在使用倾向得分进行协变量调整来估计治疗效果时,倾向得分模型的拟合优度诊断。

Goodness-of-fit diagnostics for the propensity score model when estimating treatment effects using covariate adjustment with the propensity score.

作者信息

Austin Peter C

机构信息

Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.

出版信息

Pharmacoepidemiol Drug Saf. 2008 Dec;17(12):1202-17. doi: 10.1002/pds.1673.

Abstract

The propensity score is defined to be a subject's probability of treatment selection, conditional on observed baseline covariates. Conditional on the propensity score, treated and untreated subjects have similar distributions of observed baseline covariates. In the medical literature, there are three commonly employed propensity-score methods: stratification (subclassification) on the propensity score, matching on the propensity score, and covariate adjustment using the propensity score. Methods have been developed to assess the adequacy of the propensity score model in the context of stratification on the propensity score and propensity-score matching. However, no comparable methods have been developed for covariate adjustment using the propensity score. Inferences about treatment effect made using propensity-score methods are only valid if, conditional on the propensity score, treated and untreated subjects have similar distributions of baseline covariates. We develop both quantitative and qualitative methods to assess the balance in baseline covariates between treated and untreated subjects. The quantitative method employs the weighted conditional standardized difference. This is the conditional difference in the mean of a covariate between treated and untreated subjects, in units of the pooled standard deviation, integrated over the distribution of the propensity score. The qualitative method employs quantile regression models to determine whether, conditional on the propensity score, treated and untreated subjects have similar distributions of continuous covariates. We illustrate our methods using a large dataset of patients discharged from hospital with a diagnosis of a heart attack (acute myocardial infarction). The exposure was receipt of a prescription for a beta-blocker at hospital discharge.

摘要

倾向得分被定义为一个受试者接受治疗选择的概率,条件是基于观察到的基线协变量。在倾向得分的条件下,接受治疗和未接受治疗的受试者在观察到的基线协变量上具有相似的分布。在医学文献中,有三种常用的倾向得分方法:按倾向得分进行分层(亚分类)、按倾向得分进行匹配以及使用倾向得分进行协变量调整。已经开发出方法来评估倾向得分模型在按倾向得分分层和倾向得分匹配的背景下的充分性。然而,尚未开发出用于使用倾向得分进行协变量调整的可比方法。使用倾向得分方法对治疗效果进行的推断仅在以下条件下才有效:在倾向得分的条件下,接受治疗和未接受治疗的受试者在基线协变量上具有相似的分布。我们开发了定量和定性方法来评估接受治疗和未接受治疗的受试者之间基线协变量的平衡。定量方法采用加权条件标准化差异。这是接受治疗和未接受治疗的受试者之间协变量均值的条件差异,以合并标准差为单位,在倾向得分的分布上进行积分。定性方法采用分位数回归模型来确定在倾向得分的条件下,接受治疗和未接受治疗的受试者在连续协变量上是否具有相似的分布。我们使用一个因心脏病发作(急性心肌梗死)出院的患者的大型数据集来说明我们的方法。暴露因素是出院时收到β受体阻滞剂的处方。

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