High-dimensional propensity score adjustment in studies of treatment effects using health care claims data.
Open accessAbstract
BACKGROUND: Adjusting for large numbers of covariates ascertained from patients' health care claims data may improve control of confounding, as these variables may collectively be proxies for unobserved factors. Here, we develop and test an algorithm that empirically identifies candidate covariates, prioritizes covariates, and integrates them into a propensity-score-based confounder adjustment model. METHODS: We developed a multistep algorithm to implement high-dimensional proxy adjustment in claims data. Steps include (1) identifying data dimensions, eg, diagnoses, procedures, and medications; (2) empirically identifying candidate covariates; (3) assessing recurrence of codes; (4) prioritizing covariates; (5) selecting covariates for adjustment; (6) estimating the exposure propensity score; and (7) estimating an outcome model. This algorithm was tested in Medicare claims data, including a study on the effect of Cox-2 inhibitors on reduced gastric toxicity compared with nonselective nonsteroidal anti-inflammatory drugs (NSAIDs). RESULTS: In a population of 49,653 new users of Cox-2 inhibitors or nonselective NSAIDs, a crude relative risk (RR) for upper GI toxicity (RR = 1.09 [95% confidence interval = 0.91-1.30]) was initially observed. Adjusting for 15 predefined covariates resulted in a possible gastroprotective effect (0.94 [0.78-1.12]). A gastroprotective effect became stronger when adjusting for an additional 500 algorithm-derived covariates (0.88 [0.73-1.06]). Results of a study on the effect of statin on reduced mortality were similar. Using the algorithm adjustment confirmed a null finding between influenza vaccination and hip fracture (1.02 [0.85-1.21]). CONCLUSIONS: In typical pharmacoepidemiologic studies, the proposed high-dimensional propensity score resulted in improved effect estimates compared with adjustment limited to predefined covariates, when benchmarked against results expected from randomized trials.
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The high-dimensional propensity score data mining algorithm leverages that large volumes of covariates can collectively serve as good proxies for unmeasured confounders and thus produce results from observational data that more closely resemble results from randomization.
“This algorithm leverages that large volumes of covariates can collectively serve as good proxies for unmeasured confounders and thus produce results from observational data that more closely resemble results from randomization.42”
From Hysterectomy versus uterine preservation for pelvic organ prolapse surgery: a prospective cohort study (2025) · cites this paper as [42]
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- Authors
- Schneeweiss, S., Rassen, J. A., Glynn, R. J., Avorn, J., Mogun, H., & Brookhart, M. A.
- Affiliations
- Brigham and Women's Hospital (US)
- Corresponding author
- Schneeweiss, Sebastian
- Venue
- Epidemiology
- Published
- 2009-07
- Volume
- 20
- Issue
- 4
- Pages
- 512-522
- ISSN
- 1044-3983 (ISSN-L)
- PMC
- PMC3077219
- OpenAlex
- W1967862917
- Cited by
- 1,128
- References
- 44
- Citations by year
- 2026: 51 · 2025: 78 · 2024: 77 · 2023: 62 · 2022: 71 · 2021: 104 · 2020: 87 · 2019: 86 · 2018: 69 · 2017: 73 · 2016: 72 · 2015: 62 · 2014: 61 · 2013: 66 · 2012: 55
- FWCI
- 29.60
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (1r01lm010213-01)
- National Institute on Aging (R01AG021950, R01-AG027400, K25AG027400, R01AG018833, R01AG023178)
- National Institute of Mental Health (R01-MH078708, U01MH078708)
- U.S. National Library of Medicine (R01-LM010213)
- Topics
- Physical Sciences › Mathematics › Statistics and Probability › Advanced Causal Inference Techniques
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
- Keywords
- high-dimensional propensity score, confounding adjustment, health insurance claims, COX-2 inhibitors, non-selective NSAIDs, influenza vaccination, hip fracture, Medicare claims data, pharmacoepidemiology
- MeSH terms
- Aged, Aged, 80 and over, Algorithms, Anti-Inflammatory Agents, Non-Steroidal, Female, Medicare, Humans, Insurance Claim Review, Male, United States, Confounding Factors, Epidemiologic, Treatment Outcome, Pharmacoepidemiology, Risk Assessment, Upper Gastrointestinal Tract, Cyclooxygenase 2 Inhibitors
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