arXiv subjects

Susan Shortreed

Publications and source records attributed to Susan Shortreed.

5 recordsLinked to original sources

arXiv2024

Adjusting for Selection Bias Due to Missing Eligibility Criteria in Emulated Target Trials

Target trial emulation (TTE) is a popular framework for observational studies based on electronic health records (EHR). A key component of this framework is determining the patient population eligible for inclusion in both a target trial of interest and its observational emulation. Missingness in variables that define eligibility criteria, however, presents a major challenge towards determining the eligible population when emulating a target trial with an observational study. In practice, patients with incomplete data are almost always excluded from analysis despite the possibility of selection bias, which can arise when subjects with observed eligibility data are fundamentally different than excluded subjects. Despite this, to the best of our knowledge, very little work has been done to mitigate this concern. In this paper, we propose a novel conceptual framework to address selection bias in TTE studies, tailored towards time-to-event endpoints, and describe estimation and inferential procedures via inverse probability weighting (IPW). Under an EHR-based simulation infrastructure, developed to reflect the complexity of EHR data, we characterize common settings under which missing eligibility data poses the threat of selection bias and investigate the ability of the proposed methods to address it. Finally, using EHR databases from Kaiser Permanente, we demonstrate the use of our method to evaluate the effect of bariatric surgery on microvascular outcomes among a cohort of severely obese patients with Type II diabetes mellitus (T2DM).

stat.ME↗

arXiv2023

Causal Quantile Treatment Effects with missing data by double-sampling

Causal weighted quantile treatment effects (WQTE) are a useful complement to standard causal contrasts that focus on the mean when interest lies at the tails of the counterfactual distribution. To-date, however, methods for estimation and inference regarding causal WQTEs have assumed complete data on all relevant factors. In most practical settings, however, data will be missing or incomplete data, particularly when the data are not collected for research purposes, as is the case for electronic health records and disease registries. Furthermore, such data sources may be particularly susceptible to the outcome data being missing-not-at-random (MNAR). In this paper, we consider the use of double-sampling, through which the otherwise missing data are ascertained on a sub-sample of study units, as a strategy to mitigate bias due to MNAR data in the estimation of causal WQTEs. With the additional data in-hand, we present identifying conditions that do not require assumptions regarding missingness in the original data. We then propose a novel inverse-probability weighted estimator and derive its asymptotic properties, both pointwise at specific quantiles and uniformly across a range of quantiles over some compact subset of (0,1), allowing the propensity score and double-sampling probabilities to be estimated. For practical inference, we develop a bootstrap method that can be used for both pointwise and uniform inference. A simulation study is conducted to examine the finite sample performance of the proposed estimators. The proposed method is illustrated with data from an EHR-based study examining the relative effects of two bariatric surgery procedures on BMI loss at 3 years post-surgery.

stat.ME↗

arXiv2022

Monte Carlo Sensitivity Analysis for Unmeasured Confounding in Dynamic Treatment Regimes

Data-driven methods for personalizing treatment assignment have garnered much attention from clinicians and researchers. Dynamic treatment regimes formalize this through a sequence of decision rules that map individual patient characteristics to a recommended treatment. Observational studies are commonly used for estimating dynamic treatment regimes due to the potentially prohibitive costs of conducting sequential multiple assignment randomized trials. However, estimating a dynamic treatment regime from observational data can lead to bias in the estimated regime due to unmeasured confounding. Sensitivity analyses are useful for assessing how robust the conclusions of the study are to a potential unmeasured confounder. A Monte Carlo sensitivity analysis is a probabilistic approach that involves positing and sampling from distributions for the parameters governing the bias. We propose a method for performing a Monte Carlo sensitivity analysis of the bias due to unmeasured confounding in the estimation of dynamic treatment regimes. We demonstrate the performance of the proposed procedure with a simulation study and apply it to an observational study examining tailoring the use of antidepressants for reducing symptoms of depression using data from Kaiser Permanente Washington (KPWA).

stat.ME↗

arXiv2022

Using Pilot Data to Size Observational Studies for the Estimation of Dynamic Treatment Regimes

There has been significant attention given to developing data-driven methods for tailoring patient care based on individual patient characteristics. Dynamic treatment regimes formalize this through a sequence of decision rules that map patient information to a suggested treatment. The data for estimating and evaluating treatment regimes are ideally gathered through the use of Sequential Multiple Assignment Randomized Trials (SMARTs) though longitudinal observational studies are commonly used due to the potentially prohibitive costs of conducting a SMART. These studies are typically sized for simple comparisons of fixed treatment sequences or, in the case of observational studies, a priori sample size calculations are often not performed. We develop sample size procedures for the estimation of dynamic treatment regimes from observational studies. Our approach uses pilot data to ensure a study will have sufficient power for comparing the value of the optimal regime, i.e. the expected outcome if all patients in the population were treated by following the optimal regime, with a known comparison mean. Our approach also ensures the value of the estimated optimal treatment regime is within an a priori set range of the value of the true optimal regime with a high probability. We examine the performance of the proposed procedure with a simulation study and use it to size a study for reducing depressive symptoms using data from electronic health records.

stat.ME↗

arXiv2012

Unsupervised spectral learning

In spectral clustering and spectral image segmentation, the data is partioned starting from a given matrix of pairwise similarities S. the matrix S is constructed by hand, or learned on a separate training set. In this paper we show how to achieve spectral clustering in unsupervised mode. Our algorithm starts with a set of observed pairwise features, which are possible components of an unknown, parametric similarity function. This function is learned iteratively, at the same time as the clustering of the data. The algorithm shows promosing results on synthetic and real data.

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