Healthcare utilization is a collider: an introduction to collider bias in EHR data reuse.

Healthcare utilization is a collider: an introduction to collider bias in EHR data reuse.
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DOI:
10.1093/jamia/ocad013
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发表时间:
2023-04-19
影响因子:
6.4
通讯作者:
Thompson, Caroline A.
Thompson, Caroline A.
中科院分区:
管理学2区
文献类型:
--
作者:
Weiskopf, Nicole G.;Dorr, David A.;Jackson, Christie;Lehmann, Harold P.;Thompson, Caroline A.

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对撞机偏倚是临床研究中内部效度的常见威胁,但在信息学教育或文献中很少提及。碰撞子是一个变量,它是暴露和结果的共享因果后代,对碰撞子的制约可能会导致暴露和结果之间的虚假关联。我们的目标是向读者介绍电子健康记录(EHR)数据的回顾性分析中的对撞机偏差及其推论。由于数据生成机制和美国医疗保健访问和利用的性质,在EHR数据的重用中可能会出现碰撞偏差。因此,本教程针对的是没有流行病学方法或因果推理背景的信息学家和其他EHR数据消费者。我们特别关注的问题,可能会出现条件的医疗保健利用的形式,一个共同的碰撞,是一个隐式的选择标准,当一个重复使用EHR数据。引入有向无环图(DAG)作为在研究设计和规划期间识别潜在偏倚来源的工具。提供了有关因果推理和DAG构造的其他资源的参考。
Collider bias is a common threat to internal validity in clinical research but is rarely mentioned in informatics education or literature. Conditioning on a collider, which is a variable that is the shared causal descendant of an exposure and outcome, may result in spurious associations between the exposure and outcome. Our objective is to introduce readers to collider bias and its corollaries in the retrospective analysis of electronic health record (EHR) data. Collider bias is likely to arise in the reuse of EHR data, due to data-generating mechanisms and the nature of healthcare access and utilization in the United States. Therefore, this tutorial is aimed at informaticians and other EHR data consumers without a background in epidemiological methods or causal inference. We focus specifically on problems that may arise from conditioning on forms of healthcare utilization, a common collider that is an implicit selection criterion when one reuses EHR data. Directed acyclic graphs (DAGs) are introduced as a tool for identifying potential sources of bias during study design and planning. References for additional resources on causal inference and DAG construction are provided.
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