Journal article
What's the Weight? Estimating Controlled Outcome Differences in Complex Surveys for Health Disparities Research
Statistics in medicine, Vol.44(23-24), e70289
10/2025
DOI: 10.1002/sim.70289
PMCID: PMC12636266
PMID: 41055541
Abstract
In this work, we are motivated by the problem of estimating racial disparities in health outcomes, specifically the average controlled difference (ACD) in telomere length between Black and White individuals, using data from the National Health and Nutrition Examination Survey (NHANES). To do so, we build a propensity for race to properly adjust for other social determinants while characterizing the controlled effect of race on telomere length. Propensity score methods are broadly employed with observational data as a tool to achieve covariate balance, but how to implement them in complex surveys is less studied-in particular, when the survey weights depend on the group variable under comparison (as the NHANES sampling scheme depends on self-reported race). We propose identification formulas to properly estimate the ACD in outcomes between Black and White individuals, with appropriate weighting for both covariate imbalance across the two racial groups and generalizability. Via extensive simulation, we show that our proposed methods outperform traditional analytic approaches in terms of bias, mean squared error, and coverage when estimating the ACD for our setting of interest. In our data, we find that evidence of racial differences in telomere length between Black and White individuals attenuates after accounting for confounding by socioeconomic factors and utilizing appropriate propensity score and survey weighting techniques. Software to implement these methods and code to reproduce our results can be found in the R package svycdiff, available through the Comprehensive R Archive Network (CRAN) at cran.r-project.org/web/packages/svycdiff/, or in a development version on GitHub at github.com/salernos/svycdiff.
Details
- Title: Subtitle
- What's the Weight? Estimating Controlled Outcome Differences in Complex Surveys for Health Disparities Research
- Creators
- Stephen Salerno - Fred Hutch Cancer CenterEmily K Roberts - University of IowaBelinda L Needham - University of MichiganTyler H McCormick - University of WashingtonFan Li - Yale UniversityBhramar Mukherjee - Yale UniversityXu Shi - University of Michigan
- Resource Type
- Journal article
- Publication Details
- Statistics in medicine, Vol.44(23-24), e70289
- DOI
- 10.1002/sim.70289
- PMID
- 41055541
- PMCID
- PMC12636266
- NLM abbreviation
- Stat Med
- ISSN
- 1097-0258
- eISSN
- 1097-0258
- Publisher
- Wiley
- Grant note
- P2C HD042828 / NIMH NIH HHS R01 GM139926 / NIGMS NIH HHS R01 HD107015 / NIMH NIH HHS R35 GM144128 / NIGMS NIH HHS 1712933 / Division of Mathematical Sciences DP2 MH122405 / NIMH NIH HHS Fred Hutchinson Cancer Center UG3 CA267907 / NCI NIH HHS
- Language
- English
- Date published
- 10/2025
- Academic Unit
- Biostatistics
- Record Identifier
- 9984969111302771
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