Inference for proportional hazard model with propensity score

Since the publication of the seminal paper by Cox (1972), proportional hazard model has become very popular in regression analysis for right censored data. In observational studies, treatment assignment may depend on observed covariates. If these confounding variables are not accounted for properly, the inference based on the Cox proportional hazard model may perform poorly. As shown in Rosenbaum and Rubin (1983), under the strongly ignorable treatment assignment assumption, conditioning on the propensity score yields valid causal effect estimates. Therefore we incorporate the propensity score into the Cox model for causal inference with survival data. We derive the asymptotic property of the maximum partial likelihood estimator when the model is correctly specified. Simulation results show that our method performs quite well for observational data. The approach is applied to a real dataset on the time of readmission of trauma patients. We also derive the asymptotic property of the maximum partial likelihood estimator with a robust variance estimator, when the model is incorrectly specified.     

The formation and outcomes of cohabiting and marital partnerships in early adulthood: the role of previous partnership experience

Summary.  We estimate a joint model of the formation and dissolution of cohabiting and marital unions among British women who were born in 1970. The focus of the analysis is the effect of previous cohabitation and marriage on subsequent partnership transitions. We use a multilevel simultaneous equations event history model to allow for residual correlation between the hazards of moving from an unpartnered state into cohabitation or marriage, converting a cohabiting union into marriage and dissolution of either form of union. A simultaneous modelling approach allows for the joint determination of these transitions, which may otherwise bias estimates of the effects of previous partnership outcomes on later transitions.     

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.     

Matching Using Sufficient Dimension Reduction for Causal Inference

ABSTRACT

To estimate causal treatment effects, we propose a new matching approach based on the reduced covariates obtained from sufficient dimension reduction. Compared with the original covariates and the propensity score, which are commonly used for matching in the literature, the reduced covariates are nonparametrically estimable and are effective in imputing the missing potential outcomes, under a mild assumption on the low-dimensional structure of the data. Under the ignorability assumption, the consistency of the proposed approach requires a weaker common support condition. In addition, researchers are allowed to employ different reduced covariates to find matched subjects for different treatment groups. We develop relevant asymptotic results and conduct simulation studies as well as real data analysis to illustrate the usefulness of the proposed approach.     

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.     

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.     

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.     

基于协变量平衡加权的平均处理效应的稳健有效估计

倾向性得分是估计平均处理效应的重要工具。但在观察性研究中,通常会由于协变量在处理组与对照组分布的不平衡性而导致极端倾向性得分的出现,即存在十分接近于0或1的倾向性得分,这使得因果推断的强可忽略假设接近于违背,进而导致平均处理效应的估计出现较大的偏差与方差。Li等(2018a)提出了协变量平衡加权法,在无混杂性假设下通过实现协变量分布的加权平衡,解决了极端倾向性得分带来的影响。本文在此基础上,提出了基于协变量平衡加权法的稳健且有效的估计方法,并通过引入超级学习算法提升了模型在实证应用中的稳健性;更进一步,将前一方法推广至理论上不依赖于结果回归模型和倾向性得分模型假设的基于协变量平衡加权的稳健有效估计。蒙特卡洛模拟表明,本文提出的两种方法在结果回归模型和倾向性得分模型均存在误设时仍具有极小的偏差和方差。实证部分将两种方法应用于右心导管插入术数据,发现右心导管插入术大约会增加患者6. 3%死亡率。     

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.     

Propensity score model specification for estimation of average treatment effects

Treatment effect estimators that utilize the propensity score as a balancing score, e.g., matching and blocking estimators are robust to misspecifications of the propensity score model when the misspecification is a balancing score. Such misspecifications arise from using the balancing property of the propensity score in the specification procedure. Here, we study misspecifications of a parametric propensity score model written as a linear predictor in a strictly monotonic function, e.g. a generalized linear model representation. Under mild assumptions we show that for misspecifications, such as not adding enough higher order terms or choosing the wrong link function, the true propensity score is a function of the misspecified model. Hence, the latter does not bring bias to the treatment effect estimator. It is also shown that a misspecification of the propensity score does not necessarily lead to less efficient estimation of the treatment effect. The results of the paper are highlighted in simulations where different misspecifications are studied.     

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.     

A Note on the Role of the Propensity Score for Estimating Average Treatment Effects

Hahn [Hahn, J. (1998). On the role of the propensity score in efficient semiparametric estimation of average treatment effects. Econometrica 66:315-331] derived the semiparametric efficiency bounds for estimating the average treatment effect (ATE) and the average treatment effect on the treated (ATET). The variance of ATET depends on whether the propensity score is known or unknown. Hahn attributes this to “dimension reduction.” In this paper, an alternative explanation is given: Knowledge of the propensity score improves upon the estimation of the distribution of the confounding variables.     

