Columbia University, Jupiter, NY.
Am J Med. 2020 Feb;133(2):178-181. doi: 10.1016/j.amjmed.2019.08.055. Epub 2019 Oct 13.
Propensity score matching has been used with increasing frequency in the analyses of non-prespecified subgroups of randomized clinical trials, and in retrospective analyses of clinical trial data sets, registries, observational studies, electronic medical record analyses, and more. The method attempts to adjust post hoc for recognized unbalanced factors at baseline such that the data once analyzed will hopefully approximate or indicate what a prospective randomized data set-the "gold standard" for comparing two or more therapies-would have shown. However, for practical limitations, propensity score matching cannot assess and balance all the factors that come into play in the clinical management of patients and that may be present in the circumstances of the study. Thus, propensity score matching analyses may omit, due to nonrecognition, the effects of several clinically important but not considered factors that can affect the outcomes of the analyses being reported, causing them to possibly be misleading, or hypothesis-generating at best. This review discusses this issue, using several specific examples, and is targeted at clinicians to make them aware of the limitations of such analyses when they apply their results to patients in their care.
倾向评分匹配已越来越多地用于随机临床试验非预设亚组的分析,以及临床试验数据集、注册中心、观察性研究、电子病历分析等的回顾性分析。该方法试图事后调整基线时已知的不平衡因素,以便一旦进行数据分析,将有望近似或表明前瞻性随机数据集(“黄金标准”)所显示的内容,用于比较两种或更多种治疗方法。然而,由于实际限制,倾向评分匹配无法评估和平衡患者临床管理中可能出现的以及研究情况中可能存在的所有因素。因此,由于未被识别,倾向评分匹配分析可能会忽略几个可能影响正在报告的分析结果的重要但未被考虑的因素的影响,从而导致这些分析结果可能具有误导性,或者最多只能产生假设。本文使用了几个具体的例子来讨论这个问题,旨在使临床医生在将这些分析结果应用于他们所照顾的患者时,意识到这些分析的局限性。
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