Marginal structural Cox model to estimate the causal effect of clinical mastitis on Québec dairy cow culling risk

The estimated CM causal hazard ratios were 1.96 [1.57-2.44] and 1.47 [1.28-1.69] for heifers and cows, respectively, and as long as causal assumptions hold. Our findings confirm that CM was a risk factor for culling, but with a reduced effect compared to previous studies, which did not properly control for the presence of time-dependent confounders such as milk yield and somatic cell count. Cows experienced a lower risk for CM, with milk production having more influence on culling risk in cows than heifers.