The heterogeneity of treatment effect (HTE) lies at the heart of precision medicine. Randomized controlled trials are gold-standard for treatment effect estimation but are typically underpowered for heterogeneous effects. In contrast, large observational studies have high predictive power but are often confounded due to the lack of randomization of treatment. We show that an observational study, even subject to hidden confounding, may be used to empower trials in estimating the HTE using the notion of confounding function. The confounding function summarizes the impact of unmeasured confounders on the difference between the observed treatment effect and the causal treatment effect, given the observed covariates, which is unidentifiable based only on the observational study. Coupling the trial and observational study, we show that the HTE and confounding function are identifiable. We then derive the semiparametric efficient scores and the integrative estimators of the HTE and confounding function. We clarify the conditions under which the integrative estimator of the HTE is strictly more efficient than the trial estimator. Finally, we illustrate the integrative estimators via simulation and an application.
This paper presents a novel nonlinear regression model for estimating heterogeneous treatment effects from observational data, geared specifically towards situations with small effect sizes, heterogeneous effects, and strong confounding. Standard nonlinear regression models, which may work quite well for prediction, have two notable weaknesses when used to estimate heterogeneous treatment effects. First, they can yield badly biased estimates of treatment effects when fit to data with strong confounding. The Bayesian causal forest model presented in this paper avoids this problem by directly in…
It is often of interest in the health and social sciences to investigate the joint mediation effects of multiple post-exposure mediating variables. Identification of such joint mediation effects generally require no unmeasured confounding of the outcome with respect to the whole set of mediators. As the number of mediators under consideration grows, this key assumption is likely to be violated as it is often infeasible to intervene on any of the mediators. In this paper, we develop a simple two-step method of moments estimation procedure to assess mediation with multiple mediators simultaneous…
Two important considerations in clinical research studies are proper evaluations of internal and external validity. While randomized clinical trials can overcome several threats to internal validity, they may be prone to poor external validity. Conversely, large prospective observational studies sampled from a broadly generalizable population may be externally valid, yet susceptible to threats to internal validity, particularly confounding. Thus, methods that address confounding and enhance transportability of study results across populations are essential for internally and externally valid c…
A fundamental limitation of causal inference in observational studies is that perceived evidence for an effect might instead be explained by factors not accounted for in the primary analysis. Methods for assessing the sensitivity of a study's conclusions to unmeasured confounding have been established under the assumption that the treatment effect is constant across all individuals. In the potential presence of unmeasured confounding, it has been argued that certain patterns of effect heterogeneity may conspire with unobserved covariates to render the performed sensitivity analysis inadequate.…
An important concern in an observational study is whether or not there is unmeasured confounding, i.e., unmeasured ways in which the treatment and control groups differ before treatment that affect the outcome. We develop a test of whether there is unmeasured confounding when an instrumental variable (IV) is available. An IV is a variable that is independent of the unmeasured confounding and encourages a subject to take one treatment level vs. another, while having no effect on the outcome beyond its encouragement of a certain treatment level. We show what types of unmeasured confounding can b…
The Predictive Approaches to Treatment Effect Heterogeneity statement focused on baseline risk as a robust predictor of treatment effect and provided guidance on risk-based assessment of treatment effect heterogeneity in the RCT setting. The aim of this study was to extend this approach to the observational setting using a standardized scalable framework. The proposed framework consists of five steps: 1) definition of the research aim, i.e., the population, the treatment, the comparator and the outcome(s) of interest; 2) identification of relevant databases; 3) development of a prediction mode…
Estimating treatment effects conditional on observed covariates can improve the ability to tailor treatments to particular individuals. Doing so effectively requires dealing with potential confounding, and also enough data to adequately estimate effect moderation. A recent influx of work has looked into estimating treatment effect heterogeneity using data from multiple randomized controlled trials and/or observational datasets. With many new methods available for assessing treatment effect heterogeneity using multiple studies, it is important to understand which methods are best used in which …
Semiparametric Mediation Analysis with Separately Observed Mediator and Outcome under Unmeasured Confounding
Department of Biostatistics, University of California, Los Angeles（加州大学洛杉矶分校生物统计系）；Department of Biostatistics, Harvard T.H. Chan School of Public Health（哈佛大学陈曾熙公共卫生学院生物统计系）
