Estimating causal effects of continuous-time dynamic treatments with unmeasured confounders
Key Laboratory of Advanced Theory and Application in Statistics and Data Science -MOE, School of Statistics, East China Normal University（华东师范大学统计学院统计学与数据科学前沿理论及应用教育部重点实验室）
Modern medical research demands specialized causal inference methods evaluating complex continuous-time dynamic treatment regimens using observational data. For instance, obtaining the causal effects of intravenous administration, a continuous process involving dynamic adjustments of the treatment dose, can guide clinicians on drug use. However, the existing causal inference frameworks in longitudinal studies typically assume that time advances in discrete time steps. Therefore, this paper proposes a new methodology to estimate the causal effects of continuous-time dynamic treatments in the presence of unmeasured confounding. Unmeasured confounding is incorporated into estimating continuous-time Marginal Structural Models from a Bayesian perspective. Simulation demonstrates that compared to existing methods, the proposed approach can provide approximately unbiased estimates for target causal parameters across three degrees of confounding. The proposed method is applied to analyze the causal relationship between the intravenous oxytocin administration process and postpartum hemorrhage, leading to meaningful results that may guide clinicians in using oxytocin.
We consider a causal effect that is confounded by an unobserved variable, but with observed proxy variables of the confounder. We show that, with at least two independent proxy variables satisfying a certain rank condition, the causal effect is nonparametrically identified, even if the measurement error mechanism, i.e., the conditional distribution of the proxies given the con- founder, may not be identified. Our result generalizes the identification strategy of Kuroki & Pearl (2014) that rests on identification of the measurement error mechanism. When only one proxy for the confounder is avai…
Identifying causal treatment (or exposure) effects in observational studies requires the data to satisfy the unconfoundedness assumption which is not testable using the observed data. With sensitivity analysis, one can determine how the conclusions might change if assumptions are violated to a certain degree. In this paper, we propose a new technique for sensitivity analysis applicable to clusters observational data with a normally distributed or binary outcome. The proposed methods aim to assess the robustness of estimated treatment effects in a single study as well as in multiple studies, i.…
Proximal Mediation Analysis with Unmeasured Treatment-Induced Confounding
Center for Applied Statistics and School of Statistics, Renmin University of China（中国人民大学统计学院与应用统计中心）；Department of Biostatistics & Medical Informatics, University of Wisconsin-Madison（威斯康星大学麦迪逊分校生物统计与医学信息学系）
Inferring the causal effect of a non-randomly assigned exposure on an outcome requires adjusting for common causes of the exposure and outcome to avoid biased conclusions. Notwithstanding the efforts investigators routinely make to measure and adjust for such common causes (or confounders), some confounders typically remain unmeasured, raising the prospect of biased inference in observational studies. Therefore, it is crucial that investigators can practically assess their substantive conclusions' relative (in)sensitivity to potential unmeasured confounding. In this article, we propose a sensi…
In observational studies, identification of ATEs is generally achieved by assuming that the correct set of confounders has been measured and properly included in the relevant models. Because this assumption is both strong and untestable, a sensitivity analysis should be performed. Common approaches include modeling the bias directly or varying the propensity scores to probe the effects of a potential unmeasured confounder. In this paper, we take a novel approach whereby the sensitivity parameter is the "proportion of unmeasured confounding:" the proportion of units for whom the treatment is no…
The era of big data has witnessed an increasing availability of multiple data sources for statistical analyses. We consider estimation of causal effects combining big main data with unmeasured confounders and smaller validation data with supplementary information on these confounders. Under the unconfoundedness assumption with completely observed confounders, the smaller validation data allow for constructing consistent estimators for causal effects, but the big main data can only give error-prone estimators in general. However, by leveraging the information in the big main data in a principle…
Identification of treatment effects in the presence of unmeasured confounding is a persistent problem in the social, biological, and medical sciences. The problem of unmeasured confounding in settings with multiple treatments is most common in statistical genetics and bioinformatics settings, where researchers have developed many successful statistical strategies without engaging deeply with the causal aspects of the problem. Recently there have been a number of attempts to bridge the gap between these statistical approaches and causal inference, but these attempts have either been shown to be…
No unmeasured confounding is often assumed in estimating treatment effects in observational data when using approaches such as propensity scores and inverse probability weighting. However, in many such studies due to the limitation of the databases, collected confounders are not exhaustive, and it is crucial to examine the extent to which the resulting estimate is sensitive to the unmeasured confounders. We consider this problem for survival and competing risks data. Due to the complexity of models for such data, we adapt the simulated potential confounders approach of Carnegie et al. (2016), …
A central question in causal inference with observational studies is the sensitivity of conclusions to unmeasured confounding. The classical Cornfield condition allows us to assess whether an unmeasured binary confounder can explain away the observed relative risk of the exposure on the outcome. It states that for an unmeasured confounder to explain away an observed relative risk, the association between the unmeasured confounder and the exposure, and also that between the unmeasured confounder and the outcome, must both be larger than the observed relative risk. In this paper, we extend the c…
