Testing for covariate balance using quantile regression and resampling methods

Consistency of propensity score matching estimators hinges on the propensity score's ability to balance the distributions of covariates in the pools of treated and non-treated units. Conventional balance tests merely check for differences in covariates’ means, but cannot account for differences in higher moments. For this reason, this paper proposes balance tests which test for differences in the entire distributions of continuous covariates based on quantile regression (to derive Kolmogorov–Smirnov and Cramer–von-Mises–Smirnov-type test statistics) and resampling methods (for inference). Simulations suggest that these methods are very powerful and capture imbalances related to higher moments when conventional balance tests fail to do so.     

Variance estimation of the risk difference when using propensity-score matching and weighting with time-to-event outcomes

Observational studies are increasingly being used in medicine to estimate the effects of treatments or exposures on outcomes. To minimize the potential for confounding when estimating treatment effects, propensity score methods are frequently implemented. Often outcomes are the time to event. While it is common to report the treatment effect as a relative effect, such as the hazard ratio, reporting the effect using an absolute measure of effect is also important. One commonly used absolute measure of effect is the risk difference or difference in probability of the occurrence of an event within a specified duration of follow-up between a treatment and comparison group. We first describe methods for point and variance estimation of the risk difference when using weighting or matching based on the propensity score when outcomes are time-to-event. Next, we conducted Monte Carlo simulations to compare the relative performance of these methods with respect to bias of the point estimate, accuracy of variance estimates, and coverage of estimated confidence intervals. The results of the simulation generally support the use of weighting methods (untrimmed ATT weights and IPTW) or caliper matching when the prevalence of treatment is low for point estimation. For standard error estimation the simulation results support the use of weighted robust standard errors, bootstrap methods, or matching with a naïve standard error (i.e., Greenwood method). The methods considered in the article are illustrated using a real-world example in which we estimate the effect of discharge prescribing of statins on patients hospitalized for acute myocardial infarction.     

Controlling for confounding via propensity score methods can result in biased estimation of the conditional AUC: A simulation study

In the medical literature, there has been an increased interest in evaluating association between exposure and outcomes using nonrandomized observational studies. However, because assignments to exposure are not random in observational studies, comparisons of outcomes between exposed and nonexposed subjects must account for the effect of confounders. Propensity score methods have been widely used to control for confounding, when estimating exposure effect. Previous studies have shown that conditioning on the propensity score results in biased estimation of conditional odds ratio and hazard ratio. However, research is lacking on the performance of propensity score methods for covariate adjustment when estimating the area under the ROC curve (AUC). In this paper, AUC is proposed as measure of effect when outcomes are continuous. The AUC is interpreted as the probability that a randomly selected nonexposed subject has a better response than a randomly selected exposed subject. A series of simulations has been conducted to examine the performance of propensity score methods when association between exposure and outcomes is quantified by AUC; this includes determining the optimal choice of variables for the propensity score models. Additionally, the propensity score approach is compared with that of the conventional regression approach to adjust for covariates with the AUC. The choice of the best estimator depends on bias, relative bias, and root mean squared error. Finally, an example looking at the relationship of depression/anxiety and pain intensity in people with sickle cell disease is used to illustrate the estimation of the adjusted AUC using the proposed approaches.     

Effects of correlated covariates on the asymptotic efficiency of matching and inverse probability weighting estimators for causal inference

In observational studies, the overall aim when fitting a model for the propensity score is to reduce bias for an estimator of the causal effect. To make the assumption of an unconfounded treatment plausible researchers might include many, possibly correlated, covariates in the propensity score model. In this paper, we study how the asymptotic efficiency of matching and inverse probability weighting estimators for average causal effects change when the covariates are correlated. We investigate the case with multivariate normal covariates, a logistic model for the propensity score and linear models for the potential outcomes and show results under different model assumptions. We show that the correlation can both increase and decrease the large sample variances of the estimators, and that the correlation affects the asymptotic efficiency of the estimators differently, both with regard to direction and magnitude. Moreover, the strength of the confounding towards the outcome and the treatment plays an important role.     

