Immortal-time bias in older vs younger age groups: a simulation study with application to a population-based cohort of patients with colon cancer.
Immortal-time bias in older vs younger age groups: a simulation study with application to a population-based cohort of patients with colon cancer.
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DOI：
10.1038/s41416-023-02187-0
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发表时间：
2023-04
影响因子：
8.8
通讯作者：
Leyrat, Clemence
中科院分区：
文献类型：
--
作者：
Pilleron, Sophie;Maringe, Camille;Morris, Eva J. A.;Leyrat, Clemence
在观察性研究中，永生时间偏倚（ITB）的风险随着早死的可能性而增加，早死本身随年龄而增加。我们研究了在英国50-74岁和75-84岁IV期结肠癌患者中，在估计手术对1年总生存期（OS）的影响时，年龄如何影响ITB的程度。使用模拟，我们比较了时间固定暴露模型的估计值与解决ITB的三种统计方法：时变暴露、延迟进入和地标方法。然后，我们使用来自CORECT-R资源的基于人群的患者队列评估手术对OS的影响，并使用模拟目标试验框架进行分析。在模拟中，当老年患者的早期死亡概率增加或治疗延迟时，ITB的幅度更大。使用ITB方法纠正偏倚。当应用于CORECT-R数据时，这些方法产生的手术影响小于固定时间暴露方法，但两个年龄组的影响相似。在所有纵向研究中必须解决ITB问题，特别是在研究暴露对不同人群结局的影响时（例如，年龄组），具有不同的暴露和结果分布。
In observational studies, the risk of immortal-time bias (ITB) increases with the likelihood of early death, itself increasing with age. We investigated how age impacts the magnitude of ITB when estimating the effect of surgery on 1-year overall survival (OS) in patients with Stage IV colon cancer aged 50–74 and 75–84 in England. Using simulations, we compared estimates from a time-fixed exposure model to three statistical methods addressing ITB: time-varying exposure, delayed entry and landmark methods. We then estimated the effect of surgery on OS using a population-based cohort of patients from the CORECT-R resource and conducted the analysis using the emulated target trial framework. In simulations, the magnitude of ITB was larger among older patients when their probability of early death increased or treatment was delayed. The bias was corrected using the methods addressing ITB. When applied to CORECT-R data, these methods yielded a smaller effect of surgery than the time-fixed exposure approach but effects were similar in both age groups. ITB must be addressed in all longitudinal studies, particularly, when investigating the effect of exposure on an outcome in different groups of people (e.g., age groups) with different distributions of exposure and outcomes.
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