Multiply robust matching estimators of average and quantile treatment effects

Propensity score matching has been a long-standing tradition for handling confounding in causal inference, however, requiring stringent model assumptions. In this article, we propose novel double score matching (DSM) utilizing both the propensity score and prognostic score. To gain the protection of possible model misspecification, we posit multiple candidate models for each score. We show that the debiasing DSM estimator achieves the multiple robustness property in that it is consistent if any one of the score models is correctly specified. We characterize the asymptotic distribution for the DSM estimator requiring only one correct model specification based on the martingale representations of the matching estimators and theory for local normal experiments. We also provide a two-stage replication method for variance estimation and extend DSM for quantile estimation. Simulation demonstrates DSM outperforms single-score matching and prevailing multiply robust weighting estimators in the presence of extreme propensity scores.     

Non-parametric inference for the effect of a treatment on survival times with application in the health and social sciences

In this paper we perform inference on the effect of a treatment on survival times in studies where the treatment assignment is not randomized and the assignment time is not known in advance. Two such studies are discussed: a heart transplant program and a study of Swedish unemployed eligible for employment subsidy. We estimate survival functions on a treated and a control group which are made comparable through matching on observed covariates. The inference is performed by conditioning on waiting time to treatment, that is, time between the entrance in the study and treatment. This can be done only when sufficient data are available. In other cases, averaging over waiting times is a possibility, although the classical interpretation of the estimated survival functions is lost unless hazards are not functions of waiting time. To show unbiasedness and to obtain an estimator of the variance, we build on the potential outcome framework, which was introduced by J. Neyman in the context of randomized experiments, and adapted to observational studies by D.B. Rubin. Our approach does not make parametric or distributional assumptions. In particular, we do not assume proportionality of the hazards compared. Small sample performance of the estimator and a derived test of no treatment effect are studied in a Monte Carlo study.     

工会会员身份对农民工工资率的影响——基于代际差异的视角

本文采用2013年和2016年广东省佛山市南海区“雇主—雇员”匹配数据库,利用倾向得分匹配和工具变量等估计方法,实证检验了工会会员身份对农民工工资率的影响及其在两代农民工之间的差异,并进行了影响机制的探索和分析。研究发现,将工会会员身份的工资溢价效应分解为覆盖效应和会员效应后,覆盖效应的影响难以发挥,而会员效应的影响则存在代际差异,其只在新生代农民工中显著,而在第一代农民工中不显著。进一步研究发现,覆盖效应难以发挥主要是由于工会未能有效地开展集体协商,会员效应存在代际差异则是源于两代农民工不同的需求层次所导致的入会行为导向的不同。本文研究,有利于企业工会着力解决农民工的工资问题,建立农民工工资的长效增长机制,同时为企业构建和谐劳动关系以及实施多元化的人力资源管理策略等提供参考和借鉴。     

Cohabitation in Great Britain: not for long, but here to stay

This paper uses a new source of data to study the dramatic increase in cohabiting unions in Great Britain. It analyses, in turn, entry into first partnership, the stability of cohabiting unions and repartnering after dissolution of cohabitation. In excess of 70% of first partnerships are now cohabitations, and these last a relatively short time before being either turned into marriage or dissolved. The shift to cohabitation as the dominant mode of first partnership plays an important role in the delay of first marriage and motherhood. The paper also investigates the factors that are associated with the outcome of cohabitations.     

A nonparametric test to compare survival distributions with covariate adjustment

Summary.  The analysis of covariance is a technique that is used to improve the power of a k -sample test by adjusting for concomitant variables. If the end point is the time of survival, and some observations are right censored, the score statistic from the Cox proportional hazards model is the method that is most commonly used to test the equality of conditional hazard functions. In many situations, however, the proportional hazards model assumptions are not satisfied. Specifically, the relative risk function is not time invariant or represented as a log-linear function of the covariates. We propose an asymptotically valid k -sample test statistic to compare conditional hazard functions which does not require the assumption of proportional hazards, a parametric specification of the relative risk function or randomization of group assignment. Simulation results indicate that the performance of this statistic is satisfactory. The methodology is demonstrated on a data set in prostate cancer.     

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.     

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.     

Prognostic score matching methods for estimating the average effect of a non-reversible binary time-dependent treatment on the survival function

In evaluating the benefit of a treatment on survival, it is often of interest to compare post-treatment survival with the survival function that would have been observed in the absence of treatment. In many practical settings, treatment is time-dependent in the sense that subjects typically begin follow-up untreated, with some going on to receive treatment at some later time point. In observational studies, treatment is not assigned at random and, therefore, may depend on various patient characteristics. We have developed semi-parametric matching methods to estimate the average treatment effect on the treated (ATT) with respect to survival probability and restricted mean survival time. Matching is based on a prognostic score which reflects each patient’s death hazard in the absence of treatment. Specifically, each treated patient is matched with multiple as-yet-untreated patients with similar prognostic scores. The matched sets do not need to be of equal size, since each matched control is weighted in order to preserve risk score balancing across treated and untreated groups. After matching, we estimate the ATT non-parametrically by contrasting pre- and post-treatment weighted Nelson–Aalen survival curves. A closed-form variance is proposed and shown to work well in simulation studies. The proposed methods are applied to national organ transplant registry data.