High-Dimensional Propensity Score and Its Machine Learning Extensions in Residual Confounding Control

“The use of health care claims datasets often encounters criticism due to the pervasive issues of omitted variables and inaccuracies or mis-measurements in available confounders. Ultimately, the treatment effects estimated using such data sources may be subject to residual confounding. Digital electronic administrative records routinely collect a large volume of health-related information; and many of which are usually not considered in conventional pharmacoepidemiological studies. A high-dimensional propensity score (hdPS) algorithm was proposed that uses such information as surrogates or proxies for mismeasured and unobserved confounders in an effort to reduce residual confounding bias. Since then, many machine learning and semi-parametric extensions of this algorithm have been proposed to better exploit the wealth of high-dimensional proxy information. In this tutorial, we will (i) demonstrate logic, steps and implementation guidelines of hdPS using an open data source as an example (using reproducible R codes), (ii) familiarize readers with the key difference between propensity score versus hdPS, as well as the requisite sensitivity analyses, (iii) explain the rationale for using the machine learning and double robust extensions of hdPS, and (iv) discuss advantages, controversies, and hdPS reporting guidelines while writing amanuscript.