Estimation of causal effects using instrumental variables with nonignorable missing covariates: Application to effect of type of delivery NICU on premature infants

Understanding how effective high-level NICUs (neonatal intensive care units that have the capacity for sustained mechanical assisted ventilation and high volume) are compared to low-level NICUs is important and valuable for both individual mothers and for public policy decisions. The goal of this paper is to estimate the effect on mortality of premature babies being delivered in a high-level NICU vs. a low-level NICU through an observational study where there are unmeasured confounders as well as nonignorable missing covariates. We consider the use of excess travel time as an instrumental variable (IV) to control for unmeasured confounders. In order for an IV to be valid, we must condition on confounders of the IV---outcome relationship, for example, month prenatal care started must be conditioned on for excess travel time to be a valid IV. However, sometimes month prenatal care started is missing, and the missingness may be nonignorable because it is related to the not fully measured mother's/infant's risk of complications. We develop a method to estimate the causal effect of a treatment using an IV when there are nonignorable missing covariates as in our data, where we allow the missingness to depend on the fully observed outcome as well as the partially observed compliance class, which is a proxy for the unmeasured risk of complications. A simulation study shows that under our nonignorable missingness assumption, the commonly used estimation methods, complete-case analysis and multiple imputation by chained equations assuming missingness at random, provide biased estimates, while our method provides approximately unbiased estimates. We apply our method to the NICU study and find evidence that high-level NICUs significantly reduce deaths for babies of small gestational age, whereas for almost mature babies like 37 weeks, the level of NICUs makes little difference. A sensitivity analysis is conducted to assess the sensitivity of our conclusions to key assumptions about the missing covariates. The method we develop in this paper may be useful for many observational studies facing similar issues of unmeasured confounders and nonignorable missing data as ours.Comment: Published in at http://dx.doi.org/10.1214/13-AOAS699 the Annals of Applied Statistics (http://www.imstat.org/aoas/) by the Institute of Mathematical Statistics (http://www.imstat.org

Identifying safety strategies for on-farm grain bins using risk analysis

The potential for grain bin accidents exists each year on Arkansas farms and farms across the nation. The trend toward increasing utilization of on-farm grain drying and storage could lead to an increase in grain bin accidents. The sharp contrast between a safe, efficient operation and one that leads to injury or death can be represented as sets of farmer-decisions and subsequent chance events. A model was constructed to define the risk associated with grain bin entry and inbin activity so that safety interventions could be identified and implemented to reduce the probability of injury and death. A survey was distributed to Arkansas grain farmers to gather data on the level of safety education, storage techniques, operations management, and other parameters. The data collected from the survey provided quantitative input of many of the model’s probability-distribution functions. Using a fault tree (with parallel modes of failure) in conjunction with a Monte Carlo simulation technique, we evaluated six safety intervention strategies and identified the one with the greatest potential for reducing the risk of serous injury or death. As part of senior design in biological engineering, plans are underway to design and test a probe that can locate and break bridged grain (a common risk factor in grain bin management) while working outside the bin on the ground