Propensity Score Methods for Analyzing Observational Data Like Randomized Experiments: Challenges and Solutions for Rare Outcomes and Exposures

Ross, Michelle; Kreider, Amanda R.; Huang, Yuan‐Shung; Matone, Meredith; Rubin, David M.; Localio, A. Russell

doi:10.1093/aje/kwu469

Cited by 62 publications

(48 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Matching methodology is a convenient way to adjust for preexisting differences between groups and therefore balances confounders and reduces bias. 23 It is also robust in determining outcomes of observational studies as it attempts to replicate a randomized experiment. 24 By creating 2 equivalent groups based on patient characteristics between younger and older women, the study minimizes bias due to the confounding adverse risk factors and allows for more meaningful conclusions.…”

Section: Discussionmentioning

confidence: 99%

Is Older Age a Real Adverse Prognostic Factor in Women With Early-Stage Endometrial Carcinoma? A Matched Analysis

Haley

Burmeister²,

Buekers

et al. 2017

International Journal of Gynecological Cancer

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Is Older Age a Real Adverse Prognostic Factor in Women With Early-Stage Endometrial Carcinoma? A Matched Analysis

Haley

Burmeister²,

Buekers

et al. 2017

International Journal of Gynecological Cancer

View full text Add to dashboard Cite

show abstract

“…Therefore, this study design might understate the risk of sustained treatment with SGAs. 28 Although unlikely to explain the aggregate SGA effect, premorbid and unmeasured obesity might confound the analysis of differential risk for diabetes mellitus by specific SGA medications. Previous trials in smaller clinical samples suggested that newer SGAs (aripiprazole and ziprasidone) might carry fewer metabolic adverse effects, particularly weight gain, than other SGA medications.…”

Section: Discussionmentioning

confidence: 99%

“…26 This approach was previously applied to a reanalysis of the Women's Health Initiative. 27 Our methods appear in a separate report 28 and in eAppendix 1 in the Supplement. The institutional review board at The Children's Hospital of Philadelphia approved this study.…”

Section: Sample and Outcomesmentioning

confidence: 99%

Risk for Incident Diabetes Mellitus Following Initiation of Second-Generation Antipsychotics Among Medicaid-Enrolled Youths

et al. 2015

View full text Add to dashboard Cite

IMPORTANCE Second-generation antipsychotics (SGAs) have increasingly been prescribed to Medicaid-enrolled children, either singly or in a medication combination. Although metabolic adverse effects have been linked to SGA use in youths, estimating the risk for type 2 diabetes mellitus, a rarer outcome, has been challenging.OBJECTIVE To determine whether SGA initiation was associated with an increased risk for incident type 2 diabetes mellitus. Secondary analyses examined the risk associated with multiple-drug regimens, including stimulants and antidepressants, as well as individual SGAs. DESIGN, SETTING, AND PARTICIPANTSRetrospective national cohort study of Medicaid-enrolled youths between January 2003 and December 2007. In this observational study using national Medicaid Analytic eXtract data files, initiators and noninitiators of SGAs were identified in each month. Included in this study were US youths aged 10 to 18 years with a mental health diagnosis and enrolled in a Medicaid fee-for-service arrangement during the study. Those with chronic steroid exposure, a diagnosis of diabetes mellitus, or SGA use during a 1-year look-back period were ineligible. The mean follow-up time for all participants was 17.2 months. Youths were followed up until diagnosis of diabetes mellitus or end of follow-up owing to censoring caused by the transition into a Medicaid managed care arrangement or Medicaid ineligibility (the end of available data). Propensity weights were developed to balance observed demographic and clinical characteristics between exposure groups. Discrete failure time models were fitted using weighted logistic regression to estimate the risk for incident diabetes mellitus between initiators and noninitiators. EXPOSURE A filled SGA prescription. MAIN OUTCOMES AND MEASURESIncident type 2 diabetes mellitus identified through visit and pharmacy claims during the observation period. RESULTS Among 107 551 SGA initiators and 1 221 434 noninitiators, the risk for incident diabetes mellitus was increased among initiators (odds ratio [OR], 1.51; 95% CI, 1.35-1.69; P < .001). Compared with youths initiating only SGAs, the risk was higher among SGA initiators who used antidepressants concomitantly at the time of SGA initiation (OR, 1.54; 95% CI, 1.17-2.03; P = .002) but was not significantly different for SGA initiators who were concomitantly using stimulants. As compared with a reference group of risperidone initiators, the risk was higher among those initiating ziprasidone (OR, 1.61; 95% CI, 0.99-2.64; P = .06) and aripiprazole (OR, 1.58; 95% CI, 1.21-2.07; P = .001) but not quetiapine fumarate or olanzapine. CONCLUSIONS AND RELEVANCEThe risk for incident type 2 diabetes mellitus was increased among youths initiating SGAs and was highest in those concomitantly using antidepressants. Compared with risperidone, newer antipsychotics were not associated with decreased risk.

