Causal inference with recurrent and competing events

DOI10.1007/S10985-023-09594-8arXiv2202.08500OpenAlexW4376253742WikidataQ130416377 ScholiaQ130416377MaRDI QIDQ6205045FDOQ6205045

Pål C. Ryalen, Mats J. Stensrud, Jessica G. Young, Matias Janvin

Publication date: 11 April 2024

Published in: Lifetime Data Analysis (Search for Journal in Brave)

Abstract: Many research questions concern treatment effects on outcomes that can recur several times in the same individual. For example, medical researchers are interested in treatment effects on hospitalizations in heart failure patients and sports injuries in athletes. Competing events, such as death, complicate causal inference in studies of recurrent events because once a competing event occurs, an individual cannot have more recurrent events. Several statistical estimands have been studied in recurrent event settings, with and without competing events. However, the causal interpretations of these estimands, and the conditions that are required to identify these estimands from observed data, have yet to be formalized. Here we use a counterfactual framework for causal inference to formulate several causal estimands in recurrent event settings, with and without competing events. When competing events exist, we clarify when commonly used classical statistical estimands can be interpreted as causal quantities from the causal mediation literature, such as (controlled) direct effects and total effects. Furthermore, we show that recent results on interventionist mediation estimands allow us to define new causal estimands with recurrent and competing events that may be of particular clinical relevance in many subject matter settings. We use causal directed acyclic graphs and single world intervention graphs to illustrate how to reason about identification conditions for the various causal estimands using subject matter knowledge. Furthermore, using results on counting processes, we show how our causal estimands and their identification conditions, which are articulated in discrete time, converge to classical continuous-time counterparts in the limit of fine discretizations of time. Finally, we propose several estimators and establish their consistency for the various identifying functionals.

Full work available at URL: https://arxiv.org/abs/2202.08500

zbMATH Keywords

causal inferencerecurrent eventsevent history analysiscompeting eventsseparable effects

Mathematics Subject Classification ID

Applications of statistics to biology and medical sciences; meta analysis (62P10) Survival analysis and censored data (62Nxx)

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Cited In (1)

• Robust inference for causal mediation analysis of recurrent event data

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