Identification and Estimation of the Heterogeneous Survivor Average Causal Effect in Observational Studies

Clinical studies often encounter with truncation-by-death problems, which may render the outcomes undefined. Statistical analysis based only on observed survivors may lead to biased results because the characters of survivors may differ greatly between treatment groups. Under the principal stratification framework, a meaningful causal parameter, the survivor average causal effect, in the always-survivor group can be defined. This causal parameter may not be identifiable in observational studies where the treatment assignment and the survival or outcome process are confounded by unmeasured features. In this paper, we propose a new method to deal with unmeasured confounding when the outcome is truncated by death. First, a new method is proposed to identify the heterogeneous conditional survivor average causal effect based on a substitutional variable under monotonicity. Second, under additional assumptions, the survivor average causal effect on the overall population is also identified. Furthermore, we consider estimation and inference for the conditional survivor average causal effect based on parametric and nonparametric methods with good asymptotic properties. Good finite-sample properties are demonstrated by simulation and sensitivity analysis. The proposed method is applied to investigate the effect of allogeneic stem cell transplantation types on leukemia relapse.