Is Checking for Sequential Positivity Violations Getting You Down? Try sPoRT!

Background: Sequential positivity is often a necessary assumption for drawing causal inferences, such as through marginal structural modeling. Unfortunately, verification of this assumption can be challenging because it usually relies on multiple parametric propensity score models, unlikely to all be correctly specified. Therefore, we propose a new algorithm, called sequential Positivity Regression Tree (sPoRT), to overcome this issue and identify the subgroups found to be violating this assumption, allowing for insights about the nature of the violations and potential solutions.

Methods: We present different versions of sPoRT based on either stratifying or pooling over time under static or dynamic treatment strategies. This methodologic development was motivated by a real-life application of the impact of the timing of initiation of HIV treatment with and without smoothing over time, which we also use to demonstrate the method.

Results: The illustration of sPoRT demonstrates its easy use and the interpretability of the results for applied epidemiologists. Furthermore, an R notebook showing how to use sPoRT in practice is available at github.com/ArthurChatton/sPoRT-notebook.

Conclusions: The sPoRT algorithm provides interpretable subgroups violating the sequential positivity violation, allowing patterns and trends in the confounders to be easily identified. We finally provided practical implications and recommendations when positivity violations are identified.