Instrumental variable with competing risk model

A nonparametric instrumental approach to confounding in competing risks models

This paper discusses nonparametric identification and estimation of the causal effect of a treatment in the presence of confounding, competing risks and random right-censoring. Our identification strategy is based on an instrumental variable. We show that the competing risks model generates a nonparametric quantile instrumental regression problem. Quantile treatment effects on the subdistribution function can be recovered from the regression function. A distinguishing feature of the model is that censoring and competing risks prevent identification at some quantiles. We characterize the set of quantiles for which exact identification is possible and give partial identification results for other quantiles. We outline an estimation procedure and discuss its properties. The finite sample performance of the estimator is evaluated through simulations. We apply the proposed method to the Health Insurance Plan of Greater New York experiment.

Instrumental variable estimation of early treatment effect in randomized screening trials

The primary analysis of randomized screening trials for cancer typically adheres to the intention-to-screen principle, measuring cancer-specific mortality reductions between screening and control arms. These mortality reductions result from a combination of the screening regimen, screening technology and the effect of the early, screening-induced, treatment. This motivates addressing these different aspects separately. Here we are interested in the causal effect of early versus delayed treatments on cancer mortality among the screening-detectable subgroup, which under certain assumptions is estimable from conventional randomized screening trial using instrumental variable type methods. To define the causal effect of interest, we formulate a simplified structural multi-state model for screening trials, based on a hypothetical intervention trial where screening detected individuals would be randomized into early versus delayed treatments. The cancer-specific mortality reductions after screening detection are quantified by a cause-specific hazard ratio. For this, we propose two estimators, based on an estimating equation and a likelihood expression. The methods extend existing instrumental variable methods for time-to-event and competing risks outcomes to time-dependent intermediate variables. Using the multi-state model as the basis of a data generating mechanism, we investigate the performance of the new estimators through simulation studies. In addition, we illustrate the proposed method in the context of CT screening for lung cancer using the US National Lung Screening Trial data.

Estimation of causal quantile effects with a binary instrumental variable and censored data

The causal effect of a treatment is of fundamental interest in the social, biological, and health sciences. Instrumental variable (IV) methods are commonly used to determine causal treatment effects in the presence of unmeasured confounding. In this work, we study a new binary IV framework with randomly censored outcomes where we propose to quantify the causal treatment effect by the concept of complier quantile causal effect (CQCE). The CQCE is identifiable under weaker conditions than the complier average causal effect when outcomes are subject to censoring, and it can provide useful insight into the dynamics of the causal treatment effect. Employing the special characteristic of the binary IV and adapting the principle of conditional score, we uncover a simple weighting scheme that can be incorporated into the standard censored quantile regression procedure to estimate CQCE. We develop robust nonparametric estimation of the derived weights in the first stage, which permits stable implementation of the second stage estimation based on existing software. We establish rigorous asymptotic properties for the proposed estimator, and confirm its validity and satisfactory finite-sample performance via extensive simulations. The proposed method is applied to a bone marrow transplant dataset to evaluate the causal effect of rituximab in diffuse large B-cell lymphoma patients.

Explained variation under the additive hazards model

We study explained variation under the additive hazards regression model for right-censored data. We consider different approaches for developing such a measure, and focus on one that estimates the proportion of variation in the failure time explained by the covariates. We study the properties of the measure both analytically, and through extensive simulations. We apply the measure to a well-known survival dataset as well as the linked surveillance, epidemiology, and end results-Medicare database for prediction of mortality in early stage prostate cancer patients using high-dimensional claims codes.

Two-stage residual inclusion for survival data and competing risks-An instrumental variable approach with application to SEER-Medicare linked data

Instrumental variable is an essential tool for addressing unmeasured confounding in observational studies. Two-stage predictor substitution (2SPS) estimator and two-stage residual inclusion (2SRI) are two commonly used approaches in applying instrumental variables. Recently, 2SPS was studied under the additive hazards model in the presence of competing risks of time-to-events data, where linearity was assumed for the relationship between the treatment and the instrument variable. This assumption may not be the most appropriate when we have binary treatments. In this paper, we consider the 2SRI estimator under the additive hazards model for general survival data and in the presence of competing risks, which allows generalized linear models for the relation between the treatment and the instrumental variable. We derive the asymptotic properties including a closed-form asymptotic variance estimate for the 2SRI estimator. We carry out numerical studies in finite samples and apply our methodology to the linked Surveillance, Epidemiology and End Results (SEER)-Medicare database comparing radical prostatectomy versus conservative treatment in early-stage prostate cancer patients.

Instrumental variables estimation with competing risk data

Time-to-event analyses are often plagued by both—possibly unmeasured—confounding and competing risks. To deal with the former, the use of instrumental variables (IVs) for effect estimation is rapidly gaining ground. We show how to make use of such variables in competing risk analyses. In particular, we show how to infer the effect of an arbitrary exposure on cause-specific hazard functions under a semi-parametric model that imposes relatively weak restrictions on the observed data distribution. The proposed approach is flexible accommodating exposures and IVs of arbitrary type, and enabling covariate adjustment. It makes use of closed-form estimators that can be recursively calculated, and is shown to perform well in simulation studies. We also demonstrate its use in an application on the effect of mammography screening on the risk of dying from breast cancer.