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Differences Between Marginal Structural Models and Conventional Models in Their Exposure Effect Estimates: A Systematic Review

Suarez, Davida,b; Borràs, Rogera; Basagaña, Xavierc,d,e

doi: 10.1097/EDE.0b013e31821d0507
Methods: Brief Report

Background: Marginal structural models were developed to address time-varying confounding in nonrandomized exposure effect studies. It is unclear how estimates from marginal structural models and conventional models might differ in real settings.

Methods: We systematically reviewed the literature on marginal structural models since 2000.

Results: Data to compare marginal structural models and conventional models were obtained from 65 papers reporting 164 exposure-outcome associations. In 58 (40%), estimates differed by at least 20%, and in 18 (11%), the 2 techniques resulted in estimates with opposite interpretations. In 88 papers, marginal structural models were used to analyze real data; only 53 (60%) papers reported the use of stabilized inverse-probability weights and only 28 (32%) reported that they verified that the mean of the stabilized inverse-probability weights was close to 1.0.

Conclusions: We found important differences in results from marginal structural models and from conventional models in real studies. Furthermore, reporting of marginal structural models can be improved.


From the aEpidemiology and Assessment Unit, Fundació Parc Tauli, Universitat Autònoma de Barcelona, Sabadell, Spain; bDepartment of Studies and Statistics, Comisión del Mercado de las Telecomunicaciones, Barcelona, Spain; cCentre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; dMunicipal Institute of Medical Research (IMIM-Hospital del Mar), Barcelona, Spain; and eCIBER Epidemiología y Salud Pública (CIBERESP), Spain.

Submitted 11 October 2010; accepted 20 January 2011; posted 3 May 2011.

Supported by research grants from the Instituto de Salud Carlos III, Ministerio de Sanidad y Consumo, Spain and from the Departament de Salut, Generalitat de Catalunya (FIS ECA07/041) (to D.S.).

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Correspondence: David Suarez, Epidemiology and Assessment Unit Fundació Parc Taulí, Parc Taulí, 1, 08208 Sabadell (Barcelona), Spain. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.