The Effect of Prenatal Treatments on Offspring Events in the Presence of Competing Events: An Application to a Randomized Trial of Fertility Therapies.
The Effect of Prenatal Treatments on Offspring Events in the Presence of Competing Events: An Application to a Randomized Trial of Fertility Therapies.
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DOI：
10.1097/ede.0000000000001222
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发表时间：
2020-09
期刊：
影响因子：
--
通讯作者：
Hernán MA
中科院分区：
文献类型：
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作者：
Chiu YH;Stensrud MJ;Dahabreh IJ;Rinaudo P;Diamond MP;Hsu J;Hernández-Díaz S;Hernán MA
当研究产前治疗对后代事件的影响时，未能产生活产是后代事件的竞争事件。处理这种竞争事件的常用方法是报告活产和活产中关注事件的治疗特异性概率。然而，当治疗影响竞争事件时，后者的概率不能解释为活产之间的因果效应。在这里，我们提供了指导感兴趣的研究人员在竞争事件“无活产”的存在下，产前治疗对后代事件的影响。我们回顾了治疗对复合事件的总效应和治疗对感兴趣事件的总效应。这些因果效应有助于决策制定，但对于治疗影响感兴趣事件的途径是不可知的。因此，基于最近的工作，我们还审查了三种因果效应，明确考虑了在存在竞争事件的情况下治疗可能影响感兴趣事件的途径：在消除竞争事件的干预下，治疗对感兴趣事件的直接影响，治疗对感兴趣事件的可分离的直接和间接影响，以及治疗对主要阶层中无论选择何种治疗都会活产的人的影响。作为一个说明性的例子，我们使用生育治疗和新生儿并发症风险的随机试验。
When studying the effect of a prenatal treatment on events in the offspring, failure to produce a live birth is a competing event for events in the offspring. A common approach to handle this competing event is reporting both the treatment-specific probabilities of live births and of the event of interest among live births. However, when the treatment affects the competing event, the latter probability cannot be interpreted as the causal effect among live births. Here we provide guidance for researchers interested in the effects of prenatal treatments on events in the offspring in the presence of the competing event “no live birth”. We review the total effect of treatment on a composite event and the total effect of treatment on the event of interest. These causal effects are helpful for decision making, but are agnostic about the pathways through which treatment affects the event of interest. Therefore, based on recent work, we also review three causal effects that explicitly consider the pathways through which treatment may affect the event of interest in the presence of competing events: the direct effect of treatment on the event of interest under an intervention to eliminate the competing event, the separable direct and indirect effects of treatment on the event of interest, and the effect of treatment in the principal stratum of those who would have had a live birth irrespective of treatment choice. As an illustrative example, we use a randomized trial of fertility treatments and risk of neonatal complications.