Estimate Time-Varying Exposure Effects via Ensemble Learning-Based Marginal Structural Model With Application to...

Evaluating the effects of time-varying exposures is essential for longitudinal studies. The effect estimation becomes increasingly challenging when dealing with hundreds of time-dependent confounders. We propose a Marginal Structure Ensemble Learning Model (MASE) to provide a marginal structural model (MSM)-based robust estimator under the longitudinal setting. The proposed model integrates multiple machine learning algorithms to model propensity scores and a sequence of conditional outcome means such that it becomes less sensitive to model misspecification due to any single algorithm and allows many confounders with potential nonlinear confounding effects to reduce the risk of inconsistent estimation. Extensive simulation analysis demonstrates the superiority of MASE over benchmark methods (e.g., MSM, G-computation, and Targeted maximum likelihood), yielding smaller estimation bias and improved inference accuracy. We apply MASE to the adolescent cognitive development study to investigate the time-varying effects of sleep insufficiency on cognitive performance. The results reveal an aggregated negative impact of insufficient sleep on cognitive development among youth.