June 2022 A flexible sensitivity analysis approach for unmeasured confounding with multiple treatments and a binary outcome with application to SEER-Medicare lung cancer data
Liangyuan Hu, Jungang Zou, Chenyang Gu, Jiayi Ji, Michael Lopez, Minal Kale
Author Affiliations +
Ann. Appl. Stat. 16(2): 1014-1037 (June 2022). DOI: 10.1214/21-AOAS1530

Abstract

In the absence of a randomized experiment, a key assumption for drawing causal inference about treatment effects is the ignorable treatment assignment. Violations of the ignorability assumption may lead to biased treatment effect estimates. Sensitivity analysis helps gauge how causal conclusions will be altered in response to the potential magnitude of departure from the ignorability assumption. However, sensitivity analysis approaches for unmeasured confounding in the context of multiple treatments and binary outcomes are scarce. We propose a flexible Monte Carlo sensitivity analysis approach for causal inference in such settings. We first derive the general form of the bias introduced by unmeasured confounding, with emphasis on theoretical properties uniquely relevant to multiple treatments. We then propose methods to encode the impact of unmeasured confounding on potential outcomes and adjust the estimates of causal effects in which the presumed unmeasured confounding is removed. Our proposed methods embed nested multiple imputation within the Bayesian framework, which allow for seamless integration of the uncertainty about the values of the sensitivity parameters and the sampling variability as well as use of the Bayesian Additive Regression Trees for modeling flexibility. Expansive simulations validate our methods and gain insight into sensitivity analysis with multiple treatments. We use the SEER-Medicare data to demonstrate sensitivity analysis using three treatments for early stage nonsmall cell lung cancer. The methods developed in this work are readily available in the R package SAMTx.

Funding Statement

The first author was supported in part by NIH Grants R21 CA245855-01 and and P30CA196521-01 and by award ME_2017C3_9041 from the Patient-Centered Outcomes Research Institute.

Citation

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Liangyuan Hu. Jungang Zou. Chenyang Gu. Jiayi Ji. Michael Lopez. Minal Kale. "A flexible sensitivity analysis approach for unmeasured confounding with multiple treatments and a binary outcome with application to SEER-Medicare lung cancer data." Ann. Appl. Stat. 16 (2) 1014 - 1037, June 2022. https://doi.org/10.1214/21-AOAS1530

Information

Received: 1 February 2021; Revised: 1 June 2021; Published: June 2022
First available in Project Euclid: 13 June 2022

MathSciNet: MR4438822
zbMATH: 1498.62223
Digital Object Identifier: 10.1214/21-AOAS1530

Keywords: Bayesian inference , Causal inference , ignorability assumption , nested multiple imputation , observational data

Rights: Copyright © 2022 Institute of Mathematical Statistics

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Vol.16 • No. 2 • June 2022
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