Recoverability and estimation of causal effects under typical multivariable missingness mechanisms

TL;DR

This paper investigates when and how the average causal effect can be recovered from incomplete data using causal diagrams, extending previous work to effect modification and evaluating data methods through simulations.

Contribution

It extends the recoverability analysis of causal effects to settings with effect modification and assesses the performance of multiple imputation methods via simulations.

Findings

Recoverability depends on missingness mechanisms and effect modification.

Compatible multiple imputation can yield approximately unbiased estimates.

Sensitivity analyses are necessary when outcome causes missingness.

Abstract

In the context of missing data, the identifiability or "recoverability" of the average causal effect (ACE) depends on causal and missingness assumptions. The latter can be depicted by adding variable-specific missingness indicators to causal diagrams, creating "missingness-directed acyclic graphs" (m-DAGs). Previous research described ten canonical m-DAGs, representing typical multivariable missingness mechanisms in epidemiological studies, and determined the recoverability of the ACE in the absence of effect modification. We extend the research by determining the recoverability of the ACE in settings with effect modification and conducting a simulation study evaluating the performance of widely used missing data methods when estimating the ACE using correctly specified g-computation, which has not been previously studied. Methods assessed were complete case analysis (CCA) and various multiple imputation (MI) implementations regarding the degree of compatibility with the outcome model used in g-computation. Simulations were based on an example from the Victorian Adolescent Health Cohort Study (VAHCS), where interest was in estimating the ACE of adolescent cannabis use on mental health in young adulthood. In the canonical m-DAGs that excluded unmeasured common causes of missingness indicators, we derived the recoverable ACE if no incomplete variable causes its missingness, and non-recoverable otherwise. Besides, the simulation showed that compatible MI approaches may enable approximately unbiased ACE estimation, unless the outcome causes its missingness or it causes the missingness of a variable that causes its missingness. Researchers must consider sensitivity analysis methods incorporating external information in the latter setting. The VAHCS case study illustrates the practical implications of these findings.