倾向性得分的比较有效性估计方法治疗的逆概率权衡分析与复杂的调查数据:一个模拟研究
Lihua Li1, Chen Yang2, Liangyuan Hu3
1Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Institute for Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
随机森林 (RF) 在复杂的调查数据分析中优于其他倾向评分方法的因果推理. 这种机器学习方法是推用于估计人口平均治疗效果的,特别是有限的重叠.
科学领域:
- 老年学研究 老年学研究
- 生物统计学 生物统计学
- 卫生经济学 卫生经济学
背景情况:
- 倾向分数 (PS) 方法对于复杂的调查数据中的因果推断至关重要.
- 在这种情况下,各种PS估计技术的比较性能,特别是机器学习算法,尚未得到充分研究.
研究的目的:
- 通过使用复杂的调查数据,在治疗权重的逆概率 (IPTW) 分析中全面比较六种PS估计方法.
- 确定最有效的PS估计方法,在老年研究中推断因果关系.
主要方法:
- 一项模拟研究评估了后勤回归,共变平衡倾向得分,通用增强模型,分类和回归树,随机森林 (RF) 和超级学习者.
- 在12个不同治疗效果的场景中评估了表现,共变联 (非线性,非添加性) 和倾向性得分重叠.
- 方法还应用于医疗保险受益者当前调查 (2002-2019) 数据,以评估临终关怀医院的使用和终身成本.
主要成果:
- 所有的方法都以类似的方式进行,具有强烈的倾向性得分重叠.
- 随机森林 (RF) 在具有弱倾向分数重叠的场景中以及在非添加/非线性条件下表现优异.
- 在现实应用中,临终关怀的使用与Medicare受益人生命末期医疗保健成本显著降低有关.
结论:
- 与其他评估方法相比,随机森林 (RF) 是IPTW分析中使用复杂调查数据进行倾向性得分估计的更有效方法.
- 这些发现支持RF在老年医学和健康经济学研究中用于可靠的因果效应估计.
- 临终关怀与医疗保险人口的终身医疗保健支出减少有关.
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