Application of information from external data to correct for collider bias in a Covid-19 hospitalised cohort

Abstract

Abstract Background Throughout the Covid-19 pandemic, researchers have made use of electronic health records to research this disease in a rapidly evolving environment of questions and discoveries. These studies are prone to collider bias as they restrict the population of Covid-19 patients to only those with severe disease. Inverse probability weighting is typically used to correct for this bias but requires information from the unrestricted population. Using electronic health records from a South London NHS trust, this work demonstrates a method to correct for collider bias using external sourced data while examining the relationship between minority ethnicities and poor Covid-19 outcomes.Methods The probability of inclusion within the observed hospitalised cohort was modelled based on estimates from published national data. The model described the relationship between hospitalisation, patient ethnicity, and death due to Covid-19 – all the components of example relationship experiencing collider bias. The obtained probabilities (as applied to the observed patient cohort) were used as inverse probability weights in survival analysis examining ethnicity (and covariates) as a risk factor for death due to Covid-19.Results Within the observed cohort, unweighted analysis of survival suggested a reduced risk of death in those of Black ethnicity – differing from the published literature. Applying inverse probability weights to this analysis corrected this aberrant result. This correction was true when the analysis was applied to patients within only the first wave of Covid-19 and across two waves of Covid-19 and was robust against adjustments to the modelled relationship between hospitalisation, patient ethnicity, and death due to Covid-19 made as part of a sensitivity analysis.Conclusions In conclusion, this analysis demonstrates the feasibility of using external publications to correct for collider bias (or other forms of selection bias) induced by the restriction of a population to a hospitalised cohort using an example from the recent Covid-19 pandemic.