From Narratives to Numbers: Valid Inference Using Language Model Predictions from Verbal Autopsy Narratives

In settings where most deaths occur outside the healthcare system, verbal autopsies (VAs) are a common tool to monitor trends in causes of death (COD). VAs are interviews with a surviving caregiver or relative that are used to predict the decedent's COD. Turning VAs into actionable insights for researchers and policymakers requires two steps (i) predicting likely COD using the VA interview and (ii) performing inference with predicted CODs (e.g. modeling the breakdown of causes by demographic factors using a sample of deaths). In this paper, we develop a method for valid inference using outcomes (in our case COD) predicted from free-form text using state-of-the-art NLP techniques. This method, which we call multiPPI++, extends recent work in "prediction-powered inference" to multinomial classification. We leverage a suite of NLP techniques for COD prediction and, through empirical analysis of VA data, demonstrate the effectiveness of our approach in handling transportability issues. multiPPI++ recovers ground truth estimates, regardless of which NLP model produced predictions and regardless of whether they were produced by a more accurate predictor like GPT-4-32k or a less accurate predictor like KNN. Our findings demonstrate the practical importance of inference correction for public health decision-making and suggests that if inference tasks are the end goal, having a small amount of contextually relevant, high quality labeled data is essential regardless of the NLP algorithm.

Do We Really Even Need Data?

As artificial intelligence and machine learning tools become more accessible, and scientists face new obstacles to data collection (e.g. rising costs, declining survey response rates), researchers increasingly use predictions from pre-trained algorithms as outcome variables. Though appealing for financial and logistical reasons, using standard tools for inference can misrepresent the association between independent variables and the outcome of interest when the true, unobserved outcome is replaced by a predicted value. In this paper, we characterize the statistical challenges inherent to this so-called ``inference with predicted data'' problem and elucidate three potential sources of error: (i) the relationship between predicted outcomes and their true, unobserved counterparts, (ii) robustness of the machine learning model to resampling or uncertainty about the training data, and (iii) appropriately propagating not just bias but also uncertainty from predictions into the ultimate inference procedure.

Deep Learning of Semi-Competing Risk Data via a New Neural Expectation-Maximization Algorithm

Prognostication for lung cancer, a leading cause of mortality, remains a complex task, as it needs to quantify the associations of risk factors and health events spanning a patient's entire life. One challenge is that an individual's disease course involves non-terminal (e.g., disease progression) and terminal (e.g., death) events, which form semi-competing relationships. Our motivation comes from the Boston Lung Cancer Study, a large lung cancer survival cohort, which investigates how risk factors influence a patient's disease trajectory. Following developments in the prediction of time-to-event outcomes with neural networks, deep learning has become a focal area for the development of risk prediction methods in survival analysis. However, limited work has been done to predict multi-state or semi-competing risk outcomes, where a patient may experience adverse events such as disease progression prior to death. We propose a novel neural expectation-maximization algorithm to bridge the gap between classical statistical approaches and machine learning. Our algorithm enables estimation of the non-parametric baseline hazards of each state transition, risk functions of predictors, and the degree of dependence among different transitions, via a multi-task deep neural network with transition-specific sub-architectures. We apply our method to the Boston Lung Cancer Study and investigate the impact of clinical and genetic predictors on disease progression and mortality.