Propensity score matching and stratification using multiparty data without pooling

Matching and stratification based on confounding factors or propensity scores (PS) are powerful approaches for reducing confounding bias in indirect treatment comparisons. However, implementing these approaches requires pooled individual patient data (IPD). The research presented here was motivated by an indirect comparison between a single-armed trial in acute myeloid leukemia (AML), and two external AML registries with current treatments for a control. For confidentiality reasons, IPD cannot be pooled. Common approaches to adjusting confounding bias, such as PS matching or stratification, cannot be applied as 1) a model for PS, for example, a logistic model, cannot be fitted without pooling covariate data; 2) pooling response data may be necessary for some statistical inference (e.g., estimating the SE of mean difference of matched pairs) after PS matching. We propose a set of approaches that do not require pooling IPD, using a combination of methods including a linear discriminant for matching and stratification, and secure multiparty computation for estimation of within-pair sample variance and for calculations involving multiple control sources. The approaches only need to share aggregated data offline, rather than real-time secure data transfer, as required by typical secure multiparty computation for model fitting. For survival analysis, we propose an approach using restricted mean survival time. A simulation study was conducted to evaluate this approach in several scenarios, in particular, with a mixture of continuous and binary covariates. The results confirmed the robustness and efficiency of the proposed approach. A real data example is also provided for illustration.     

Covariate handling approaches in combination with dynamic borrowing for hybrid control studies

Borrowing data from external control has been an appealing strategy for evidence synthesis when conducting randomized controlled trials (RCTs). Often named hybrid control trials, they leverage existing control data from clinical trials or potentially real-world data (RWD), enable trial designs to allocate more patients to the novel intervention arm, and improve the efficiency or lower the cost of the primary RCT. Several methods have been established and developed to borrow external control data, among which the propensity score methods and Bayesian dynamic borrowing framework play essential roles. Noticing the unique strengths of propensity score methods and Bayesian hierarchical models, we utilize both methods in a complementary manner to analyze hybrid control studies. In this article, we review methods including covariate adjustments, propensity score matching and weighting in combination with dynamic borrowing and compare the performance of these methods through comprehensive simulations. Different degrees of covariate imbalance and confounding are examined. Our findings suggested that the conventional covariate adjustment in combination with the Bayesian commensurate prior model provides the highest power with good type I error control under the investigated settings. It has desired performance especially under scenarios of different degrees of confounding. To estimate efficacy signals in the exploratory setting, the covariate adjustment method in combination with the Bayesian commensurate prior is recommended.     

A comparison of balancing scores for estimating rate ratios of count data in observational studies

In this article, we conduct a Monte Carlo study to examine four balancing scores (BS1: propensity score, BS2: prognostic score, BS3: adjusted propensity score estimated by the estimated prognostic score, and BS4: adjusted propensity score estimated by the estimated prognostic score and other covariates) for adjusting bias in estimating the marginal and the conditional rate ratios of count data in observational studies. Simulation results show that BS1–BS4 are not much different in terms of estimating the marginal and the conditional rate ratios, however, choosing the appropriate matching algorithm is more important than selecting a balancing scores.     

Comparison of adjusted and unadjusted marginal probabilities for estimating binomial parameters in observational studies

In this study, we demonstrate how generalized propensity score estimators (Imbens’ weighted estimator, the propensity score weighted estimator and the generalized doubly robust estimator) can be used to calculate the adjusted marginal probabilities for estimating the three common binomial parameters: the risk difference (RD), the relative risk (RR), and the odds ratio (OR). We further conduct a simulation study to compare the estimated RD, RR, and OR using the adjusted and the unadjusted marginal probabilities in terms of the bias and mean-squared error (MSE). Although there is no clear winner in terms of the MSE for estimating RD, RR, and OR, simulation results surprisingly show thatthe unadjusted marginal probabilities produce the smallest bias compared with the adjusted marginal probabilities in most of the estimates. Hence, in conclusion, we recommend using the unadjusted marginal probabilities to estimate RD, RR, and OR, in practice.     

A comparison of doubly robust estimators of the mean with missing data

We consider data with a continuous outcome that is missing at random and a fully observed set of covariates. We compare by simulation a variety of doubly-robust (DR) estimators for estimating the mean of the outcome. An estimator is DR if it is consistent when either the regression model for the mean function or the propensity to respond is correctly specified. Performance of different methods is compared in terms of root mean squared error of the estimates and width and coverage of confidence intervals or posterior credibility intervals in repeated samples. Overall, the DR methods tended to yield better inference than the incorrect model when either the propensity or mean model is correctly specified, but were less successful for small sample sizes, where the asymptotic DR property is less consequential. Two methods tended to outperform the other DR methods: penalized spline of propensity prediction [Little RJA, An H. Robust likelihood-based analysis of multivariate data with missing values. Statist Sinica. 2004;14:949–968] and the robust method proposed in [Cao W, Tsiatis AA, Davidian M. Improving efficiency and robustness of the doubly robust estimator for a population mean with incomplete data. Biometrika. 2009;96:723–734].     

