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      Causal inference and the data-fusion problem

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      Proceedings of the National Academy of Sciences
      Proceedings of the National Academy of Sciences

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          Causal inference in statistics: An overview

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            Identification of Causal Effects Using Instrumental Variables

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              Generalizing evidence from randomized clinical trials to target populations: The ACTG 320 trial.

              Properly planned and conducted randomized clinical trials remain susceptible to a lack of external validity. The authors illustrate a model-based method to standardize observed trial results to a specified target population using a seminal human immunodeficiency virus (HIV) treatment trial, and they provide Monte Carlo simulation evidence supporting the method. The example trial enrolled 1,156 HIV-infected adult men and women in the United States in 1996, randomly assigned 577 to a highly active antiretroviral therapy and 579 to a largely ineffective combination therapy, and followed participants for 52 weeks. The target population was US people infected with HIV in 2006, as estimated by the Centers for Disease Control and Prevention. Results from the trial apply, albeit muted by 12%, to the target population, under the assumption that the authors have measured and correctly modeled the determinants of selection that reflect heterogeneity in the treatment effect. In simulations with a heterogeneous treatment effect, a conventional intent-to-treat estimate was biased with poor confidence limit coverage, but the proposed estimate was largely unbiased with appropriate confidence limit coverage. The proposed method standardizes observed trial results to a specified target population and thereby provides information regarding the generalizability of trial results.
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                Author and article information

                Journal
                Proceedings of the National Academy of Sciences
                Proc Natl Acad Sci USA
                Proceedings of the National Academy of Sciences
                0027-8424
                1091-6490
                July 05 2016
                July 05 2016
                : 113
                : 27
                : 7345-7352
                Article
                10.1073/pnas.1510507113
                27382148
                520f9298-1c49-4dc9-a9fe-8390e18823cc
                © 2016
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