Assessing the causal effects of a stochastic intervention in time series data: Are heat alerts effective in preventing deaths and hospitalizations?

TL;DR

This paper develops a new causal inference method for time series data to evaluate heat alert effectiveness, overcoming overlap limitations, and applies it to assess health impacts across U.S. counties.

Contribution

It introduces a stochastic intervention via incremental propensity scores, enabling causal effect estimation under weaker assumptions in time series data.

Findings

Heat alerts significantly reduce deaths and hospitalizations.

The proposed estimators demonstrate low bias and variance in simulations.

Application shows effectiveness of increased heat alert issuance.

Abstract

The methodological development of this paper is motivated by the need to address the following scientific question: does the issuance of heat alerts prevent adverse health effects? Our goal is to address this question within a causal inference framework in the context of time series data. A key challenge is that causal inference methods require the overlap assumption to hold: each unit (i.e., a day) must have a positive probability of receiving the treatment (i.e., issuing a heat alert on that day). In our motivating example, the overlap assumption is often violated: the probability of issuing a heat alert on a cooler day is zero. To overcome this challenge, we propose a stochastic intervention for time series data which is implemented via an incremental time-varying propensity score (ItvPS). The ItvPS intervention is executed by multiplying the probability of issuing a heat alert on day $t$ -- conditional on past information up to day $t$ -- by an odds ratio $\delta_t$. First, we introduce a new class of causal estimands that relies on the ItvPS intervention. We provide theoretical results to show that these causal estimands can be identified and estimated under a weaker version of the overlap assumption. Second, we propose nonparametric estimators based on the ItvPS and derive an upper bound for the variances of these estimators. Third, we extend this framework to multi-site time series using a spatial meta-analysis approach. Fourth, we show that the proposed estimators perform well in terms of bias and root mean squared error via simulations. Finally, we apply our proposed approach to estimate the causal effects of increasing the probability of issuing heat alerts on each warm-season day in reducing deaths and hospitalizations among Medicare enrollees in $2,837$ U.S. counties.