我们为什么要权衡? 从倾向性得分权重和匹配方法理解估计
Niveditta Ramkumar1,2,3, Alexander Iribarne1,3, Elaine M Olmstead2
1The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, NH (N.R., A.I., T.A.M.).
Circulation. Cardiovascular quality and outcomes
|January 8, 2024
概括
在冠状动脉旁路移植中使用双边内部乳腺动脉 (BIMA) 与单个动脉使用相比,显著降低了长期死亡率. 不同的倾向评分方法会影响治疗效果的估计,强调选择正确的方法以获得准确的结果的重要性.
科学领域:
- 心血管外科心血管外科
- 生物统计学 生物统计学
- 流行病学 流行病学
背景情况:
- 观察性研究使用倾向性得分来平衡患者的特征,当随机化是不可行的.
- 了解不同的倾向评分方法如何影响治疗效果估计对于准确的解释至关重要.
研究的目的:
- 为了解释治疗效果估计,从各种倾向得分方法中获得的冠状动脉旁路移植后的长期死亡率.
- 为了比较单个内部乳腺动脉与双边内部乳腺动脉 (BIMA) 导管的有效性.
主要方法:
- 对47984例冠状动脉旁路移植手术 (1992-2014) 的回顾分析.
- 利用多变量考克斯回归, 1:1倾向得分匹配,以及治疗和整体人群之间的反向概率加权 (IPW).
- 单次使用后评估的长期死亡率与BIMA导管使用.
主要成果:
- 多变量考克斯回归和倾向得分匹配显示,BIMA显著降低了死亡率 (HR分别为0.83和0.79).
- 在接受治疗的人群中,IPW也表明了BIMA的保护作用 (HR 0.83).
- 总人口的IPW表明BIMA的死亡风险增加不显著 (HR1.08).
结论:
- 虽然大多数方法表明BIMA降低了死亡率,但IPW在总人口中产生了非显著的风险增加.
- 差异来自IPW方法 (整体与治疗) 权重的不同人群.
- 倾向性得分方法的选择显著影响治疗效果的估计,并且应该与所需的人口推断保持一致.
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