BACKGROUND AND AIM: In environmental health sciences, it is critically important to identify subgroups of the study population where a treatment (or exposure) has a notably larger or smaller causal effect on an outcome compared to the population average. METHODS: In this paper, we propose a new causal rule ensemble (CRE) method that: 1) discovers de novo subgroups with significantly heterogeneous treatment effects (i.e., causal rules); 2) ensures interpretability of these subgroups because they are defined in terms of decision rules; and 3) estimates the causal effect for each of these newly discovered subgroups with small bias and high statistical precision. We also introduce a new sensitivity analysis to unmeasured confounding bias. RESULTS:We apply the proposed CRE method to the Medicare data to study the heterogeneous effects of long-term exposure to PM2.5 on 5-year mortality. The population consists of Medicare beneficiaries in New England regions in the United States between 2000 and 2006. The treatment is whether the two-year (2000-2001) average of exposure to PM2.5 is greater than 12μg/m3. The outcome is five-year mortality measured between 2002-2006. We found that younger than 80 years old and not eligible for Medicaid are significantly less vulnerable than the baseline subgroup. Results were not sensitive to unmeasured confounding bias. CONCLUSIONS:We introduce a new method for studying treatment effect heterogeneity that notably improves interpretability in terms of causal rules. The proposed CRE methodology provides a more stable approach to discover and estimate heterogeneous effects while maintaining high levels of interpretability. KEYWORDS: Air pollution, causal inference, mortality, methodological study design
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