S3E6: Stratification with Rich MacLehose: Should you have Bert or Ernie pick you up from surgery?

In this episode Hailey and Matt talk about Matt’s technology troubles (including having his computer just decide not to let him log on) before we discuss regression discontinuity and difference in difference approaches as part of quasi experimental methods. We focus on what quasi experimental means and encompasses and its relation to natural experiments. We talk about who owns interrupted time series (epidemiologists, economists, other social scientists?). Matt again admits he can’t define exogeneity. We talk about how both designs exploit a threshold when there is a rapid change in the probability of being exposed and we think of those on either side of the discontinuity close to the threshold are exchangeable and we can estimate effects in that population under a set of assumptions. And we talk about how difference in difference takes this same approach but adds a control group. And we debate whether the last difference is singular or plural.

In this episode we talk to Dr. Usama Bilal of Drexel University about Regression Discontinuity Design (RDD) and Difference-in-Differences (DiD), two quasi experimental methods that fall under the instrumental variables framework which we discussed in previous episodes. We talk about what RDD is, the different types (fuzzy vs sharp) and what we are actually estimating (LATE vs CACE). We talk about the bias vs variance tradeoff in how far from the threshold we choose to draw inferences. We talk about the assumptions that are needed for these methods to give valid estimate of effects. Then we talk about DiD and how this is a form of RDD with a second group that does not experience the discontinuity as a control. And we talk about the additional assumptions needed for this approach (e.g. parallel trends).

In this episode, Hailey and Matt discuss whether IVs are rebellious or magical or the midlife crisis of methods. We talk about how they deal with confounding problems. We talk about how they are used to attempt to mimic randomization and the assumptions for IVs. We talk about why it’s so helpful to think about who gets the exposure and why for causal inference. We talk about how IVs fit in with the target trial framework and wham it might tell us about how to teach intro epi. We talk about what estimand IVs estimate. And we relitigate the soda vs pop discussion.

In this episode, we discuss instrumental variables with Dr. Rita Hamad of Harvard’s TH Chan School of Public Health. This episode is focused on the first part of Chapter 28 of Modern Epidemiology 4th edition on quasi experimental methods. We start with what quasi experimental designs are and why we would want to use them (and whether more epidemiologists are being exposed to them). We also talk about why these methods are more common in economics than in epi. We talk about how these methods try to take advantage of something that approximates randomization to estimate causal effects. We talk about what instrumental variables are and the conditions required to be met for a variable to be an instrument. We focus on the strengths and limitations of the methods and when they make the most sense to use them. We talk about what happens when you violate the assumptions of IV. We talk about weak and strong IVs and we talk about Mendelian randomization and its role in epi. And we ask the age-old question, how do you find the elusive instrumental variable?

In this episode we follow up on our conversation about mediation. We talk about what mediation is and when it is useful. We talk about the history of these methods. We debate what direct and indirect effects are. We describe natural and controlled effects. We discuss the importance of the number 666 in Matt’s life. We talk about exposure mediator interaction.  Matt learns what kinesiology is. We discuss proportion mediated and proportion eliminated. And we talk about the confounding assumptions needed for mediation analysis.

In this episode, Matt and Hailey talk with Dr. Kara Rudolph and Dr. Ivan Diaz about mediation analysis. We talk through what it is, what it means and when we want to do it. We talk about mechanism of causation and how mediation can help. We cover things like natural direct and indirect effects and controlled direct effects (and why there isn’t a controlled indirect effect – a thing that stumped Matt for some time). And we discuss the different assumptions need to draw valid inferences in a mediation analysis, like all the many no confounding assumptions and the cross world assumption. And we talk about what Matt refers to as mediated moderation (interaction in the effect on the outcome between the exposure and mediator).

In this episode, Hailey and Matt continue on their discussion on study efficiency and realize that we think about efficiency in very different ways. We talk about the difference between statistical efficiency and cost efficiency and we each make our case for one of them being the driving force in how we design and analyze studies. It may be the biggest disagreement we’ve had yet (though maybe that was interaction).We talk about matching and its impact of efficiency and also why we do matching. And we try to understand when matching is useful. Studies mentioned in the podcast: Rothman KJ, Poole C. A strengthening programme for weak associations. Int J Epidemiol. 1988 Dec;17(4):955-9. doi: 10.1093/ije/17.4.955. PMID: 3225112.

In this episode we are joined by Professor Robert Platt of McGill University to talk about study efficiency and the ways we can think about this in terms of study design. We talk about hierarchies of evidence and its relationship to things like target validity. We get into why we think case control studies are so often misunderstood, particularly with respect to missing that they should be nested within a cohort.  We talked about the varying definitions of efficient (variance, efficiency of confounding control, cost efficient, etc.) and how they relate to different study designs, and we disagreed about which definition is the most useful. And we talk about sampling and how it affects study efficiency and also what question we are asking. The paper that Rob reads over and over is: Kurth T, Walker AM, Glynn RJ, Chan KA, Gaziano JM, Berger K, Robins JM. Results of multivariable logistic regression, propensity matching, propensity adjustment, and propensity-based weighting under conditions of nonuniform effect. Am J Epidemiol. 2006;163:262-70. We also referenced: Westreich D, Edwards JK, Lesko CR, Cole SR, Stuart EA. Target Validity and the Hierarchy of Study Designs. Am J Epidemiol. 2019;188:438-443. Kramer MS, Guo T, Platt RW, Shapiro S, Collet JP, Chalmers B, Hodnett E, Sevkovskaya Z, Dzikovich I, Vanilovich I; PROBIT Study Group. Breastfeeding and infant growth: biology or bias? Pediatrics. 2002;110(2 Pt 1):343-7.

We kick off season 4 by reminiscing about the origins of the podcast and preview what’s upcoming for season 4 where we will continue on our last season of reviewing Modern Epidemiology 4th edition. We touch on a few of the topics we are most excited about for the coming season and we preview some small formatting changes. But then we put each other through the fun questions that we ask our guests so you all can get to know us better (spoiler: Matt has no idea what the word non-fiction means). We are excited for our upcoming guests this season and the fun conversations we have in store.

It’s hard to believe this is the final episode of season 3! In this season finale episode, we continue our discussion of topics related to Chapter 26 in Modern Epidemiology (4th Edition) with Dr. Eric Tchetgen Tchetgen. In this conversation we ask Dr. Tchetgen Tchetgen to help us better understand several issues related to interaction, including why it’s so important to study interaction.  He provides a helpful framework for thinking about interaction: start simple and then move on to more complex questions. As part of this framework, he emphasizes the distinction between total effects and main effects, how confounding plays into conversations about interaction, and the role of scale dependence when interpretating interaction.