Physical Sciences and Mathematics Commons^™

Comparing The Cohort Design And The Nested Case-Control Design In The Presence Of Both Time-Invariant And Time-Dependent Treatment And Competing Risks: Bias And Precision, Peter C. Austin

Peter Austin

Purpose: Observational studies using electronic administrative health care databases are often used to estimate the effects of treatments and exposures. Traditionally, a cohort design has been used to estimate these effects, but increasingly studies are using a nested case-control (NCC) design. The relative statistical efficiency of these two designs has not been examined in detail.

Methods: We used Monte Carlo simulations to compare these two designs in terms of the bias and precision of effect estimates. We examined three different settings: (A): treatment occurred at baseline and there was a single outcome of interest; (B): treatment was time-varying and there …

Optimal Caliper Widths For Propensity-Score Matching When Estimating Differences In Means And Differences In Proportions In Observational Studies., Peter C. Austin

Peter Austin

In a study comparing the effects of two treatments, the propensity score is the probability of assignment to one treatment conditional on a subject's measured baseline covariates. Propensity-score matching is increasingly being used to estimate the effects of exposures using observational data. In the most common implementation of propensity-score matching, pairs of treated and untreated subjects are formed whose propensity scores differ by at most a pre-specified amount (the caliper width). There has been a little research into the optimal caliper width. We conducted an extensive series of Monte Carlo simulations to determine the optimal caliper width for estimating differences …

The Performance Of Different Propensity-Score Methods For Estimating Differences In Proportions (Risk Differences Or Absolute Risk Reductions) In Observational Studies, Peter C. Austin

Peter Austin

Propensity score methods are increasingly being used to estimate the effects of treatments on health outcomes using observational data. There are four methods for using the propensity score to estimate treatment effects: covariate adjustment using the propensity score, stratification on the propensity score, propensity-score matching, and inverse probability of treatment weighting (IPTW) using the propensity score. When outcomes are binary, the effect of treatment on the outcome can be described using odds ratios, relative risks, risk differences, or the number needed to treat. Several clinical commentators suggested that risk differences and numbers needed to treat are more meaningful for clinical …

Treatment Modality And Quality Differences For Black And White Breast Cancer Patients Treated In Community Hospitals, Paula Diehr

Paula Diehr

This study assessed the relationship of race and patterns of care, defined by an expert NCI-appointed committee, for 7,781 patients with breast cancer treated in 107 hospitals in 45 communities between 1982 and 1985. After control for age and stage of disease, black patients had significantly different care from white patients for four of the ten patterns examined. They were less likely to have a progesterone receptor assay or to be referred for postmastectomy rehabilitation, two patterns deemed desirable for all patients. Black patients were also more likely to receive liver scans and radiation therapy in situations in which these …

The Effect Of Age On The Care Of Women With Breast Cancer In Community Hospitals, Paula Diehr, Joe Chu

Paula Diehr

We studied the process of care received by 1,680 female breast cancer patients treated in 17 community hospitals. The probability of receiving various diagnostic, consultation, therapy, or rehabilitation services was almost always significantly associated with patient age for one or more disease stages. Most often there was a linear trend for older patients to receive fewer services (e.g., biopsies prior to definitive treatment, number of lymph nodes examined, chemotherapy, radiation therapy) but other age patterns also were found. Age was not significantly associated with clinical staging or estrogen receptors.