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Dealing with Time-Varying Eligibility for Exposure Using the Target Trials Approach to Causal Inference
Improper handling of time-dependent exposures can result in ill-defined causal effects, residual time-dependent confounding, and immortal time bias. Marginal structural models were proposed for time-varying exposures where confounders may be affected by prior treatment. However, typical definitions of exposure effects no longer apply when eligibility for exposure varies over time. We demonstrate how “treatment strategies” in the context of a target trial (Hernán and Robins, 2016) provide a solution using two real examples. The first example involves post-baseline contraindications to Direct Oral Anticoagulants (DOACs) in a study that aims to contrast DOACs with warfarin in patients with atrial fibrillation. The second involves contrasting trimester-specific exposures during pregnancy when some women deliver in the second trimester. For both of these examples, we define effects based on "treatment strategies" and describe alternate implementations of existing causal inference methods.
Date and Time
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Co-auteurs (non y compris vous-même)
Lucie Blais
Université de Montréal
Robert Platt
McGill University
Madeleine Durand
Centre Hospitalier de l’Université de Montréal and the Research Center of Centre Hospitalier de l’Université de Montréal
Langue de la présentation orale
Anglais
Langue des supports visuels
Anglais

Speaker

Edit Name Primary Affiliation
Mireille Schnitzer Université de Montréal