DOI QR코드

DOI QR Code

Application of Standardization for Causal Inference in Observational Studies: A Step-by-step Tutorial for Analysis Using R Software

  • Lee, Sangwon (Department of Public Health Science, Graduate School of Public Health, Seoul National University) ;
  • Lee, Woojoo (Department of Public Health Science, Graduate School of Public Health, Seoul National University)
  • Received : 2021.10.22
  • Accepted : 2022.01.06
  • Published : 2022.03.31

Abstract

Epidemiological studies typically examine the causal effect of exposure on a health outcome. Standardization is one of the most straightforward methods for estimating causal estimands. However, compared to inverse probability weighting, there is a lack of user-centric explanations for implementing standardization to estimate causal estimands. This paper explains the standardization method using basic R functions only and how it is linked to the R package stdReg, which can be used to implement the same procedure. We provide a step-by-step tutorial for estimating causal risk differences, causal risk ratios, and causal odds ratios based on standardization. We also discuss how to carry out subgroup analysis in detail.

Keywords

Acknowledgement

This study was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No.2021R1A2C1014409).

References

  1. Concato J, Shah N, Horwitz RI. Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med 2000;342(25):1887-1892. https://doi.org/10.1056/NEJM200006223422507
  2. Altman N, Krzywinski M. Association, correlation and causation. Nat Methods 2015;12(10):899-900. https://doi.org/10.1038/nmeth.3587
  3. Hernan MA, Hernandez-Diaz S, Werler MM, Mitchell AA. Causal knowledge as a prerequisite for confounding evaluation: an application to birth defects epidemiology. Am J Epidemiol 2002;155(2):176-184. https://doi.org/10.1093/aje/155.2.176
  4. Hernan MA, Robins JM. Causal inference: what If [cited 2021 Oct 1]. Available from: https://cdn1.sph.harvard.edu/wp-content/uploads/sites/1268/2021/03/ciwhatif_hernanrobins_30mar21.pdf.
  5. Sjolander A. Regression standardization with the R package stdReg. Eur J Epidemiol 2016;31(6):563-574. https://doi.org/10.1007/s10654-016-0157-3
  6. Hernan MA, Hernandez-Diaz S, Robins JM. A structural approach to selection bias. Epidemiology 2004;15(5):615-625. https://doi.org/10.1097/01.ede.0000135174.63482.43
  7. Cole SR, Platt RW, Schisterman EF, Chu H, Westreich D, Richardson D, et al. Illustrating bias due to conditioning on a collider. Int J Epidemiol 2010;39(2):417-420. https://doi.org/10.1093/ije/dyp334
  8. Shrier I, Platt RW. Reducing bias through directed acyclic graphs. BMC Med Res Methodol 2008;8:70. https://doi.org/10.1186/1471-2288-8-70
  9. Westreich D, Cole SR. Invited commentary: positivity in practice. Am J Epidemiol 2010;171(6):674-677. https://doi.org/10.1093/aje/kwp436
  10. Song BG, Kim MJ, Sinn DH, Kang W, Gwak GY, Paik YH, et al. A comparison of factors associated with the temporal improvement in the overall survival of BCLC stage 0 hepatocellular carcinoma patients. Dig Liver Dis 2021;53(2):210-215. https://doi.org/10.1016/j.dld.2020.10.030
  11. Nowok B, Raab GM, Dibben C. synthpop: Bespoke creation of synthetic data in R. J Stat Softw 2016;74(11):1-26.
  12. Kim GA, Shim JH, Kim MJ, Kim SY, Won HJ, Shin YM, et al. Radiofrequency ablation as an alternative to hepatic resection for single small hepatocellular carcinomas. Br J Surg 2016;103(1):126-135. https://doi.org/10.1002/bjs.9960
  13. Textor J. Drawing and analyzing causal DAGs with DAGitty. arXiv [Preprint]. 2015 [cited 2021 Oct 22]. Available from: https://arxiv.org/pdf/1508.04633.pdf.
  14. Judea Pearl, Madelyn Glymour, Nicholas P Jewell. Causal inference in statistics: a primer. Chichester: Wiley; 2016, p. 1-136.
  15. Thabane L, Mbuagbaw L, Zhang S, Samaan Z, Marcucci M, Ye C, et al. A tutorial on sensitivity analyses in clinical trials: the what, why, when and how. BMC Med Res Methodol 2013;13:92. https://doi.org/10.1186/1471-2288-13-92
  16. Gharibzadeh S, Mohammad K, Rahimiforoushani A, Amouzegar A, Mansournia MA. Standardization as a tool for causal inference in medical research. Arch Iran Med 2016;19(9):666-670.
  17. Keiding N, Clayton D. Standardization and control for confounding in observational studies: a historical perspective. Stat Sci 2014;29(4):529-558. https://doi.org/10.1214/13-STS453
  18. Ferguson KD, McCann M, Katikireddi SV, Thomson H, Green MJ, Smith DJ, et al. Evidence synthesis for constructing directed acyclic graphs (ESC-DAGs): a novel and systematic method for building directed acyclic graphs. Int J Epidemiol 2020;49(1):322-329. https://doi.org/10.1093/ije/dyz150
  19. Hernan MA, Robins JM. Estimating causal effects from epidemiological data. J Epidemiol Community Health 2006;60(7):578-586. https://doi.org/10.1136/jech.2004.029496
  20. Stuart EA. Matching methods for causal inference: a review and a look forward. Stat Sci 2010;25(1):1-21. https://doi.org/10.1214/09-STS313