Performance evaluation of propensity score methods for estimating average treatment effects with multi-level treatments*

The propensity score (PS) method is widely used to estimate the average treatment effect (TE) in observational studies. However, it is generally confined to the binary treatment assignment. In an extension to the settings of a multi-level treatment, Imbens proposed a generalized propensity score which is the conditional probability of receiving a particular level of the treatment given pre-treatment variables. The average TE can then be estimated by conditioning solely on the generalized PS under the assumption of weak unconfoundedness. In the present work, we adopted this approach and conducted extensive simulations to evaluate the performance of several methods using the generalized PS, including subclassification, matching, inverse probability of treatment weighting (IPTW), and covariate adjustment. Compared with other methods, IPTW had the preferred overall performance. We then applied these methods to a retrospective cohort study of 228,876 pregnant women. The impact of the exposure to different types of the antidepressant medications (no exposure, selective serotonin reuptake inhibitor (SSRI) only, non-SSRI only, and both) during pregnancy on several important infant outcomes (birth weight, gestation age, preterm labor, and respiratory distress) were assessed.     

Propensity score matched augmented controls in randomized clinical trials: A case study

Existing statutes in the United States and Europe require manufacturers to demonstrate evidence of effectiveness through the conduct of adequate and well‐controlled studies to obtain marketing approval of a therapeutic product. What constitutes adequate and well‐controlled studies is usually interpreted as randomized controlled trials (RCTs). However, these trials are sometimes unfeasible because of their size, duration, cost, patient preference, or in some cases, ethical concerns. For example, RCTs may not be fully powered in rare diseases or in infections caused by multidrug resistant pathogens because of the low number of enrollable patients. In this case, data available from external controls (including historical controls and observational studies or data registries) can complement information provided by RCT. Propensity score matching methods can be used to select or “borrow” additional patients from the external controls, for maintaining a one‐to‐one randomization between the treatment arm and active control, by matching the new treatment and control units based on a set of measured covariates, ie, model‐based pairing of treatment and control units that are similar in terms of their observable pretreatment characteristics. To this end, 2 matching schemes based on propensity scores are explored and applied to a real clinical data example with the objective of using historical or external observations to augment data in a trial where the randomization is disproportionate or asymmetric.     

Better experimental design by hybridizing binary matching with imbalance optimization

We present a new experimental design procedure that divides a set of experimental units into two groups in order to minimize error in estimating a treatment effect. One concern is the elimination of large covariate imbalance between the two groups before the experiment begins. Another concern is robustness of the design to misspecification in response models. We address both concerns in our proposed design: we first place subjects into pairs using optimal nonbipartite matching, making our estimator robust to complicated nonlinear response models. Our innovation is to keep the matched pairs extant, take differences of the covariate values within each matched pair, and then use the greedy switching heuristic of Krieger et al. (2019) or rerandomization on these differences. This latter step greatly reduces covariate imbalance. Furthermore, our resultant designs are shown to be nearly as random as matching, which is robust to unobserved covariates. When compared to previous designs, our approach exhibits significant improvement in the mean squared error of the treatment effect estimator when the response model is nonlinear and performs at least as well when the response model is linear. Our design procedure can be found as a method in the open source R package available on CRAN called GreedyExperimentalDesign .     

