Common Methods for Handling Missing Data in Marginal Structural Models: What Works and Why.

Common Methods for Handling Missing Data in Marginal Structural Models: What Works and Why.
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DOI:
10.1093/aje/kwaa225
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发表时间:
2021-04-06
影响因子:
5
通讯作者:
Williamson EJ
Williamson EJ
中科院分区:
医学2区
文献类型:
--
作者:
Leyrat C;Carpenter JR;Bailly S;Williamson EJ

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在纵向非随机研究中,边际结构模型(MSMs)常用于估计因果干预效应。当使用msm分析观察性研究时,一个常见的挑战是不完整的混杂数据,其中信息不充分的分析方法将导致对干预效果的估计有偏差。尽管文献中描述了许多处理msm中缺失数据的方法,但很少有关于实践中哪些方法有效以及为什么有效的指导。我们回顾了现有的msm缺失数据方法,并讨论了其潜在假设的合理性。我们还进行了现实模拟,量化了实践中使用的5种方法的偏差:完整案例分析、最后一次观测结转、缺失模式方法、多次插值和缺失逆概率加权。我们考虑了在基于电子健康记录数据的研究中遇到的非单调缺失数据的3种机制。进一步说明这些分析方法的优势和局限性是通过使用一组睡眠呼吸暂停患者的应用程序提供的:法国Sommeil de la fsamdsamacry de Pneumologie天文台的研究数据库。我们建议仔细考虑1)缺失的原因,2)缺失是否改变了观测数据之间的现有关系,以及3)科学背景和数据源,以便选择适当的方法来处理MSMs中部分观测到的混杂因素。
Marginal structural models (MSMs) are commonly used to estimate causal intervention effects in longitudinal nonrandomized studies. A common challenge when using MSMs to analyze observational studies is incomplete confounder data, where a poorly informed analysis method will lead to biased estimates of intervention effects. Despite a number of approaches described in the literature for handling missing data in MSMs, there is little guidance on what works in practice and why. We reviewed existing missing-data methods for MSMs and discussed the plausibility of their underlying assumptions. We also performed realistic simulations to quantify the bias of 5 methods used in practice: complete-case analysis, last observation carried forward, the missingness pattern approach, multiple imputation, and inverse-probability-of-missingness weighting. We considered 3 mechanisms for nonmonotone missing data encountered in research based on electronic health record data. Further illustration of the strengths and limitations of these analysis methods is provided through an application using a cohort of persons with sleep apnea: the research database of the French Observatoire Sommeil de la Fédération de Pneumologie. We recommend careful consideration of 1) the reasons for missingness, 2) whether missingness modifies the existing relationships among observed data, and 3) the scientific context and data source, to inform the choice of the appropriate method(s) for handling partially observed confounders in MSMs.
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