmental impacts is to analyze the scores of a particular subtest in a battery taken separately as the dependent variable with regression analysis, which adjusts for cultural background, educational level, and socioeconomic status. The impact of this analysis is to determine the correlation of each of the psychometric test results to exposure. We show a statistical method to simultaneously analyze the multiple outcomes of many tests using General Estimating Equations (GEE) to determine if a correlation exists between the global measure of all these tests and exposure adjusted for covariates of interest and the correlation among the dependent psychometric variables. We show the application of this method to the results of children whose mothers were exposed to mercury during pregnancy.