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Theodore J. Iwashyna

Publications and source records attributed to Theodore J. Iwashyna.

2 recordsLinked to original sources

Federated Learning with Incomplete Data: When to Use Complete Cases and When to Weight

Privacy constraints have driven the rise of federated learning (FL), which enables multi-site analyses without sharing individual participant data. Existing FL estimators largely assume complete data, whereas multi-site studies often face missingness. We develop a framework for FL with missing data, identifying conditions under which the complete case (CC) estimator is preferred over the inverse probability weighting (IPW) estimator. For settings where the CC estimator leads to bias, we introduce a calibrated weight estimation approach that combines candidate weighting models across sites and remains consistent if at least one is correctly specified at each site; we further show that pooling many weighting candidate models with redundant information degrades the calibrated estimator, so a small set is preferable. Consistency conditions are stated at the site level, ensuring that the federated estimator inherits validity from site-level properties. We prove consistency and derive a sandwich variance estimator that accounts for uncertainty in the outcome model, and in both the estimated weighting models and the calibration step. Additionally, we show that all estimators require only one or a few communication rounds, making them practical under real-world data-governance constraints. We illustrate the framework by evaluating risk factors for 90-day mortality among patients with pleural infections treated with intrapleural enzyme therapy.

stat.ME↗

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.

stat.ME↗