arXiv subjects

John W. Jackson

Publications and source records attributed to John W. Jackson.

5 recordsLinked to original sources

arXiv2026

Nesting a Target Study within a Target Trial: A Framework for Evaluating Intervention Effects on Disparities

We present a novel framework (TS+TT) to nest a Target Study (TS) within a Target Trial (TT) for evaluating the effects of interventions on disparities. The TS component grounds the measurement of disparity in ethical assumptions, based on the concept of allowability, and anchors it to an explicit population within calendar time. It specifies an enrollment plan of stratified sampling of eligible persons to yield a sample where social groups are distributionally similar on covariates deemed allowable for measuring disparity. Within this enrolled sample, the TT component specifies randomization of intervention strategies within each social group. Because social groups are similarly situated on allowable covariates at baseline, and because assigned intervention arms are exchangeable within social groups, TS+TT reflects a meaningful causal estimand for evaluating how interventions impact disparity. We describe the framework's key components, its emulation, and demonstrate its application to evaluate how hypothetical interventions on pulse oximeter bias affect disparities in treatment receipt in clinical care. We also extend semiparametric G-computation to accommodate continuous stochastic interventions and estimate counterfactual disparities in time-to-event outcomes. The TS+TT framework offers a versatile and policy-relevant approach for generating ethically informed causal evidence to reduce disparities and avoid exacerbating disparities.

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arXiv2026

Estimation Strategies for Causal Decomposition Analysis with Allowability Specifications

Causal decomposition analysis (CDA) is an approach for modeling the impact of hypothetical interventions to reduce disparities. It is useful for identifying foci that future interventions, including multilevel and multimodal interventions, could focus on to reduce disparities. Based within the potential outcomes framework, CDA has a causal interpretation when the identifying assumptions are met. CDA also allows an analyst to consider which covariates are allowable (i.e., fair) for defining the disparity in the outcome and in the point of intervention, so that its interpretation is also meaningful. While the incorporation of causal inference and allowability promotes robustness, transparency, and dialogue in disparities research, it can lead to challenges in estimation such as the need to correctly model densities. Also, how CDA differs from commonly used statistical decomposition estimators from the econometrics literature may not be clear, which may limit its uptake. To address these challenges, we provide a tour of estimation strategies for CDA, reviewing existing proposals and introducing novel estimators that overcome key estimation challenges. Among them we introduce what we call "bridging" estimators that avoid modeling any density, and sequential weighted regression estimators that are multiply robust. Additionally, we provide diagnostics to assess the quality of the nuisance density models and weighting functions they rely on. We formally establish the estimators' robustness to model mis-specification, demonstrate their performance through a simulation study based on real data, and apply them to study disparities in uncontrolled hypertension using electronic health records in a large healthcare system.

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arXiv2025

The Target Study: A Conceptual Model and Framework for Measuring Disparity

We present a conceptual model to measure disparity--the target study--where social groups may be similarly situated (i.e., balanced) on allowable covariates. Our model, based on a sampling design, does not intervene to assign social group membership or alter allowable covariates. To address non-random sample selection, we extend our model to generalize or transport disparity or to assess disparity after an intervention on eligibility-related variables that eliminates forms of collider-stratification. To avoid bias from differential timing of enrollment, we aggregate time-specific study results by balancing calendar time of enrollment across social groups. To provide a framework for emulating our model, we discuss study designs, data structures, and G-computation and weighting estimators. We compare our sampling-based model to prominent decomposition-based models used in healthcare and algorithmic fairness. We provide R code for all estimators and apply our methods to measure health system disparities in hypertension control using electronic medical records.

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arXiv2020

Meaningful causal decompositions in health equity research: definition, identification, and estimation through a weighting framework

Causal decomposition analyses can help build the evidence base for interventions that address health disparities (inequities). They ask how disparities in outcomes may change under hypothetical intervention. Through study design and assumptions, they can rule out alternate explanations such as confounding, selection-bias, and measurement error, thereby identifying potential targets for intervention. Unfortunately, the literature on causal decomposition analysis and related methods have largely ignored equity concerns that actual interventionists would respect, limiting their relevance and practical value. This paper addresses these concerns by explicitly considering what covariates the outcome disparity and hypothetical intervention adjust for (so-called allowable covariates) and the equity value judgements these choices convey, drawing from the bioethics, biostatistics, epidemiology, and health services research literatures. From this discussion, we generalize decomposition estimands and formulae to incorporate allowable covariate sets, to reflect equity choices, while still allowing for adjustment of non-allowable covariates needed to satisfy causal assumptions. For these general formulae, we provide weighting-based estimators based on adaptations of ratio-of-mediator-probability and inverse-odds-ratio weighting. We discuss when these estimators reduce to already used estimators under certain equity value judgements, and a novel adaptation under other judgements.

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arXiv2017

Decomposition analysis to identify intervention targets for reducing disparities

There has been considerable interest in using decomposition methods in epidemiology (mediation analysis) and economics (Oaxaca-Blinder decomposition) to understand how health disparities arise and how they might change upon intervention. It has not been clear when estimates from the Oaxaca-Blinder decomposition can be interpreted causally because its implementation does not explicitly address potential confounding of target variables. While mediation analysis does explicitly adjust for confounders of target variables, it does so in a way that entails equalizing confounders across racial groups, which may not reflect the intended intervention. Revisiting prior analyses in the National Longitudinal Survey of Youth on disparities in wages, unemployment, incarceration, and overall health with test scores, taken as a proxy for educational attainment, as a target intervention, we propose and demonstrate a novel decomposition that controls for confounders of test scores (measures of childhood SES) while leaving their association with race intact. We compare this decomposition with others that use standardization (to equalize childhood SES alone), mediation analysis (to equalize test scores within levels of childhood SES), and one that equalizes both childhood SES and test scores. We also show how these decompositions, including our novel proposals, are equivalent to causal implementations of the Oaxaca-Blinder decomposition.

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