Characterizing Underrepresentation when Generalizing Causal Survival Estimates

원문 초록

Randomized trial findings are routinely generalized to broader target populations to inform decisions in medicine and public policy. When the trial sample is misaligned with the target population, generalized effect estimates can yield suboptimal decisions. We characterize the target subgroups that are underrepresented in the trial cohort in time-to-event settings. Here, underrepresentation arises in two distinct ways: baseline underrepresentation, when a subgroup's covariate profile is rare in the trial relative to the target, and time-varying underrepresentation, when differential censoring erodes a subgroup over follow-up. Existing diagnostics either conflate these mechanisms or apply only to the baseline case. We show that the asymptotic variance of the efficient generalizability estimator admits a decomposition in which only two terms can diverge as representation weakens: a sampling-weight term capturing baseline misalignment and a censoring-weight term capturing differential loss to follow-up. Underrepresented subgroups are therefore those with imprecise generalized estimates, and the larger of the two terms gives the responsible channel. We use this decomposition in TRACE (Temporal Rashomon Analysis of CEnsored data), which combines a self-normalized variance objective with a tree-based search to localize underrepresented subgroups, attribute each to baseline mismatch or censoring, and find the follow-up intervals where censoring drives the variance inflation. We solve the joint problem with a parametric dynamic program nested inside a Rashomon ensemble of near-optimal trees. In synthetic benchmarks, TRACE recovers the planted underrepresented regions. In a case study generalizing the National Job Training Partnership Act (JTPA) Study to U.S. JTPA-eligible adults, restricting to reliably generalizable subgroups narrows the 95% confidence interval for the refined estimand by 60%.