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A growing area of research in epidemiology is the identification ofhealth-related sibling spillover effects, or the effect of one individual'sexposure on their sibling's outcome. The health and health care of familymembers may be inextricably confounded by unobserved factors, renderingidentification of spillover effects within families particularly challenging.We demonstrate a gain-score regression method for identifyingexposure-to-outcome spillover effects within sibling pairs in a linear fixedeffects framework. The method can identify the exposure-to-outcome spillovereffect if only one sibling's exposure affects the other's outcome; and itidentifies the difference between the spillover effects if both siblings'exposures affect the others' outcomes. The method fails in the presence ofoutcome-to-exposure spillover and outcome-to-outcome spillover. Analyticresults and Monte Carlo simulations demonstrate the method and its limitations.To exercise this method, we estimate the spillover effect of a child's pretermbirth on an older sibling's literacy skills, measured by the PhonologicalAwarenesses Literacy Screening-Kindergarten test. We analyze 20,010 siblingpairs from a population-wide, Wisconsin-based (United States) birth cohort.Without covariate adjustment, we estimate that preterm birth modestly decreasesan older sibling's test score (-2.11 points; 95% confidence interval: -3.82,-0.40 points). In conclusion, gain-scores are a promising strategy foridentifying exposure-to-outcome spillovers in sibling pairs while controllingfor sibling-invariant unobserved confounding in linear settings.

Estimating Sibling Spillover Effects with Unobserved Confounding Using Gain-Scores