A Marginal Structural Modeling Approach with Super Learning for a Study on Oral Bisphosphonate Therapy and Atrial Fibrillation
Notice bibliographique
Résumé
Abstract Purpose : Observational studies designed to investigate the safety of a drug in a postmarketing setting typically aim to examine rare and non-acute adverse effects in a population that is not restricted to particular patient subgroups for which the therapy, typically a drug, was originally approved. Large healthcare databases and, in particular, rich electronic medical record (EMR) databases, are well suited for the conduct of these safety studies since they can provide detailed longitudinal information on drug exposure, confounders, and outcomes for large and representative samples of patients that are considered for treatment in clinical settings. Analytic efforts for drawing valid causal inferences in such studies are faced with three challenges: (1) the formal definition of relevant effect measures addressing the safety question of interest; (2) the development of analytic protocols to estimate such effects based on causal methodologies that can properly address the problems of time-dependent confounding and selection bias due to informative censoring, and (3) the practical implementation of such protocols in a large clinical/medical database setting. In this article, we describe an effort to specifically address these challenges with marginal structural modeling based on inverse probability weighting with data reduction and super learning. Methods : We describe the principles of, motivation for, and implementation of an analytical protocol applied in a safety study investigating possible effects of exposure to oral bisphosphonate therapy on the risk of non-elective hospitalization for atrial fibrillation or atrial flutter among older women based on EMR data from the Kaiser Permanente Northern California integrated health care delivery system. Adhering to guidelines brought forward by Hernan (Epidemiology 2011;22:290-1), we start by framing the safety research question as one that could be directly addressed by a sequence of ideal randomized experiments before describing the estimation approach that we implemented to emulate inference from such trials using observational data. Results : This report underlines the important computation burden involved in the application of the current R implementation of super learning with large data sets. While computing time and memory requirements did not permit aggressive estimator selection with super learning, this analysis demonstrates the applicability of simplified versions of super learning based on select sets of candidate learners to avoid complete reliance on arbitrary selection of parametric models for confounding and selection bias adjustment. Results do not raise concern over the safety of one-year exposure to BP but may suggest residual bias possibly due to unmeasured confounders or insufficient parametric adjustment for observed confounders with the candidate learners selected. Conclusions : Adjustment for time-dependent confounding and selection bias based on the ad hoc inverse probability weighting approach described in this report may provide a feasible alternative to extended Cox modeling or the point treatment analytic approaches (e.g. based on propensity score matching) that are often adopted in safety research with large data sets. Alternate algorithms are needed to permit the routine and more aggressive application of super learning with large data sets.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,056 | 0,109 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,004 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,002 | 0,004 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,005 | 0,005 |
| Intégrité de la recherche | 0,003 | 0,005 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,007 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».