show abstract

“…Matching methodology has been reported to be a beneficial way to adjust for preexisting differences between racial groups, thus balancing confounders and reducing bias [21,22]. Matching can also be used as a means of endeavoring to replicate a randomized trial when attempting to determine outcomes in observational studies.…”

Section: Discussionmentioning

confidence: 99%

A Matched Analysis on the Prognostic Impact of Race on Survival Endpoints of Women with Early-Stage Endometrial Cancer

Feldman

Chaugle

Burmeister

et al. 2018

Gynecol Obstet Invest

View full text Add to dashboard Cite

Objective: To compare survival endpoints between African American (AA) and non-AA (NAA) women with endometrial carcinoma (EC) stage I–II using a robust matching analysis. Methods and Materials: Patients were matched by stage, grade, adjuvant management (surveillance, vaginal brachytherapy or pelvic radiation treatment), age, and year of hysterectomy. Recurrence-free survival (RFS), disease-specific survival (DSS) and overall survival (OS) were calculated. Results: A total of 758 patients were included. Body mass index and Age-Adjusted Charlson comorbidity index was significantly higher in AA compared to NAA women. There were no significant differences between the AA and NAA groups in regard to 5-year RFS (94 vs. 93%), DSS (96 vs. 98%) or 5-year OS (90 vs. 92%). On multivariate analysis of survival endpoints for the entire study cohort, it was found that race (AA vs. NAA) was not a significant predictor of RFS, DSS, or OS. Grade 3 tumors and the presence of lymphovascular space invasion (LVSI) were the only 2 independent predictors of RFS and DSS, while age-adjusted Charlson comorbidity score, grade 3, stage II and the presence of LVSI were independent predictors of shorter OS. Conclusions: When matched based on the tumor stage, grade, adjuvant treatment, age, and year of surgery, our study suggests that there is no statistically significant difference in any survival endpoints between AA and NAA women with early-stage EC. Based on these data, disparities in outcome likely do not stem from uterine cancer-related causes. The increased comorbidity burden in AA women is likely a factor contributing to the racial disparity in endometrial cancer.

show abstract

Propensity Score Methods for Analyzing Observational Data Like Randomized Experiments: Challenges and Solutions for Rare Outcomes and Exposures

Cited by 62 publications

References 24 publications

Is Older Age a Real Adverse Prognostic Factor in Women With Early-Stage Endometrial Carcinoma? A Matched Analysis

Is Older Age a Real Adverse Prognostic Factor in Women With Early-Stage Endometrial Carcinoma? A Matched Analysis

Risk for Incident Diabetes Mellitus Following Initiation of Second-Generation Antipsychotics Among Medicaid-Enrolled Youths

A Matched Analysis on the Prognostic Impact of Race on Survival Endpoints of Women with Early-Stage Endometrial Cancer

Contact Info

Product

Resources

About