Commonly used semiparametric estimators of causal effects specify parametric models for the propensity score (PS) and the conditional outcome. An example is an augmented inverse probability weighting (IPW) estimator, frequently referred to as a doubly robust estimator, because it is consistent if at least one of the two models is correctly specified. However, in many observational studies, the role of the parametric models is often not to provide a representation of the data-generating process but rather to facilitate the adjustment for confounding, making the assumption of at least one true model unlikely to hold. In this paper, we propose a crude analytical approach to study the large-sample bias of estimators when the models are assumed to be approximations of the data-generating process, namely, when all models are misspecified. We apply our approach to three prototypical estimators of the average causal effect, two IPW estimators, using a misspecified PS model, and an augmented IPW (AIPW) estimator, using misspecified models for the outcome regression (OR) and the PS. For the two IPW estimators, we show that normalization, in addition to having a smaller variance, also offers some protection against bias due to model misspecification. To analyze the question of when the use of two misspecified models is better than one we derive necessary and sufficient conditions for when the AIPW estimator has a smaller bias than a simple IPW estimator and when it has a smaller bias than an IPW estimator with normalized weights. If the misspecification of the outcome model is moderate, the comparisons of the biases of the IPW and AIPW estimators show that the AIPW estimator has a smaller bias than the IPW estimators. However, all biases include a scaling with the PS-model error and we suggest caution in modeling the PS whenever such a model is involved. For numerical and finite sample illustrations, we include three simulation studies and corresponding approximations of the large-sample biases. In a dataset from the National Health and Nutrition Examination Survey, we estimate the effect of smoking on blood lead levels.
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http://dx.doi.org/10.1002/bimj.202100118 | DOI Listing |
Stat Med
February 2025
Department of Biomedical Statistics, Graduate School of Medicine, Osaka University, Osaka, Japan.
In estimating the average treatment effect in observational studies, the influence of confounders should be appropriately addressed. To this end, the propensity score is widely used. If the propensity scores are known for all the subjects, bias due to confounders can be adjusted by using the inverse probability weighting (IPW) by the propensity score.
View Article and Find Full Text PDFJ Acquir Immune Defic Syndr
January 2025
West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
Background: Fertility desire-based service guided by behavioral theory is a potential strategy to mitigate the HIV transmission risk, while related evidence remains scarce. We examined the long-term effect of theory-guided fertility desire-based services on HIV seroconversion between seropositive/seronegative partners in areas with high HIV prevalence and a cultural emphasis on fertility in China.
Methods: We established a retrospective cohort by recruiting 8,653 seropositive partners with seronegative partners between January 1, 2009, and December 31, 2020, in Liangshan, China.
Clinical trials have shown favorable effects of exercise on frailty, supporting physical activity (PA) as a treatment and prevention strategy. Proteomics studies suggest that PA alters levels of many proteins, some of which may function as molecules in the biological processes underlying frailty. However, these studies have focused on structured exercise programs or cross-sectional PA-protein associations.
View Article and Find Full Text PDFAm J Epidemiol
December 2024
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Target trial emulation (TTE) is a popular framework for observational studies based on electronic health records (EHR). A key component of this framework is determining the patient population eligible for inclusion in both a target trial of interest and its observational emulation. Missingness in variables that define eligibility criteria, however, presents a major challenge towards determining the eligible population when emulating a target trial with an observational study.
View Article and Find Full Text PDFJ Clin Periodontol
December 2024
Faculty of Medicine, Department of Clinical Dentistry, University of Bergen, Bergen, Norway.
Aim: The objective of this cross-sectional survey was to assess the attitude among general practitioners (GPs) and periodontal specialists (PSs) in Norway towards developing and implementing guideline-based periodontal referral practise.
Material And Methods: A multiple-choice questionnaire was distributed online to a sample of professionally active GPs and PSs. The survey included questions on demographics, practise profile, proficiency and insight among oral healthcare providers, periodontal referral patterns, and attitude on establishing guideline-based referral practise.
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