Adjusting effect estimates for unmeasured confounding with validation data using propensity score calibration
Adjusting effect estimates for unmeasured confounding with validation data using propensity score calibration
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DOI：
10.1093/aje/kwi192
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发表时间：
2005-08-01
影响因子：
5
通讯作者：
Glynn, RJ
中科院分区：
文献类型：
--
作者：
Stürmer, T;Schneeweiss, S;Glynn, RJ
通常，队列研究中没有关于重要混杂因素的数据。已经提出了基于单个（而非多个）未测量混杂因素与单独验证研究中关注暴露量之间关系的敏感性分析。在本文中，作者使用倾向评分（PS）控制了主要队列中的测量混杂，并通过在验证研究中估计两个额外的PS来解决未测量混杂。“容易出错”的PS仅使用主要队列中可用的信息。“金标准”PS还包括仅在验证研究中可用的协变量数据。基于验证研究中的这两个PS，应用回归校准来调整回归系数。这种倾向评分校准（PSC）调整了队列研究中未测量的混杂因素，并在某些通常不可检验的假设下使用验证数据。作者使用PSC评估了一个大型老年人队列中非甾体类抗炎药（NSAID）与1年死亡率之间的关系。“传统”调整导致NSAID使用者的风险比为0.80（95%置信区间（CI）：0.77，0.83），而未调整的风险比为0.68（95% CI：0.66，0.71）。PSC的应用导致更合理的风险比为1.06（95% CI：1.00，1.12）。在不同环境下评估PSC的有效性和局限性之前，应将该方法视为敏感性分析。
Often, data on important confounders are not available in cohort studies. Sensitivity analyses based on the relation of single, but not multiple, unmeasured confounders with an exposure of interest in a separate validation study have been proposed. In this paper, the authors controlled for measured confounding in the main cohort using propensity scores (PS's) and addressed unmeasured confounding by estimating two additional PS's in a validation study. The "error-prone" PS exclusively used information available in the main cohort. The "gold standard" PS additionally included data on covariates available only in the validation study. Based on these two PS's in the validation study, regression calibration was applied to adjust regression coefficients. This propensity score calibration (PSC) adjusts for unmeasured confounding in cohort studies with validation data under certain, usually untestable, assumptions. The authors used PSC to assess the relation between nonsteroidal antiinflammatory drugs (NSAIDs) and 1-year mortality in a large cohort of elderly persons. "Traditional" adjustment resulted in a hazard ratio for NSAID users of 0.80 (95% confidence interval (CI): 0.77, 0.83) as compared with an unadjusted hazard ratio of 0.68 (95% CI: 0.66, 0.71). Application of PSC resulted in a more plausible hazard ratio of 1.06 (95% CI: 1.00, 1.12). Until the validity and limitations of PSC have been assessed in different settings, the method should be seen as a sensitivity analysis.