A Comprehensive Review and Tutorial on Confounding Adjustment Methods for Estimating Treatment Effects Using Observational Data

Abstract

Controlling for confounding bias is crucial in causal inference. Causal inference using data from observational studies (e.g., electronic health records) or imperfectly randomized trials (e.g., imperfect randomization or compliance) requires accounting for confounding variables. Many different methods are currently employed to mitigate bias due to confounding. This paper provides a comprehensive review and tutorial of common estimands and confounding adjustment approaches, including outcome regression, g-computation, propensity score, and doubly robust methods. We discuss bias and precision, advantages and disadvantages, and software implementation for each method. Moreover, approaches are illustrated empirically with a reproducible case study. We conclude that different scientific questions are better addressed by certain estimands. No estimand is uniformly more appropriate. Upon selecting an estimand, decisions on which estimator can be driven by performance and available background knowledge.