Loading...
Propensity score matching and randomization
Mnatzaganian, George Davidson, David C. Hiller, Janet E. Ryan, Philip
Mnatzaganian, George
Davidson, David C.
Hiller, Janet E.
Ryan, Philip
Abstract
Objectives We used elective total joint replacement (TJR) as a case study to demonstrate selection bias toward offering this procedure to younger and healthier patients. Study Design and Setting Longitudinal data from 2,202 men were integrated with hospital data and mortality records. Study participants were followed from recruitment (1996–1999) until TJR, death, or 2007 (end of follow-up). A propensity score (PS) was constructed to quantify each subject's likelihood of undergoing TJR. TJR recipients were later matched to their non-TJR counterparts by PS and year of hospitalization. Ten-year mortality from index admission was compared between cases and controls. Results Overall, 819 (37.2%) had TJR. Those were younger, healthier, and belonged to higher socioeconomic classes compared with those who were not proposed for surgery. Of the TJR recipients, 718 were matched to 1,109 controls. Cases and controls had similar characteristics and similar years of follow-up from recruitment till index admission. Nonetheless, controls were more likely to die (39.5%) compared with 14.5% in TJR cases (P < 0.001). Conclusion Selection for elective procedures may introduce bias in prognostic features not accounted for by PS matching. Caution must be exercised when long-term outcomes are compared between surgical and nonsurgical groups in a population at risk for that surgical procedure.
Keywords
Date
2015
Type
Journal article
Journal
Journal of Clinical Epidemiology
Book
Volume
68
Issue
7
Page Range
1-9
Article Number
ACU Department
Collections
Relation URI
Source URL
Event URL
Open Access Status
License
File Access
Controlled