Brookhart M Alan, Schneeweiss Sebastian, Rothman Kenneth J, Glynn Robert J, Avorn Jerry, Stürmer Til
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02120, USA.
Am J Epidemiol. 2006 Jun 15;163(12):1149-56. doi: 10.1093/aje/kwj149. Epub 2006 Apr 19.
Despite the growing popularity of propensity score (PS) methods in epidemiology, relatively little has been written in the epidemiologic literature about the problem of variable selection for PS models. The authors present the results of two simulation studies designed to help epidemiologists gain insight into the variable selection problem in a PS analysis. The simulation studies illustrate how the choice of variables that are included in a PS model can affect the bias, variance, and mean squared error of an estimated exposure effect. The results suggest that variables that are unrelated to the exposure but related to the outcome should always be included in a PS model. The inclusion of these variables will decrease the variance of an estimated exposure effect without increasing bias. In contrast, including variables that are related to the exposure but not to the outcome will increase the variance of the estimated exposure effect without decreasing bias. In very small studies, the inclusion of variables that are strongly related to the exposure but only weakly related to the outcome can be detrimental to an estimate in a mean squared error sense. The addition of these variables removes only a small amount of bias but can increase the variance of the estimated exposure effect. These simulation studies and other analytical results suggest that standard model-building tools designed to create good predictive models of the exposure will not always lead to optimal PS models, particularly in small studies.
尽管倾向评分(PS)方法在流行病学中越来越受欢迎,但流行病学文献中关于PS模型变量选择问题的论述相对较少。作者展示了两项模拟研究的结果,旨在帮助流行病学家深入了解PS分析中的变量选择问题。模拟研究说明了PS模型中纳入的变量选择如何影响估计暴露效应的偏差、方差和均方误差。结果表明,与暴露无关但与结局相关的变量应始终纳入PS模型。纳入这些变量将降低估计暴露效应的方差,而不会增加偏差。相比之下,纳入与暴露相关但与结局无关的变量会增加估计暴露效应的方差,而不会降低偏差。在非常小的研究中,纳入与暴露强相关但与结局弱相关的变量在均方误差意义上可能对估计不利。添加这些变量只能消除少量偏差,但会增加估计暴露效应的方差。这些模拟研究和其他分析结果表明,旨在创建良好暴露预测模型的标准模型构建工具并不总是能产生最优的PS模型,尤其是在小型研究中。