Propensity score-based adjustment for covariate effects on classification accuracy of bio-marker using ROC curve

The potential performance of bio-marker in classifying diseased from healthy population may be affected by baseline covariates (X) that are associated with both the bio-marker (Y) and the disease status (D). Some existing approaches can be able to adjust for the effect of a single covariate at a time. However, several potential covariates can be available in practice for which simultaneous adjustment in the ROC curve is essential. This study proposed a propensity score (PS) based adjustment for the effects of several covariates in the ROC curve. The PS is first derived from a linear transformation of several covariates and the PS-adjusted (and PS-specific) ROC curve was then estimated using the existing non-parametric induced ROC regression framework. The method is illustrated for both continuous and binary bio-markers. The simulation study suggests that the PS-based adjustment performed well by providing a consistent estimate of the true ROC curve and showing robustness to the mis-specification of the propensity score model as well as to a non-linear function of covariates. Further, an application of the method is provided to evaluate the effectiveness of the body-mass-index in classifying patients with hypertension or diabetes after adjusting for the potential covariates such as age, sex, education, socio-economic status.