Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark.
Stat Med. 2019 May 20;38(11):2013-2029. doi: 10.1002/sim.8084. Epub 2019 Jan 16.
In nonrandomised studies, inferring causal effects requires appropriate methods for addressing confounding bias. Although it is common to adopt propensity score analysis to this purpose, prognostic score analysis has recently been proposed as an alternative strategy. While both approaches were originally introduced to estimate causal effects for binary interventions, the theory of propensity score has since been extended to the case of general treatment regimes. Indeed, many treatments are not assigned in a binary fashion and require a certain extent of dosing. Hence, researchers may often be interested in estimating treatment effects across multiple exposures. To the best of our knowledge, the prognostic score analysis has not been yet generalised to this case. In this article, we describe the theory of prognostic scores for causal inference with general treatment regimes. Our methods can be applied to compare multiple treatments using nonrandomised data, a topic of great relevance in contemporary evaluations of clinical interventions. We propose estimators for the average treatment effects in different populations of interest, the validity of which is assessed through a series of simulations. Finally, we present an illustrative case in which we estimate the effect of the delay to Aspirin administration on a composite outcome of death or dependence at 6 months in stroke patients.
在非随机研究中,推断因果效应需要采用适当的方法来解决混杂偏差。尽管倾向评分分析常用于此目的,但最近已提出预后评分分析作为替代策略。虽然这两种方法最初都是为了估计二项干预措施的因果效应而提出的,但倾向评分理论后来已经扩展到一般治疗方案的情况。事实上,许多治疗方法并不是以二项式方式分配的,并且需要一定程度的剂量。因此,研究人员通常可能有兴趣在多个暴露中估计治疗效果。据我们所知,预后评分分析尚未推广到这种情况。在本文中,我们描述了用于具有一般治疗方案的因果推断的预后评分理论。我们的方法可应用于使用非随机数据比较多种治疗方法,这是当代临床干预评估中的一个重要主题。我们针对不同感兴趣人群提出了平均治疗效果的估计量,并通过一系列模拟评估了其有效性。最后,我们提出了一个说明性案例,其中我们估计了在中风患者中,阿司匹林给药延迟对 6 个月时死亡或依赖的复合结局的影响。