期刊
AMERICAN JOURNAL OF EPIDEMIOLOGY
卷 188, 期 9, 页码 1674-1681出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/aje/kwz121
关键词
causal diagrams; causal inference; distance to care; identifiability conditions; instrumental variables; selectionbias; unmeasured confounding; well-defined interventions
资金
- Eunice Kennedy Shriver National Institute of Child Health and Human Development [R01 HD0804701, R01 HD095766, K24 AI131924]
- National Institute of Allergy and Infectious Diseases [T32 AI007433]
Distance to care is a common exposure and proposed instrumental variable in health research, but it is vulnerable to violations of fundamental identifiability conditions for causal inference. We used data collected from the Botswana Birth Outcomes Surveillance study between 2014 and 2016 to outline 4 challenges and potential biases when using distance to care as an exposure and as a proposed instrument: selection bias, unmeasured confounding, lack of sufficiently well-defined interventions, and measurement error. We describe how these issues can arise, and we propose sensitivity analyses for estimating the degree of bias.
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