Propensity scores in the presence of effect modification A case study using the comparison of mortality on hemodialysis versus peritoneal dialysis 英文参考文献.docVIP

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Propensity scores in the presence of effect modification A case study using the comparison of mortality on hemodialysis versus peritoneal dialysis 英文参考文献.doc

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Propensity scores in the presence of effect modification A case study using the comparison of mortality on hemodialysis versus peritoneal dialysis 英文参考文献

Liem et al. Emerging Themes in Epidemiology 2010, 7 :1 /content/7/1/1 EMERGING THEMES IN EPIDEMIOLOGY ANALYTIC PERSPECTIVE Open Access Propensity scores in the presence of effect Analytic perspective modification: A case study using the comparison of mortality on hemodialysis versus peritoneal dialysis Ylian S Liem*1,2, John B Wong3, MG Myriam Hunink1,4, Frank Th de Charro5 and Wolfgang C Winkelmayer6 Abstract Purpose: To control for confounding bias from non-random treatment assignment in observational data, both traditional multivariable models and more recently propensity score approaches have been applied. Our aim was to compare a propensity score-stratified model with a traditional multivariable-adjusted model, specifically in estimating survival of hemodialysis (HD) versus peritoneal dialysis (PD) patients. Methods: Using the Dutch End-Stage Renal Disease Registry, we constructed a propensity score, predicting PD assignment from age, gender, primary renal disease, center of dialysis, and year of first renal replacement therapy. We developed two Cox proportional hazards regression models to estimate survival on PD relative to HD, a propensity score-stratified model stratifying on the propensity score and a multivariable-adjusted model, and tested several interaction terms in both models. Results: The propensity score performed well: it showed a reasonable fit, had a good c-statistic, calibrated well and balanced the covariates. The main-effects multivariable-adjusted model and the propensity score-stratified univariable Cox model resulted in similar relative mortality risk estimates of PD compared with HD (0.99 and 0.97, respectively) with fewer significant covariates in the propensity model. After introducing the missing interaction variables for effect modification in both models, the mortality risk estimates for both main effects and interactions remained comparable, but the propensity score model had nearly as many covariates because o