Using propensity scores for racial disparities analysis
Propensity score plays a central role in causal inference, but its use is not limited to causal comparisons. As a covariate balancing tool, propensity score can be used for controlled descriptive comparisons between groups whose memberships are not manipulable. A prominent example is racial disparities in health care. However, conceptual confusion and hesitation persists for using propensity score in racial disparities studies. In this commen-tary, we argue that propensity score, possibly combined with other methods, is an effective tool for racial disparities analysis. We describe relevant estimands, target population, and assumptions. In particular, we clarify that a controlled descriptive comparison requires weaker assumptions than a causal comparison. We discuss three common propensity score weighting strategies: overlap weighting, inverse probability weighting and average treatment effect for treated weighting. We further describe how to combine weighting with the rank-and-replace adjustment method to produce racial disparity estimates concordant to the Institute of Medicine’s definition. The method is illustrated by a re-analysis of the Medical Expenditure Panel Survey data.