Methods utilizing instrumental variables have been a fundamental statistical approach to estimation in the presence of unmeasured confounding, usually occurring in non-randomized observational data common to fields such as economics and public health. However, such methods usually make constricting linearity and additivity assumptions that are inapplicable to the complex modeling challenges of today. The growing body of observational data being collected will necessitate flexible regression modeling while also being able to control for confounding using instrumental variables. Therefore, this …
Suppose one is interested in estimating causal effects in the presence of potentially unmeasured confounding with the aid of a valid instrumental variable. This paper investigates the problem of making inferences about the average treatment effect when data are fused from two separate sources, one of which contains information on the treatment and the other contains information on the outcome, while values for the instrument and a vector of baseline covariates are recorded in both. We provide a general set of sufficient conditions under which the average treatment effect is nonparametrically i…
The rich longitudinal individual level data available from electronic health records (EHRs) can be used to examine treatment effect heterogeneity. However, estimating treatment effects using EHR data poses several challenges, including time-varying confounding, repeated and temporally non-aligned measurements of covariates, treatment assignments and outcomes, and loss-to-follow-up due to dropout. Here, we develop the Subgroup Discovery for Longitudinal Data (SDLD) algorithm, a tree-based algorithm for discovering subgroups with heterogeneous treatment effects using longitudinal data by combini…
The idea of "stratified medicine" is an important driver of methodological research on the identification of predictive biomarkers. Most methods proposed so far for this purpose have been developed for the use on randomized data only. However, especially for rare cancers, data from clinical registries or observational studies might be the only available data source. For such data, methods for an unbiased estimation of the average treatment effect are well established. Research on confounder adjustment when investigating the heterogeneity of treatment effects and the variables responsible for t…
Bayesian causal inference offers a principled approach to policy evaluation of proposed interventions on mediators or time-varying exposures. We outline a general approach to the estimation of causal quantities for settings with time-varying confounding, such as exposure-induced mediator-outcome confounders. We further extend this approach to propose two Bayesian data fusion (BDF) methods for unmeasured confounding. Using informative priors on quantities relating to the confounding bias parameters, our methods incorporate data from an external source where the confounder is measured in order t…
Dynamic prediction of causal effects under different treatment regimes conditional on an individual's characteristics and longitudinal history is an essential problem in precision medicine. This is challenging in practice because outcomes and treatment assignment mechanisms are unknown in observational studies, an individual's treatment efficacy is a counterfactual, and the existence of selection bias is often unavoidable. We propose a Bayesian framework for identifying subgroup counterfactual benefits of dynamic treatment regimes by adapting Bayesian g-computation algorithm (J. Robins, 1986; …
Data from both a randomized trial and an observational study are sometimes simultaneously available for evaluating the effect of an intervention. The randomized data typically allows for reliable estimation of average treatment effects but may be limited in sample size and patient heterogeneity for estimating conditional average treatment effects for a broad range of patients. Estimates from the observational study can potentially compensate for these limitations, but there may be concerns about whether confounding and treatment effect heterogeneity have been adequately addressed. We propose a…
Observational studies can play a useful role in assessing the comparative effectiveness of competing treatments. In a clinical trial the randomization of participants to treatment and control groups generally results in well-balanced groups with respect to possible confounders, which makes the analysis straightforward. However, when analysing observational data, the potential for unmeasured confounding makes comparing treatment effects much more challenging. Causal inference methods such as Instrumental Variable and Prior Even Rate Ratio approaches make it possible to circumvent the need to ad…
Understanding treatment heterogeneity is essential to the development of precision medicine, which seeks to tailor medical treatments to subgroups of patients with similar characteristics. One of the challenges to achieve this goal is that we usually do not have a priori knowledge of the grouping information of patients with respect to treatment. To address this problem, we consider a heterogeneous regression model by assuming that the coefficient for treatment variables are subject-dependent and belong to different subgroups with unknown grouping information. We develop a concave fusion penal…
Individuals do not respond uniformly to treatments, events, or interventions. Sociologists routinely partition samples into subgroups to explore how the effects of treatments vary by covariates like race, gender, and socioeconomic status. In so doing, analysts determine the key subpopulations based on theoretical priors. Data-driven discoveries are also routine, yet the analyses by which sociologists typically go about them are problematic and seldom move us beyond our expectations, and biases, to explore new meaningful subgroups. Emerging machine learning methods allow researchers to explore …
