Davis Melanie L, Neelon Brian, Nietert Paul J, Burgette Lane F, Hunt Kelly J, Lawson Andrew B, Egede Leonard E
Medical University of South Carolina, Charleston, United States.
Medical University of South Carolina, Charleston, United States.
Spat Spatiotemporal Epidemiol. 2019 Aug;30:100284. doi: 10.1016/j.sste.2019.100284. Epub 2019 Jul 5.
Using recent methods for spatial propensity score modeling, we examine differences in hospital stays between non-Hispanic black and non-Hispanic white veterans with type 2 diabetes. We augment a traditional patient-level propensity score model with a spatial random effect to create a matched sample based on the estimated propensity score. We then use a spatial negative binomial hurdle model to estimate differences in both hospital admissions and inpatient days. We demonstrate that in the presence of unmeasured geographic confounding, spatial propensity score matching in addition to the spatial negative binomial hurdle outcome model yields improved performance compared to the outcome model alone. In the motivating application, we construct three estimates of racial differences in hospitalizations: the risk difference in admission, the mean difference in number of inpatient days among those hospitalized, and the mean difference in number of inpatient days across all patients (hospitalized and non-hospitalized). Results indicate that non-Hispanic black veterans with type 2 diabetes have a lower risk of hospital admission and a greater number of inpatient days on average. The latter result is especially important considering that we observed much smaller effect sizes in analyses that did not incorporate spatial matching. These results emphasize the need to address geographic confounding in health disparity studies.
利用空间倾向评分建模的最新方法，我们研究了患有2型糖尿病的非西班牙裔黑人和非西班牙裔白人退伍军人在住院时间上的差异。我们在传统的患者水平倾向评分模型中加入空间随机效应，以基于估计的倾向评分创建匹配样本。然后，我们使用空间负二项障碍模型来估计住院次数和住院天数的差异。我们证明，在存在未测量的地理混杂因素的情况下，与仅使用结局模型相比，除了空间负二项障碍结局模型外，空间倾向评分匹配还能提高性能。在实际应用中，我们构建了住院种族差异的三个估计值：入院风险差异、住院患者住院天数的平均差异以及所有患者（住院和未住院）住院天数的平均差异。结果表明，患有2型糖尿病的非西班牙裔黑人退伍军人住院风险较低，平均住院天数较多。考虑到我们在未纳入空间匹配的分析中观察到的效应量要小得多，后一个结果尤为重要。这些结果强调了在健康差异研究中解决地理混杂因素的必要性。
