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The impact of nondifferential exposure misclassification on the performance of propensity scores for continuous and binary outcomes: a simulation study
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August 2018
Source: Med Care. 56(8):e46-e53
[PDF-577.43 KB]
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Alternative Title:Med Care
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Description:Purpose
To investigate the ability of the propensity score to reduce confounding bias in the presence of nondifferential misclassification of treatment, using simulations.
Methods
Using an example from the pregnancy medication safety literature, we carried out simulations to quantify the effect of nondifferential misclassification of treatment under varying scenarios of sensitivity and specificity, exposure prevalence (10%, 50%), outcome type (continuous and binary), true outcome (null and increased risk), confounding direction, and different propensity score applications (matching, stratification, weighting, regression), and obtained measures of bias and 95% confidence interval coverage.
Results
All methods were subject to substantial bias towards the null due to nondifferential exposure misclassification (range: 0% to 47% for 50% exposure prevalence and 0% to 80% for 10% exposure prevalence), particularly if specificity was low (<97%). Propensity score stratification produced the least biased effect estimates. We observed that the impact of sensitivity and specificity on the bias and coverage for each adjustment method is strongly related to prevalence of exposure: as exposure prevalence decreases and/or outcomes are continuous rather than categorical, the effect of misclassification is magnified, producing larger biases and loss of coverage of 95% confidence intervals. Propensity score matching resulted in unpredictably biased effect estimates.
Conclusion
The results of this study underline the importance of assessing exposure misclassification in observational studies in the context of propensity score methods. While propensity score methods reduce confounding bias, bias owing to nondifferential misclassification is of potentially greater concern.
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Pubmed ID:28922298
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Pubmed Central ID:PMC5854503
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