Biostatistics Advance Access originally published online on September 15, 2006
Biostatistics 2007 8(3):526-545; doi:10.1093/biostatistics/kxl027
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Causal inference for non-mortality outcomes in the presence of death
Biostatistics Facility, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA Brian.Egleston{at}fccc.edu
Department of Biostatistics, Johns Hopkins University, Baltimore, MD 21205, USA
Department of Ophthalmology, Johns Hopkins University, Baltimore, MD 21205, USA
* To whom correspondence should be addressed.
Evaluation of the causal effect of a baseline exposure on a morbidity outcome at a fixed time point is often complicated when study participants die before morbidity outcomes are measured. In this setting, the causal effect is only well defined for the principal stratum of subjects who would live regardless of the exposure. Motivated by gerontologic researchers interested in understanding the causal effect of vision loss on emotional distress in a population with a high mortality rate, we investigate the effect among those who would live both with and without vision loss. Since this subpopulation is not readily identifiable from the data and vision loss is not randomized, we introduce a set of scientifically driven assumptions to identify the causal effect. Since these assumptions are not empirically verifiable, we embed our methodology within a sensitivity analysis framework. We apply our method using the first three rounds of survey data from the Salisbury Eye Evaluation, a population-based cohort study of older adults. We also present a simulation study that validates our method.
Keywords: Causal inference; Competing risk; Emotional distress; Sensitivity analysis; Vision loss
Received June 27, 2005; revised March 8, 2006; revised August 2, 2006; revised September 1, 2006; accepted for publication September 13, 2006.
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