Research on the causal effects of non-small cell lung cancer treatment process on in-hospital mortality based on double ro-bust estimation method
10.11904/j.issn.1002-3070.2024.04.004
- VernacularTitle:基于双重稳健估计方法的非小细胞肺癌治疗过程对院内死亡的因果效应研究
- Author:
Jian LI
1
;
Qianni LI
;
Lingyan XU
;
Xuepei YAO
;
Meina LIU
Author Information
1. 哈尔滨医科大学公共卫生学院卫生统计学教研室(哈尔滨 150081)
- Keywords:
Non-small cell lung cancer;
Propensity score;
Inverse probability of treatment weighting;
Doubly robust estima-tion;
Treatment quality
- From:
Practical Oncology Journal
2024;38(4):235-240
- CountryChina
- Language:Chinese
-
Abstract:
Objective The aim of this study was to estimate the causal effects of non-small cell lung cancer(NSCLC)treat-ment process on in-hospital mortality based on the double robust estimation(DR)method,and provide a reference basis for reducing in-hospital mortality of NSCLC.Methods According to the quality evaluation system of NSCLC treatment,the utilization rate of treatment process indicators was calculated,and patients were divided into the high-quality or low-quality groups based on the aver-age score of treatment process quality.In-hospital mortality was used as the outcome indicator,Kaplan-Meier method and Cox regres-sion adjusted for propensity score inverse probability of treatment weighting(IPTW)correction were used to analyze the impact of treat-ment process quality on in-hospital mortality in NSCLC.DR was combined to estimate the causal effects of the treatment process on in-hospital mortality.Results The median utilization rate of treatment process indicators was 66.88%,and the mean and standard de-viation of patients′ treatment process quality scores were 0.270±0.124,including 0.358±0.069 in the high-quality group,and 0.158±0.081 in the low-quality group.After the IPTW weighting,the standardized mean difference(SMD)of patients′baseline characteris-tics decreased;The difference in survival curves between the two groups of patients before and after ITPW was statistically significant(P<0.05),and the prognosis of patients in the high-quality group was better than that of patients in the low-quality group(pre-IPTW:HR=0.367,95%CI:0.275-0.491;post-IPTW:HR=0.228,95%CI:0.167-0.312).Compared with the low-quality group,the average causal effect of treatment process on in-hospital mortality was-0.026 in the high-quality group.Conclusion DR can compensate for the shortcomings of logistic or IPTW,avoid the risk of model error,and obtain for the causal effect of treatment process on in-hospital mortality.In medical practice,the utilization rate of treatment process indicators should be increased to improve patient prognosis;The study of causal effects suggests that besides the treatment process,other factors that affect in-hospital mortality cannot be ignored.