Clinical trials traditionally employ blinding as a design mechanism to reduce the influence of placebo effects. In practice, however, it can be difficult or impossible to blind study participants and unblinded trials are common in medical research. Here we show how instrumental variables can be used to quantify and disentangle treatment and placebo effects in randomized clinical trials comparing control and active treatments in the presence of confounders. The key idea is to use randomization to separately manipulate treatment assignment and psychological encouragement messages that increase t…
Propensity score weighting is a tool for causal inference to adjust for measured confounders. Survey data are often collected under complex sampling designs such as multistage cluster sampling, which presents challenges for propensity score modeling and estimation. In addition, for clustered data, there may also be unobserved cluster effects related to both the treatment and the outcome. When such unmeasured confounders exist and are omitted in the propensity score model, the subsequent propensity score adjustment will be biased. We propose a calibrated propensity score weighting adjustment fo…
Adjusting for an unmeasured confounder is generally an intractable problem, but in the spatial setting it may be possible under certain conditions. In this paper, we derive necessary conditions on the coherence between the treatment variable of interest and the unmeasured confounder that ensure the causal effect of the treatment is estimable. We specify our model and assumptions in the spectral domain to allow for different degrees of confounding at different spatial resolutions. The key assumption that ensures identifiability is that confounding present at global scales dissipates at local sc…
Bayesian Sensitivity Analysis for Causal Estimation with Time-varying Unmeasured Confounding
Dalla Lana School of Public Health, University of Toronto（多伦多大学达拉·兰纳公共卫生学院）；Public Health Ontario（安大略省公共卫生局）；Rutgers School of Public Health, Rutgers University（罗格斯大学罗格斯公共卫生学院）；Division of Gastroenterology, Hepatology Nutrition, The Hospital for Sick Children（儿童医院胃肠病学、肝病营养科）；University of Utah and Intermountain Healthcare Primary Children’s Hospital（犹他大学和山脊医疗初级儿童医院）；Institute of Health Policy, Management and Evaluation, University of Toronto（多伦多大学卫生政策、管理与评估研究所）
The use of causal mediation analysis to evaluate the pathways by which an exposure affects an outcome is widespread in the social and biomedical sciences. Recent advances in this area have established formal conditions for identification and estimation of natural direct and indirect effects. However, these conditions typically involve stringent no unmeasured confounding assumptions and that the mediator has been measured without error. These assumptions may fail to hold in practice where mediation methods are often applied. The goal of this paper is two-fold. First, we show that the natural in…
This paper studies the confounding effects from the unmeasured confounders and the imbalance of observed confounders in IV regression and aims at unbiased causal effect estimation. Recently, nonlinear IV estimators were proposed to allow for nonlinear model in both stages. However, the observed confounders may be imbalanced in stage 2, which could still lead to biased treatment effect estimation in certain cases. To this end, we propose a Confounder Balanced IV Regression (CB-IV) algorithm to jointly remove the bias from the unmeasured confounders and the imbalance of observed confounders. The…
Instrumental variable (IV) methods are widely used for estimating average treatment effects in the presence of unmeasured confounders. However, the capability of existing IV procedures, and most notably the two-stage residual inclusion (2SRI) procedure recommended for use in nonlinear contexts, to account for unmeasured confounders in the Cox proportional hazard model is unclear. We show that instrumenting an endogenous treatment induces an unmeasured covariate, referred to as an individual frailty in survival analysis parlance, which if not accounted for leads to bias. We propose a new proced…
Estimates of the effects of treatment on cost from observational studies are subject to bias if there are unmeasured confounders. It is therefore advisable in practice to assess the potential magnitude of such biases. We derive a general adjustment formula for loglinear models of mean cost and explore special cases under plausible assumptions about the distribution of the unmeasured confounder. We assess the performance of the adjustment by simulation, in particular, examining robustness to a key assumption of conditional independence between the unmeasured and measured covariates given the tr…
Instrumental variable methods are popular choices in combating unmeasured confounding to obtain less biased effect estimates. However, we demonstrate that alternative methods may give less biased estimates depending on the nature of unmeasured confounding. Treatment preferences of clusters (e.g., physician practices) are the most f6requently used instruments in instrumental variable analyses (IVA). These preference-based IVAs are usually conducted on data clustered by region, hospital/facility, or physician, where unmeasured confounding often occurs within or between clusters. We aim to quanti…
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; …
A Practical Introduction to Regression-based Causal Inference in Meteorology (II): Unmeasured confounders
University of Washington（华盛顿大学）；Applied Physics Laboratory, University of Washington（华盛顿大学应用物理实验室）；Climate Impacts Group, University of Washington（华盛顿大学气候影响研究组）；School of Meteorology, University of Oklahoma（俄克拉荷马大学气象学院）
