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      Generalizing Study Results : A Potential Outcomes Perspective

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          Abstract

          Great care is taken in epidemiologic studies to ensure the internal validity of causal effect estimates; however, external validity has received considerably less attention. When the study sample is not a random sample of the target population, the sample average treatment effect, even if internally valid, cannot usually be expected to equal the average treatment effect in the target population. The utility of an effect estimate for planning purposes and decision making will depend on the degree of departure from the true causal effect in the target population due to problems with both internal and external validity. Herein, we review concepts from recent literature on generalizability, one facet of external validity, using the potential outcomes framework. Identification conditions sufficient for external validity closely parallel identification conditions for internal validity, namely conditional exchangeability; positivity; the same distributions of the versions of treatment; no interference; and no measurement error. We also require correct model specification. Under these conditions, we discuss how a version of direct standardization (the g-formula, adjustment formula, or transport formula) or inverse probability weighting can be used to generalize a causal effect from a study sample to a well-defined target population, and demonstrate their application in an illustrative example.

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          Marginal Structural Models and Causal Inference in Epidemiology

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            Estimating causal effects from epidemiological data.

            In ideal randomised experiments, association is causation: association measures can be interpreted as effect measures because randomisation ensures that the exposed and the unexposed are exchangeable. On the other hand, in observational studies, association is not generally causation: association measures cannot be interpreted as effect measures because the exposed and the unexposed are not generally exchangeable. However, observational research is often the only alternative for causal inference. This article reviews a condition that permits the estimation of causal effects from observational data, and two methods -- standardisation and inverse probability weighting -- to estimate population causal effects under that condition. For simplicity, the main description is restricted to dichotomous variables and assumes that no random error attributable to sampling variability exists. The appendix provides a generalisation of inverse probability weighting.
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              Toward Causal Inference With Interference.

              A fundamental assumption usually made in causal inference is that of no interference between individuals (or units); that is, the potential outcomes of one individual are assumed to be unaffected by the treatment assignment of other individuals. However, in many settings, this assumption obviously does not hold. For example, in the dependent happenings of infectious diseases, whether one person becomes infected depends on who else in the population is vaccinated. In this article, we consider a population of groups of individuals where interference is possible between individuals within the same group. We propose estimands for direct, indirect, total, and overall causal effects of treatment strategies in this setting. Relations among the estimands are established; for example, the total causal effect is shown to equal the sum of direct and indirect causal effects. Using an experimental design with a two-stage randomization procedure (first at the group level, then at the individual level within groups), unbiased estimators of the proposed estimands are presented. Variances of the estimators are also developed. The methodology is illustrated in two different settings where interference is likely: assessing causal effects of housing vouchers and of vaccines.
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                Author and article information

                Journal
                Epidemiology
                Epidemiology
                Ovid Technologies (Wolters Kluwer Health)
                1044-3983
                2017
                July 2017
                : 28
                : 4
                : 553-561
                Article
                10.1097/EDE.0000000000000664
                5466356
                28346267
                0c727461-7bf1-481c-a7ad-8e5861e7dde3
                © 2017
                History

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