Propensity score analysis for health care disparities: a deweighting approach

Abstract

Abstract Background Propensity score weighting is a useful tool to make causal or unconfounded comparisons between groups. According to the definition by the Institute of Medicine (IOM), estimates of health care disparities should be adjusted for health-status factors but not for socioeconomic status (SES) variables. There have been attempts to use propensity score weighting to generate estimates that are concordant with IOM’s definition. However, the existing propensity score methods do not preserve SES distributions in minority and majority groups unless SES variables are independent of health status variables. Methods The present study introduces a deweighting method that uses two types of propensity scores. One is a function of all covariates of health status and SES variables and is used to weight study subjects to adjust for them. The other is a function of only the SES variables and is used to deweight the subjects to preserve the original SES distributions. Results The procedure of deweighting is illustrated using a dataset from a right heart catheterization (RHC) study, where it was used to examine whether there was a disparity between black and white patients in receiving RHC. The empirical example provided promising evidence that the deweighting method successfully preserved the marginal SES distributions for both racial groups but balanced the conditional distributions of health status given SES. Conclusions Deweighting is a promising tool for implementing the IOM-definition of health care disparities. The method is expected to be broadly applied to quantitative research on health care disparities.