Doubly robust empirical likelihood inference in covariate-missing data problems

Missing covariate data occurs often in regression analysis. We study methods for estimating the regression coefficients in an assumed conditional mean function when some covariates are completely observed but other covariates are missing for some subjects. We adopt the semiparametric perspective of Robins et al. [Estimation of regression coefficients when some regressors are not always observed. J Amer Statist Assoc. 1994;89:846–866] on regression analyses with missing covariates, in which they pioneered the use of two working models, the working propensity score model and the working conditional score model. A recent approach to missing covariate data analysis is the empirical likelihood method of Qin et al. [Empirical likelihood in missing data problems. J Amer Statist Assoc. 2009;104:1492–1503], which effectively combines unbiased estimating equations. In this paper, we consider an alternative likelihood approach based on the full likelihood of the observed data. This full likelihood-based method enables us to generate estimators for the vector of the regression coefficients that are (a) asymptotically equivalent to those of Qin et al. [Empirical likelihood in missing data problems. J Amer Statist Assoc. 2009;104:1492–1503] when the working propensity score model is correctly specified, and (b) doubly robust, like the augmented inverse probability weighting (AIPW) estimators of Robins et al. [Estimation of regression coefficients when some regressors are not always observed. J Am Statist Assoc. 1994;89:846–866]. Thus, the proposed full likelihood-based estimators improve on the efficiency of the AIPW estimators when the working propensity score model is correct but the working conditional score model is possibly incorrect, and also improve on the empirical likelihood estimators of Qin, Zhang and Leung [Empirical likelihood in missing data problems. J Amer Statist Assoc. 2009;104:1492–1503] when the reverse is true, that is, the working conditional score model is correct but the working propensity score model is possibly incorrect. In addition, we consider a regression method for estimation of the regression coefficients when the working conditional score model is correctly specified; the asymptotic variance of the resulting estimator is no greater than the semiparametric variance bound characterized by the theory of Robins et al. [Estimation of regression coefficients when some regressors are not always observed. J Amer Statist Assoc. 1994;89:846–866]. Finally, we compare the finite-sample performance of various estimators in a simulation study.     

Comparison of Type I error rates and statistical power of different propensity score methods

Propensity score analysis (PSA) is a technique to correct for potential confounding in observational studies. Covariate adjustment, matching, stratification, and inverse weighting are the four most commonly used methods involving propensity scores. The main goal of this research is to determine which PSA method performs the best in terms of protecting against spurious association detection, as measured by Type I error rate, while maintaining sufficient power to detect a true association, if one exists. An examination of these PSA methods along with ordinary least squares regression was conducted under two cases: correct PSA model specification and incorrect PSA model specification. PSA covariate adjustment and PSA matching maintain the nominal Type I error rate, when the PSA model is correctly specified, but only PSA covariate adjustment achieves adequate power levels. Other methods produced conservative Type I Errors in some scenarios, while liberal Type I error rates were observed in other scenarios.     

The effects of exchange rate regimes on economic growth: evidence from propensity score matching estimates

This is the first study that employs the propensity score matching framework to examine the average treatment effect of exchange rate regimes on economic growth. Previous studies examining the effects of different exchange regimes on growth often apply time series or panel data techniques and provide mixed results. This study employs a variety of non-parametric matching methods to address the self-selection problem, which potentially causes a bias in the traditional linear regressions. We evaluate the average treatment effect of the floating exchange rate regime on economic growth in 164 countries. Time period of the quasi experiment starts in 1970, capturing the collapse of the Bretton Woods fixed exchange rate commitment system. Results show that the average treatment effect of floating exchange rate regimes on economic growth is statistically insignificant. Verifying the results with the Rosenbaum's bounds, our findings are strong and robust. The research states that there is no evidence that employing a floating exchange rate regime compared to a fixed one leads to a higher economic growth for the countries that use this particular policy.     

Using generalized doubly robust estimator to estimate average treatment effects of multiple treatments in observational studies

The generalized doubly robust estimator is proposed for estimating the average treatment effect (ATE) of multiple treatments based on the generalized propensity score (GPS). In medical researches where observational studies are conducted, estimations of ATEs are usually biased since the covariate distributions could be unbalanced among treatments. To overcome this problem, Imbens [The role of the propensity score in estimating dose-response functions, Biometrika 87 (2000), pp. 706–710] and Feng et al. [Generalized propensity score for estimating the average treatment effect of multiple treatments, Stat. Med. (2011), in press. Available at: http://onlinelibrary.wiley.com/doi/10.1002/sim.4168/abstract] proposed weighted estimators that are extensions of a ratio estimator based on GPS to estimate ATEs with multiple treatments. However, the ratio estimator always produces a larger empirical sample variance than the doubly robust estimator, which estimates an ATE between two treatments based on the estimated propensity score (PS). We conduct a simulation study to compare the performance of our proposed estimator with Imbens’ and Feng et al.’s estimators, and simulation results show that our proposed estimator outperforms their estimators in terms of bias, empirical sample variance and mean-squared error of the estimated ATEs.     

