Reducing bias due to misclassified exposures using instrumental variables

Abstract

Exposures are often misclassified in observational studies. Any analysis that does not make proper adjustments for misclassification may result in biased estimates of model parameters, resulting in distorted inference. Settings where a multicategory exposure variable has more than two nominal categories or where no validation data are available to assess misclassification probabilities are common in practice but seldom considered in the literature. This article presents a novel method of analyzing cohort data with a misclassified, multicategory exposure variable and a binary response variable that uses instrumental variables in lieu of a validation dataset. First, a sufficient condition is obtained for model identifiability. Then, methods for model estimation and inference are proposed after adopting a sufficient condition for identifiability. We consider a variational Bayesian inference procedure aided by automatic differentiation along with Markov chain Monte Carlo-based computation. Operating characteristics of the proposed methods are assessed through simulation studies. For the purpose of illustration, the proposed Bayesian methods are applied to the U.S. breast cancer mortality data sampled from the Surveillance Epidemiology and End Results database, where reported treatment therapy is the misclassified multicategory exposure variable.