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Abstract
Weighting is a general and often-used method for statistical adjustment.
Weighting has two objectives: first, to balance covariate distributions, and
second, to ensure that the weights have minimal dispersion and thus produce a
more stable estimator. A recent, increasingly common approach directly
optimizes the weights toward these two objectives. However, this approach has
not yet been feasible in large-scale datasets when investigators wish to
flexibly balance general basis functions in an extended feature space. For
example, many balancing approaches cannot scale to national-level health
services research studies. To address this practical problem, we describe a
scalable and flexible approach to weighting that integrates a basis expansion
in a reproducing kernel Hilbert space with state-of-the-art convex optimization
techniques. Specifically, we use the rank-restricted Nystr\"{o}m method to
efficiently compute a kernel basis for balancing in {nearly} linear time and
space, and then use the specialized first-order alternating direction method of
multipliers to rapidly find the optimal weights. In an extensive simulation
study, we provide new insights into the performance of weighting estimators in
large datasets, showing that the proposed approach substantially outperforms
others in terms of accuracy and speed. Finally, we use this weighting approach
to conduct a national study of the relationship between hospital profit status
and heart attack outcomes in a comprehensive dataset of 1.27 million patients.
We find that for-profit hospitals use interventional cardiology to treat heart
attacks at similar rates as other hospitals, but have higher mortality and
readmission rates.