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Early Childhood Education and Adult Depression: An Attrition Reanalysis With Inverse Propensity Score Weighting.

ABSTRACT: In a previous study of the Child-Parent Centers (CPC) education program, preschool participation was linked to a 4.6 percentage point reduction (26%) in depressive symptoms at ages 22-24 over the matched comparison group enrolling the usual programs. The present study reanalyzed these data in the Chicago Longitudinal Study to address potential attrition bias since more than a quarter of the sample was missing on the outcome. Using inverse probability weighting (IPW) involving 32 predictors of sample retention, findings for the 1,142 participants growing up in high-poverty neighborhoods indicated that CPC participation was associated with a 7.1 percentage point reduction (95% CI = [-9.7, -5.4]) in one or more depressive symptoms (39% reduction over the comparison group). Although this marginal effect was within the confidence interval of the original study (95% CI = [-9.5, 0.3]), the 54% increase in the point estimate is substantial and of practical significance, suggesting underestimation in the prior study. Alternative analysis of different predictors and IPW models, including adjustments for program selection and attrition together, yielded similar results. Findings indicate that high-quality early childhood programs continue to be an important strategy for the prevention of depression and its debilitating effects on individuals and families.

SUBMITTER: Mondi CF

PROVIDER: S-EPMC8127666 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThe diagnostic process is a key element of medicine but it is complex and prone to errors. Infectious diseases are one of the three categories of diseases in which diagnostic errors can be most harmful to patients. In this study we aimed to estimate the effect of initial misdiagnosis of the source of infection in patients with bacteraemia on 14 day mortality using propensity score methods to adjust for confounding.MethodsData from a previously described longitudinal cohort of patients diagnosed with monobacterial bloodstream infection (BSI) at the Leiden University Medical Centre (LUMC) between 2013 and 2015 were used. Propensity score matching and inversed probability of treatment weighting (IPTW) were applied to correct for confounding. The average treatment effect on the treated (ATT), which in this study was the average effect of initial misdiagnosis on the misdiagnosed (AEMM), was estimated. Methodological issues that were encountered when applying propensity score methods were addressed by performing additional sensitivity analyses. Sensitivity analyses consisted of varying caliper in propensity score matching and using different truncated weights in inversed probability of treatment weighting.ResultsData of 887 patients were included in the study. Propensity scores ranged between 0.015 and 0.999 and 80 patients (9.9%) had a propensity score > 0.95. In the matched analyses, 35 of the 171 misdiagnosed patients died within 14 days (20.5%), versus 10 of the 171 correctly diagnosed patients (5.8%), yielding a difference of 14.6% (7.6%; 21.6%). In the total group of patients, the observed percentage of patients with an incorrect initial diagnosis that died within 14 days was 19.8% while propensity score reweighting estimated that their probability of dying would have been 6.5%, if they had been correctly diagnosed (difference 13.3% (95% CI 6.9%;19.6%)). After adjustment for all variables that showed disbalance in the propensity score a difference of 13.7% (7.4%; 19.9%) was estimated. Sensitivity analyses yielded similar results. However, performing weighted analyses without truncation yielded unstable results.ConclusionThus, we observed a substantial increase of 14 day mortality in initially misdiagnosed patients. Furthermore, several patients received propensity scores extremely close to one and were almost sure to be initially misdiagnosed.

Project description:BACKGROUND:It is important to estimate the treatment effect of interest accurately and precisely within the analysis of randomised controlled trials. One way to increase precision in the estimate and thus improve the power for randomised trials with continuous outcomes is through adjustment for pre-specified prognostic baseline covariates. Typically covariate adjustment is conducted using regression analysis, however recently, Inverse Probability of Treatment Weighting (IPTW) using the propensity score has been proposed as an alternative method. For a continuous outcome it has been shown that the IPTW estimator has the same large sample statistical properties as that obtained via analysis of covariance. However the performance of IPTW has not been explored for smaller population trials (<?100 participants), where precise estimation of the treatment effect has potential for greater impact than in larger samples. METHODS:In this paper we explore the performance of the baseline adjusted treatment effect estimated using IPTW in smaller population trial settings. To do so we present a simulation study including a number of different trial scenarios with sample sizes ranging from 40 to 200 and adjustment for up to 6 covariates. We also re-analyse a paediatric eczema trial that includes 60 children. RESULTS:In the simulation study the performance of the IPTW variance estimator was sub-optimal with smaller sample sizes. The coverage of 95% CI's was marginally below 95% for sample sizes <?150 and???100. For sample sizes <?100 the coverage of 95% CI's was always significantly below 95% for all covariate settings. The minimum coverage obtained with IPTW was 89% with n?=?40. In comparison, regression adjustment always resulted in 95% coverage. The analysis of the eczema trial confirmed discrepancies between the IPTW and regression estimators in a real life small population setting. CONCLUSIONS:The IPTW variance estimator does not perform so well with small samples. Thus we caution against the use of IPTW in small sample settings when the sample size is less than 150 and particularly when sample size <?100.

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Early Childhood Education and Adult Depression: An Attrition Reanalysis With Inverse Propensity Score Weighting.

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