Regression discontinuity designs in health: a systematic review

Hilton Boon, M. , Craig, P. , Thomson, H. , Campbell, M. and Moore, L. (2020) Regression discontinuity designs in health: a systematic review. Epidemiology, (doi: 10.1097/EDE.0000000000001274) (PMID:33196561) (Early Online Publication)

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Abstract

Background: Regression discontinuity designs are non-randomized study designs that permit strong causal inference with relatively weak assumptions. Interest in these designs is growing but there is limited knowledge of the extent of their application in health. We aimed to conduct a comprehensive systematic review of the use of regression discontinuity designs in health research. Methods: We included studies that used regression discontinuity designs to investigate the physical or mental health outcomes of any interventions or exposures in any populations. We searched 32 health, social science, and grey literature databases (1 January 1960-1 January 2019). We critically appraised studies using eight criteria adapted from the What Works Clearinghouse Standards for regression discontinuity designs. We conducted a narrative synthesis, analyzing the forcing variables and threshold rules used in each study. Results: The literature search retrieved 7658 records, producing 325 studies that met the inclusion criteria. A broad range of health topics were represented. The forcing variables used to implement the design were age; socioeconomic measures; date or time of exposure or implementation; environmental measures such as air quality; geographic location; and clinical measures that act as a threshold for treatment. Twelve percent of the studies fully met the eight quality appraisal criteria. Fifteen percent of studies reported a pre-specified primary outcome or study protocol. Conclusions: This systematic review demonstrates that regression discontinuity designs have been widely applied in health research and could be used more widely still. Shortcomings in study quality and reporting suggest that the potential benefits of this method have not yet been fully realized.

Item Type:Articles
Status:Early Online Publication
Refereed:Yes
Glasgow Author(s) Enlighten ID:Thomson, Dr Hilary and Craig, Professor Peter and Campbell, Ms Mhairi and Hilton Boon, Dr Michele and Moore, Professor Laurence
Authors: Hilton Boon, M., Craig, P., Thomson, H., Campbell, M., and Moore, L.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO SPHSU
Journal Name:Epidemiology
Publisher:Lippincott, Williams and Wilkins
ISSN:1044-3983
ISSN (Online):1531-5487
Published Online:16 November 2020

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
190877Quinquennial Core FundsLaurence MooreMedical Research Council (MRC)MC_UU_12017/14HW - MRC/CSO SPHSU Support Services
727671SPHSU Core Renewal: Informing Healthy Public Policy Research ProgrammePeter CraigMedical Research Council (MRC)MC_UU_12017/15IHW - MRC/CSO SPHU