Instrumental variable analyses: Exploiting natural randomness to understand causal mechanisms

Theodore J. Iwashyna, Edward H. Kennedy

Research output: Contribution to journalArticlepeer-review


Instrumental variable analysis is a technique commonly used in the social sciences to provide evidence that a treatment causes an outcome, as contrasted with evidence that a treatment is merely associated with differences in an outcome. To extract such strong evidence from observational data, instrumental variable analysis exploits situations where some degree of randomness affects how patients are selected for a treatment. An instrumental variable is a characteristic of the world that leads some people to be more likely to get the specific treatment we want to study but does not otherwise change thosepatients' outcomes. This seminar explains, in nonmathematical language, the logic behind instrumental variable analyses, including several examples. It also provides three key questions that readers of instrumental variable analyses should ask to evaluate the quality of the evidence. (1) Does the instrumental variable lead to meaningful differences in the treatment being tested? (2) Other than through the specific treatment being tested, is there any other way the instrumental variable could influence the outcome? (3) Does anything cause patients to both receive the instrumental variable and receive the outcome?

Original languageEnglish (US)
Pages (from-to)255-260
Number of pages6
JournalAnnals of the American Thoracic Society
Issue number3
StatePublished - Jun 2013
Externally publishedYes


  • Causal analysis
  • Demystifying data
  • Instrumental variable analysis
  • Observational data
  • Randomized controlled trials

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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