Unmeasured confounding may undermine the validity of causal inference with observational studies. Sensitivity analysis provides an attractive way to partially circumvent this issue by assessing the potential influence of unmeasured confounding on the causal conclusions. However, previous sensitivity analysis approaches often make strong and untestable assumptions such as having a confounder that is binary, or having no interaction between the effects of the exposure and the confounder on the outcome, or having only one confounder. Without imposing any assumptions on the confounder or confounde…
It is emphasised that for epidemiological studies where disease incidence is rare, results from conventional proportional hazards models can often correctly estimate causal associations. The well-known "backdoor criteria" from causal-inference is applied to the common epidemiological study of rare diseases with a proportional hazards model, providing an example of when and how estimates from conventional proportional hazards studies can be used. A similar study with the "frontdoor criteria", that allows studies with unmeasured confounders, finds similar results to conventional mediation analys…
On a variety of complex decision-making tasks, from doctors prescribing treatment to judges setting bail, machine learning algorithms have been shown to outperform expert human judgments. One complication, however, is that it is often difficult to anticipate the effects of algorithmic policies prior to deployment, making the decision to adopt them risky. In particular, one generally cannot use historical data to directly observe what would have happened had the actions recommended by the algorithm been taken. One standard strategy is to model potential outcomes for alternative decisions assumi…
In this paper, we consider the extent of the biases that may arise when an unmeasured confounder is omitted from a structural equation model (SEM) and we propose sensitivity analysis techniques to correct for such biases. We give an analysis of which effects in an SEM are, and are not, biased by an unmeasured confounder. It is shown that a single unmeasured confounder will bias not just one, but numerous, effects in an SEM. We present sensitivity analysis techniques to correct for biases in total, direct, and indirect effects when using SEM analyses, and illustrate these techniques with a stud…
A Doubly Robust Instrumental Variable Approach for Estimating Average Treatment Effects in Time-to-Event Data with Unmeasured Confounding: Application to Real-World Data on ICU Patients with Septic Shock
We consider the problem of constructing bounds on the average treatment effect (ATE) when unmeasured confounders exist but have bounded influence. Specifically, we assume that omitted confounders could not change the odds of treatment for any unit by more than a fixed factor. We derive the sharp partial identification bounds implied by this assumption by leveraging distributionally robust optimization, and we propose estimators of these bounds with several novel robustness properties. The first is double sharpness: our estimators consistently estimate the sharp ATE bounds when one of two nuisa…
Real Effect or Bias? Best Practices for Evaluating the Robustness of Real-World Evidence through Quantitative Sensitivity Analysis for Unmeasured Confounding
The problem of missingness in observational data is ubiquitous. When the confounders are missing at random, multiple imputation is commonly used; however, the method requires congeniality conditions for valid inferences, which may not be satisfied when estimating average causal treatment effects. Alternatively, fractional imputation, proposed by Kim 2011, has been implemented to handling missing values in regression context. In this article, we develop fractional imputation methods for estimating the average treatment effects with confounders missing at random. We show that the fractional impu…
Estimating treatment effects plays a crucial role in causal inference, having many real-world applications like policy analysis and decision making. Nevertheless, estimating treatment effects in the longitudinal setting in the presence of hidden confounders remains an extremely challenging problem. Recently, there is a growing body of work attempting to obtain unbiased ITE estimates from time-dynamic observational data by ignoring the possible existence of hidden confounders. Additionally, many existing works handling hidden confounders are not applicable for continuous-time settings. In this …
Interventional effects have been proposed as a solution to the unidentifiability of natural (in)direct effects under mediator-outcome confounders affected by the exposure. Such confounders are an intrinsic characteristic of studies with time-varying exposures and mediators, yet the generalization of the interventional effect framework to the time-varying case has received little attention in the literature. We present an identification result for interventional effects in a general longitudinal data structure that allows flexibility in the specification of treatment-outcome, treatment-mediator…
Matched observational studies are commonly used to study treatment effects in non-randomized data. After matching for observed confounders, there could remain bias from unobserved confounders. A standard way to address this problem is to do a sensitivity analysis. A sensitivity analysis asks how sensitive the result is to a hypothesized unmeasured confounder U. One method, known as simultaneous sensitivity analysis, has two sensitivity parameters: one relating U to treatment assignment and the other to response. This method assumes that in each matched set, U is distributed to make the bias wo…
University of Pennsylvania（宾夕法尼亚大学）；University of Illinois Urbana-Champaign（伊利诺伊大学厄巴纳-香槟分校）；Washington University in St. Louis（圣路易斯华盛顿大学）；Harvard T.H. Chan School of Public Health（哈佛大学陈曾熙公共卫生学院）
Estimating the individual treatment effect (ITE) from observational data is meaningful and practical in healthcare. Existing work mainly relies on the strong ignorability assumption that no hidden confounders exist, which may lead to bias in estimating causal effects. Some studies consider the hidden confounders are designed for static environment and not easily adaptable to a dynamic setting. In fact, most observational data (e.g., electronic medical records) is naturally dynamic and consists of sequential information. In this paper, we propose Deep Sequential Weighting (DSW) for estimating I…
