In failure-time settings, a competing risk event is any event that makes it impossible for the event of interest to occur. For example, cardiovascular disease death is a competing event for prostate cancer death because an individual cannot die of prostate cancer once he has died of cardiovascular disease. Various statistical estimands have been defined as possible targets of inference in the classical competing risks literature. Many reviews have described these statistical estimands and their estimating procedures with recommendations about their use. However, this previous work has not used a formal framework for characterizing causal effects and their identifying conditions, which makes it difficult to interpret effect estimates and assess recommendations regarding analytic choices. Here we use a counterfactual framework to explicitly define each of these classical estimands. We clarify that, depending on whether competing events are defined as censoring events, contrasts of risks can define a total effect of the treatment on the event of interest, or a direct effect of the treatment on the event of interest not mediated through the competing event. In contrast, regardless of whether competing events are defined as censoring events, counterfactual hazard contrasts cannot generally be interpreted as causal effects. We illustrate how identifying assumptions for all of these counterfactual estimands can be represented in causal diagrams in which competing events are depicted as time-varying covariates. We present an application of these ideas to data from a randomized trial designed to estimate the effect of estrogen therapy on prostate cancer mortality.
The ICH E9 addendum introduces the term intercurrent event to refer to events that happen after randomisation and that can either preclude observation of the outcome of interest or affect its interpretation. It proposes five strategies for handling intercurrent events to form an estimand but does not suggest statistical methods for estimation. In this paper we focus on the hypothetical strategy, where the treatment effect is defined under the hypothetical scenario in which the intercurrent event is prevented. For its estimation, we consider causal inference and missing data methods. We establi…
The population-attributable fraction (PAF) is a popular epidemiological measure for the burden of a harmful exposure within a population. It is often interpreted causally as proportion of preventable cases after an elimination of exposure. Originally, the PAF has been defined for cohort studies of fixed length with a baseline exposure or cross-sectional studies. An extension of the definition to complex time-to-event data is not straightforward. We revise the proposed approaches in literature and provide a clear concept of the PAF for these data situations. The conceptualization is achieved by…
Assessing the causal effects of interventions on ordinal outcomes is an important objective of many educational and behavioral studies. Under the potential outcomes framework, we can define causal effects as comparisons between the potential outcomes under treatment and control. However, unfortunately, the average causal effect, often the parameter of interest, is difficult to interpret for ordinal outcomes. To address this challenge, we propose to use two causal parameters, which are defined as the probabilities that the treatment is beneficial and strictly beneficial for the experimental uni…
Case-control designs are an important tool in contrasting the effects of well-defined treatments. In this paper, we reconsider classical concepts, assumptions and principles and explore when the results of case-control studies can be endowed a causal interpretation. Our focus is on identification of target causal quantities, or estimands. We cover various estimands relating to intention-to-treat or per-protocol effects for popular sampling schemes (case-base, survivor, and risk-set sampling), each with and without matching. Our approach may inform future research on different estimands, other …
Background: Interpreting instrumental variable results often requires further assumptions in addition to the core assumptions of relevance, independence, and the exclusion restriction. Methods: We assess whether instrument-exposure additive homogeneity renders the Wald estimand equal to the average derivative effect (ADE) in the case of a binary instrument and a continuous exposure. Results: Instrument-exposure additive homogeneity is insufficient for ADE identification when the instrument is binary, the exposure is continuous and the effect of the exposure on the outcome is non-linear on the …
In observational study, the propensity score has the central role to estimate causal effects. Since the propensity score is usually unknown, estimating by appropriate procedures is an indispensable step. A point to note that a causal effect estimator might have some bias if a propensity score model was misspecified; valid model construction is important. To overcome the problem, a variety of interesting methods has been proposed. In this paper, we review four methods: using ordinary logistic regression approach; CBPS proposed by Imai and Ratkovic; boosted CART proposed by McCaffrey and colleag…
Inferring causal effects from an observational study is challenging because participants are not randomized to treatment. Observational studies in infectious disease research present the additional challenge that one participant's treatment may affect another participant's outcome, i.e., there may be interference. In this paper recent approaches to defining causal effects in the presence of interference are considered, and new causal estimands designed specifically for use with observational studies are proposed. Previously defined estimands target counterfactual scenarios in which individuals…
Clinical studies sometimes encounter truncation by death, rendering outcomes undefined. Statistical analysis based solely on observed survivors may give biased results because the characteristics of survivors differ between treatment groups. By principal stratification, the survivor average causal effect was proposed as a causal estimand defined in always-survivors. However, this estimand is not identifiable when there is unmeasured confounding between the treatment assignment and survival or outcome process. In this paper, we consider the comparison between an aggressive treatment and a conse…
Causal Inference with Missing Exposures and Missing Outcomes
University of California Berkeley（加州大学伯克利分校）；University of California San Francisco（加州大学旧金山分校）；Infectious Diseases Research Collaboration（传染病研究协作组织）；Makerere University（马凯雷雷大学）
Factorial designs are widely used due to their ability to accommodate multiple factors simultaneously. The factor-based regression with main effects and some interactions is the dominant strategy for downstream data analysis, delivering point estimators and standard errors via one single regression. Justification of these convenient estimators from the design-based perspective requires quantifying their sampling properties under the assignment mechanism conditioning on the potential outcomes. To this end, we derive the sampling properties of the factor-based regression estimators from both sat…
Causal mediation in cluster-randomized trials with multiple mediators: spillover-aware decomposition, identification, and semiparametric efficient inference
