Hazard Ratio Estimators after Terminating Observation within Matched Pairs in Sibling and Propensity Score Matched Designs.

Abstract

Similar to unmatched cohort studies, matched cohort studies may suffer from the censoring of events prior to the end of follow-up. Moreover, in some matched-pair cohort studies, observation time is prematurely terminated immediately after the follow-up of his/her matched member is completed by an event or censoring. Although the follow-up termination within matched pairs may or may not change the hazard ratio estimators, when and how the change occurs has not been clarified. We study the change in the estimates of the hazard ratio conditional on matched pairs and/or covariates by considering two types of matched-pair designs in cohort studies-sibling pair matching and propensity score matching-in which termination can be naturally considered. If all possible confounders are shared within the matched pairs, after termination, a wide range of hazard ratio estimators coincides with that obtained from a stratified Cox model. If unshared confounders should be adjusted for in the analysis, however, such coincidence is not observed. Simulation studies on sibling designs with unshared confounders suggested that the pair-stratified covariate-adjusted Cox model for the hazard ratio conditional on matched pairs and covariates is generally preferred, for which termination does not deteriorate the estimation. Conversely, the comparison between stratifying or not stratifying on pair is a more subtle issue in propensity score matching which targets a marginal or covariate-conditional hazard ratio. Based on simulation studies considering Cox models after matching based on estimated propensity scores, we discourage pair-stratified analysis and termination, particularly after data collection.