An Illustration of Inverse Probability Weighting to Estimate Policy-Relevant Causal Effects

被引:11
|
作者
Edwards, Jessie K. [1 ]
Cole, Stephen R. [1 ]
Lesko, Catherine R. [2 ]
Mathews, W. Christopher [3 ]
Moore, Richard D. [4 ]
Mugavero, Michael J. [5 ]
Westreich, Daniel [1 ]
机构
[1] Univ North Carolina Chapel Hill, Gillings Sch Global Publ Hlth, Dept Epidemiol, Chapel Hill, NC USA
[2] Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA
[3] Univ Calif San Diego, Sch Med, La Jolla, CA 92093 USA
[4] Johns Hopkins Univ, Sch Med, Baltimore, MD USA
[5] Univ Alabama Birmingham, Sch Med, Birmingham, AL USA
基金
美国国家卫生研究院;
关键词
antiretroviral therapy; causal inference; epidemiologic methods; HIV; intervention studies; policy; treatment guidelines; ACTIVE ANTIRETROVIRAL THERAPY; MARGINAL STRUCTURAL MODELS; POPULATION INTERVENTION MODELS; DOUBLY ROBUST ESTIMATION; CORONARY-HEART-DISEASE; MEASUREMENT-ERROR; MORTALITY; HIV; AIDS; INITIATION;
D O I
10.1093/aje/kwv339
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Traditional epidemiologic approaches allow us to compare counterfactual outcomes under 2 exposure distributions, usually 100% exposed and 100% unexposed. However, to estimate the population health effect of a proposed intervention, one may wish to compare factual outcomes under the observed exposure distribution to counterfactual outcomes under the exposure distribution produced by an intervention. Here, we used inverse probability weights to compare the 5-year mortality risk under observed antiretroviral therapy treatment plans to the 5-year mortality risk that would had been observed under an intervention in which all patients initiated therapy immediately upon entry into care among patients positive for human immunodeficiency virus in the US Centers for AIDS Research Network of Integrated Clinical Systems multisite cohort study between 1998 and 2013. Therapy-na < ve patients (n = 14,700) were followed from entry into care until death, loss to follow-up, or censoring at 5 years or on December 31, 2013. The 5-year cumulative incidence of mortality was 11.65% under observed treatment plans and 10.10% under the intervention, yielding a risk difference of -1.57% (95% confidence interval: -3.08, -0.06). Comparing outcomes under the intervention with outcomes under observed treatment plans provides meaningful information about the potential consequences of new US guidelines to treat all patients with human immunodeficiency virus regardless of CD4 cell count under actual clinical conditions.
引用
收藏
页码:336 / 344
页数:9
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