Approximate Likelihoods for Generalized Linear Errors-in-variables Models

When measurement error is present in covariates, it is well known that naïvely fitting a generalized linear model results in inconsistent inferences. Several methods have been proposed to adjust for measurement error without making undue distributional assumptions about the unobserved true covariates. Stefanski and Carroll focused on an unbiased estimating function rather than a likelihood approach. Their estimating function, known as the conditional score, exists for logistic regression models but has two problems: a poorly behaved Wald test and multiple solutions. They suggested a heuristic procedure to identify the best solution that works well in practice but has little theoretical support compared with maximum likelihood estimation. To help to resolve these problems, we propose a conditional quasi-likelihood to accompany the conditional score that provides an alternative to Wald's test and successfully identifies the consistent solution in large samples.     

Survival analysis using inverse probability of treatment weighted methods based on the generalized propensity score

In survival analysis, treatment effects are commonly evaluated based on survival curves and hazard ratios as causal treatment effects. In observational studies, these estimates may be biased due to confounding factors. The inverse probability of treatment weighted (IPTW) method based on the propensity score is one of the approaches utilized to adjust for confounding factors between binary treatment groups. As a generalization of this methodology, we developed an exact formula for an IPTW log‐rank test based on the generalized propensity score for survival data. This makes it possible to compare the group differences of IPTW Kaplan–Meier estimators of survival curves using an IPTW log‐rank test for multi‐valued treatments. As causal treatment effects, the hazard ratio can be estimated using the IPTW approach. If the treatments correspond to ordered levels of a treatment, the proposed method can be easily extended to the analysis of treatment effect patterns with contrast statistics. In this paper, the proposed method is illustrated with data from the Kyushu Lipid Intervention Study (KLIS), which investigated the primary preventive effects of pravastatin on coronary heart disease (CHD). The results of the proposed method suggested that pravastatin treatment reduces the risk of CHD and that compliance to pravastatin treatment is important for the prevention of CHD. Copyright © 2009 John Wiley & Sons, Ltd.     

Does the supplemental nutrition assistance program really increase obesity? The importance of accounting for misclassification errors

The prevalence of obesity among US citizens has grown rapidly over the last few decades, especially among low-income individuals. This has led to questions about the effectiveness of nutritional assistance programs such as the Supplemental Nutrition Assistance Program (SNAP). Previous results on the effect of SNAP participation on obesity are mixed. These findings are however based on the assumption that participation status can be accurately observed, despite significant misclassification errors reported in the literature. Using propensity score matching, we conclude that there seems to be a positive effect of SNAP participation on obesity rates for female participants and no such effect for males, a result that is consistent with several previous studies. However, an extensive sensitivity analysis reveals that the positive effect for females is sensitive to misclassification errors and to the conditional independence assumption. Thus analogous findings should also be used with caution unless examined under the prism of classification errors and of other assumptions used for the identification of causal parameters.     

Propensity score applied to survival data analysis through proportional hazards models: a Monte Carlo study

Propensity score methods are increasingly used in medical literature to estimate treatment effect using data from observational studies. Despite many papers on propensity score analysis, few have focused on the analysis of survival data. Even within the framework of the popular proportional hazard model, the choice among marginal, stratified or adjusted models remains unclear. A Monte Carlo simulation study was used to compare the performance of several survival models to estimate both marginal and conditional treatment effects. The impact of accounting or not for pairing when analysing propensity‐score‐matched survival data was assessed. In addition, the influence of unmeasured confounders was investigated. After matching on the propensity score, both marginal and conditional treatment effects could be reliably estimated. Ignoring the paired structure of the data led to an increased test size due to an overestimated variance of the treatment effect. Among the various survival models considered, stratified models systematically showed poorer performance. Omitting a covariate in the propensity score model led to a biased estimation of treatment effect, but replacement of the unmeasured confounder by a correlated one allowed a marked decrease in this bias. Our study showed that propensity scores applied to survival data can lead to unbiased estimation of both marginal and conditional treatment effect, when marginal and adjusted Cox models are used. In all cases, it is necessary to account for pairing when analysing propensity‐score‐matched data, using a robust estimator of the variance. Copyright © 2012 John Wiley & Sons, Ltd.