Causal inference methods are gaining increasing prominence in pharmaceutical drug development in light of the recently published addendum on estimands and sensitivity analysis in clinical trials to the E9 guideline of the International Council for Harmonisation. The E9 addendum emphasises the need to account for post-randomization or `intercurrent' events that can potentially influence the interpretation of a treatment effect estimate at a trial's conclusion. Instrumental Variables (IV) methods have been used extensively in economics, epidemiology and academic clinical studies for `causal infe…
Intercurrent events (ICEs) and missing values are inevitable in clinical trials of any size and duration, making it difficult to assess the treatment effect for all patients in randomized clinical trials. Defining the appropriate estimand that is relevant to the clinical research question is the first step in analyzing data. The tripartite estimands, which evaluate the treatment differences in the proportion of patients with ICEs due to adverse events, the proportion of patients with ICEs due to lack of efficacy, and the primary efficacy outcome for those who can adhere to study treatment unde…
Causal mediation analysis is complicated with multiple effect definitions that require different sets of assumptions for identification. This paper provides a systematic explanation of such assumptions. We define five potential outcome types whose means are involved in various effect definitions. We tackle their mean/distribution's identification, starting with the one that requires the weakest assumptions and gradually building up to the one that requires the strongest assumptions. This presentation shows clearly why an assumption is required for one estimand and not another, and provides a s…
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 double score matching(DSM) for general causal estimands utilizing two balancing scores including 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 de-biasing DSM estimator achieves the multiple robustness property in that it is consistent for the true causal estimand if any model of the propensity…
Causal identification of treatment effects for infectious disease outcomes in interconnected populations is challenging because infection outcomes may be transmissible to others, and treatment given to one individual may affect others' outcomes. Contagion, or transmissibility of outcomes, complicates standard conceptions of treatment interference in which an intervention delivered to one individual can affect outcomes of others. Several statistical frameworks have been proposed to measure causal treatment effects in this setting, including structural transmission models, mediation-based partne…
Many outcomes of interest in the social and health sciences, as well as in modern applications in computational social science and experimentation on social media platforms, are ordinal and do not have a meaningful scale. Causal analyses that leverage this type of data, termed ordinal non-numeric, require careful treatment, as much of the classical potential outcomes literature is concerned with estimation and hypothesis testing for outcomes whose relative magnitudes are well defined. Here, we propose a class of finite population causal estimands that depend on conditional distributions of the…
Most causal inference studies rely on the assumption of overlap to estimate population or sample average causal effects. When data exhibit non-overlap, estimation of these estimands requires reliance on model specifications, due to poor data support. All existing methods to address non-overlap, such as trimming or down-weighting data in regions of poor support, change the estimand. In environmental health research, where study results are often intended to influence policy, changes in the estimand can diminish the study's impact, because estimates may not be representative of effects in the po…
In non-network settings, encouragement designs have been widely used to analyze causal effects of a treatment, policy, or intervention on an outcome of interest when randomizing the treatment was considered impractical or when compliance to treatment cannot be perfectly enforced. Unfortunately, such questions related to treatment compliance have received less attention in network settings and the most well-studied experimental design in networks, the two-stage randomization design, requires perfect compliance with treatment. The paper proposes a new experimental design called peer encouragemen…
When interested in a time-to-event outcome, competing events that prevent the occurrence of the event of interest may be present. In the presence of competing events, various statistical estimands have been suggested for defining the causal effect of treatment on the event of interest. Depending on the estimand, the competing events are either accommodated or eliminated, resulting in causal effects with different interpretation. The former approach captures the total effect of treatment on the event of interest while the latter approach captures the direct effect of treatment on the event of i…
Investigators are increasingly using novel methods for extending (generalizing or transporting) causal inferences from a trial to a target population. In many generalizability and transportability analyses, the trial and the observational data from the target population are separately sampled, following a non-nested trial design. In practical implementations of this design, non-randomized individuals from the target population are often identified by conditioning on the use of a particular treatment, while individuals who used other candidate treatments for the same indication or individuals w…
We systematically investigate issues due to mis-specification that arise in estimating causal effects when (treatment) interference is informed by a network available pre-intervention, i.e., in situations where the outcome of a unit may depend on the treatment assigned to other units. We develop theory for several forms of interference through the concept of exposure neighborhood, and develop the corresponding semi-parametric representation for potential outcomes as a function of the exposure neighborhood. Using this representation, we extend the definition of two popular classes of causal est…
Statistical methods to evaluate the effectiveness of interventions are increasingly challenged by the inherent interconnectedness of units. Specifically, a recent flurry of methods research has addressed the problem of interference between observations, which arises when one observational unit's outcome depends not only on its treatment but also the treatment assigned to other units. We introduce the setting of bipartite causal inference with interference, which arises when 1) treatments are defined on observational units that are distinct from those at which outcomes are measured and 2) there…
In cluster randomized trials, patients are typically recruited after clusters are randomized, and the recruiters and patients may not be blinded to the assignment. This often leads to differential recruitment and consequently systematic differences in baseline characteristics of the recruited patients between intervention and control arms, inducing post-randomization selection bias. We rigorously define causal estimands in the presence of selection bias. We elucidate the conditions under which standard covariate adjustment methods can validly estimate these estimands. We further discuss the ad…