Standard Mendelian randomization analysis can produce biased results if the genetic variant defining the instrumental variable (IV) is confounded and/or has a horizontal pleiotropic effect on the outcome of interest not mediated by the treatment. We provide novel identification conditions for the causal effect of a treatment in presence of unmeasured confounding, by leveraging an invalid IV for which both the IV independence and exclusion restriction assumptions may be violated. The proposed Mendelian Randomization Mixed-Scale Treatment Effect Robust Identification (MR MiSTERI) approach relies…
Hazard ratios are prone to selection bias, compromising their use as causal estimands. On the other hand, the hazard difference has been shown to remain unaffected by the selection of frailty factors over time. Therefore, observed hazard differences can be used as an unbiased estimator for the causal hazard differences in the absence of confounding. However, in the presence of effect (on the hazard) heterogeneity, the hazard difference is also affected by selection. In this work, we formalize how the observed hazard difference (from a randomized controlled trial) evolves by selecting favourabl…
Principal Stratification with Bayesian Additive Regression Trees for Count-Valued Intermediate Variables: Estimating the Effect of Fertility on Women's Employment
Centre for Big Data Research in Health (CBDRH)（健康大数据研究中心）
Causal inference for observational longitudinal studies often requires the accurate estimation of treatment effects on time-to-event outcomes in the presence of time-dependent patient history and time-dependent covariates. To tackle this longitudinal treatment effect estimation problem, we have developed a time-variant causal survival (TCS) model that uses the potential outcomes framework with an ensemble of recurrent subnetworks to estimate the difference in survival probabilities and its confidence interval over time as a function of time-dependent covariates and treatments. Using simulated …
Targeted Data Fusion for Region-Specific Survival Effects in the AMP HIV Prevention Trials
North Carolina State University（北卡罗来纳州立大学）；Duke Clinical Research Institute（杜克临床研究所）；University of Pennsylvania（宾夕法尼亚大学）；Duke University School of Medicine（杜克大学医学院）；Fred Hutch Cancer Center（弗雷德·哈钦癌症中心）；Brown University（布朗大学）
When assessing causal effects, determining the target population to which the results are intended to generalize is a critical decision. Randomized and observational studies each have strengths and limitations for estimating causal effects in a target population. Estimates from randomized data may have internal validity but are often not representative of the target population. Observational data may better reflect the target population, and hence be more likely to have external validity, but are subject to potential bias due to unmeasured confounding. While much of the causal inference litera…
Heterogeneity is a hallmark of many complex diseases. There are multiple ways of defining heterogeneity, among which the heterogeneity in genetic regulations, for example GEs (gene expressions) by CNVs (copy number variations) and methylation, has been suggested but little investigated. Heterogeneity in genetic regulations can be linked with disease severity, progression, and other traits and is biologically important. However, the analysis can be very challenging with the high dimensionality of both sides of regulation as well as sparse and weak signals. In this article, we consider the scena…
The paper proposes an estimator to make inference of heterogeneous treatment effects sorted by impact groups (GATES) for non-randomised experiments. The groups can be understood as a broader aggregation of the conditional average treatment effect (CATE) where the number of groups is set in advance. In economics, this approach is similar to pre-analysis plans. Observational studies are standard in policy evaluation from labour markets, educational surveys and other empirical studies. To control for a potential selection-bias, we implement a doubly-robust estimator in the first stage. We use mac…
Centre for Computer Vision, Speech, and Signal Processing（计算机视觉、语音与信号处理中心）；University of Surrey（萨里大学）
Undertaking causal inference with observational data is incredibly useful across a wide range of tasks including the development of medical treatments, advertisements and marketing, and policy making. There are two significant challenges associated with undertaking causal inference using observational data: treatment assignment heterogeneity (\textit{i.e.}, differences between the treated and untreated groups), and an absence of counterfactual data (\textit{i.e.}, not knowing what would have happened if an individual who did get treatment, were instead to have not been treated). We address the…
Uncovering the heterogeneity in the disease progression of Alzheimer's is a key factor to disease understanding and treatment development, so that interventions can be tailored to target the subgroups that will benefit most from the treatment, which is an important goal of precision medicine. However, in practice, one top methodological challenge hindering the heterogeneity investigation is that the true subgroup membership of each individual is often unknown. In this article, we aim to identify latent subgroups of individuals who share a common disorder progress over time, to predict latent s…
