Why a Known Outcome Scale Matters
For each person, only one treatment status is observed, so one of the two potential outcomes is missing. When the outcome is known to lie between finite limits, those limits constrain the missing values, even without assuming that treated and untreated people are comparable. The resulting bounds can be wide, but they give a defensible range of average treatment effects under relatively weak assumptions.
This tutorial concerns the average treatment effect in a target population. It uses the treatment proportion and the observed outcome means in the treated and untreated groups. It does not assume that treatment assignment is random or that the observed group difference is causal. The outcome scale must have substantively justified lower and upper limits; an arbitrary choice of scale limits does not create valid information about unobserved outcomes.
Write \(p=P(D=1)\), \(m_1=E[Y\mid D=1]\), and \(m_0=E[Y\mid D=0]\), with \(0<p<1\). By consistency, \(m_1=E[Y(1)\mid D=1]\) and \(m_0=E[Y(0)\mid D=0]\). These are observed group means. The means \(E[Y(1)\mid D=0]\) and \(E[Y(0)\mid D=1]\), in contrast, are not observed.
Deriving the Worst-Case Bounds
The population mean under treatment combines the treated group, for whom \(Y(1)\) is observed, with the untreated group, for whom \(Y(1)\) is missing. The outcome-range assumption says that the missing values in that group have mean somewhere from \(L\) to \(U\). The same reasoning applies to the population mean under control.
To get a lower bound on \(\tau=E[Y(1)]-E[Y(0)]\), subtract the largest allowed value of \(E[Y(0)]\) from the smallest allowed value of \(E[Y(1)]\). For an upper bound, subtract the smallest allowed control mean from the largest allowed treatment mean. Thus:
An identified set is the set of parameter values compatible with the observed information and assumptions. These endpoints are sharp: neither can generally be improved using only the treatment proportion, observed group means, and known outcome limits. For the lower endpoint, assign the missing \(Y(1)\) values in the untreated group the value \(L\), and the missing \(Y(0)\) values in the treated group the value \(U\). This gives \(\tau=\tau_L\). Reversing those assignments, using \(U\) for missing \(Y(1)\) and \(L\) for missing \(Y(0)\), gives \(\tau=\tau_U\). Both assignments respect the scale limits and leave the observed data unchanged. Intermediate choices can produce intermediate effects, so the observed data alone do not select one value within the interval.
Worked Example: Pain Score on a Zero-to-Ten Scale
Suppose a hypothetical clinical population has 100 patients: 40 receive a treatment and 60 do not. Pain is measured on a scale from 0 (no pain) to 10 (worst pain). The treated group has mean observed pain \(m_1=3.2\), and the untreated group has mean \(m_0=5.1\). Assume both potential pain scores lie in \([0,10]\). Find the worst-case bounds for the average treatment effect, defined as treatment minus control.
The treatment proportion is \(p=40/100=0.40\), and \(L=0,\ U=10\). The lower endpoint is
The upper endpoint is
The identified set is \([-5.78,4.22]\) pain-score points. Negative values indicate lower average pain under treatment, so the set includes effects favoring treatment, effects favoring control, and zero. The observed difference in group means is \(3.2-5.1=-1.9\) points, but that difference is not itself the average treatment effect without additional assumptions.
Worked Calculations and Interpretation
Worked Example: A Laboratory Measure on a Zero-to-One-Hundred Scale
Consider hypothetical data for a continuous clinical measure known to lie between 0 and 100 units. One quarter of the population receives treatment. The observed mean is 72 units among treated people and 60 units among untreated people. Calculate the treatment-effect bounds.
Here \(p=0.25\), \(m_1=72\), \(m_0=60\), \(L=0\), and \(U=100\). The lower bound is
The upper bound is
The average treatment effect is bounded by \([-52,48]\) units. Although the treated group’s observed mean is 12 units higher, the missing potential outcomes could be sufficiently different for the population effect to be negative, zero, or positive. A known scale constrains those missing outcomes, but a broad scale and a small treated proportion can still leave a wide identified set.
Worked Example: Symptom Days in a Fourteen-Day Period
In a hypothetical study, symptom days are recorded over a 14-day period and both potential outcomes are known to be in \([0,14]\). Suppose 70% of the population receives treatment. The observed means are 4 days for the treated group and 6 days for the untreated group. Compute and interpret the bounds.
Using \(p=0.70\), \(m_1=4\), \(m_0=6\), \(L=0\), and \(U=14\), the lower endpoint is
The upper endpoint is
The average effect lies between \(-8.8\) and \(5.2\) symptom days per person over the 14-day period under these assumptions. Since fewer symptom days are better, negative effects favor treatment. The observed mean difference is \(-2\) days, but the bounds still include positive effects. The arithmetic uses the same outcome units throughout; it does not convert a count of days into a proportion or a rate.
Diagnostics, Comparisons, and Limitations
Before interpreting a result, check that the outcome limits apply to both potential outcomes for every person in the target population, not merely to the observed sample. Confirm the coding direction and units, verify that the observed means lie within the stated scale, and use the treatment proportion from the same target population as those means. A sign error is especially easy to make: the bounds above are for \(Y(1)-Y(0)\), so a negative effect means treatment lowers the outcome.
The width of the identified set has a direct interpretation:
For this unconditional worst-case interval, the width equals the full scale width. This follows because the upper and lower endpoints differ by \((1-p)(U-L)+p(U-L)=U-L\). Thus, changing the proportion treated or the observed means shifts the interval but does not change its width. The result can be uninformative when the known outcome scale is broad relative to the effect of interest. The earlier material on covariate-specific bounds explains how observed covariates can, under appropriate conditions, tighten bounds; the formulas here are the unconditional calculation.
These bounds are not a confidence interval. They describe uncertainty about the causal effect that remains even if the observed quantities \(p,m_1,m_0\) were known exactly. In an actual finite sample, those quantities are estimated, adding sampling uncertainty. A confidence procedure for the bounds would need to account for that uncertainty; reporting the plug-in endpoints alone does not do so.
The assumptions also matter. If the asserted range is incorrect, the bounds need not contain the true effect. If treatment or outcome definitions are inconsistent, consistency does not link the observed outcome to the intended potential outcome. And if interference is present, one person’s outcome may depend on other people’s treatment, so the two-potential-outcome setup used here may not describe the study. These bounds do not establish that a treatment is beneficial merely because the treated group’s observed mean is better.
Compared with a point estimate based on an exchangeability assumption, worst-case bounds require less about treatment assignment but usually provide less precise conclusions. If the whole identified set is below zero, the effect is negative for every causal model compatible with the assumptions and observed information; if the set includes zero, the sign is not determined by these assumptions. At \(p=1\), there is no untreated group mean and the effect bounds reduce to \(m_1-U\) and \(m_1-L\). At \(p=0\), they reduce to \(L-m_0\) and \(U-m_0\). The main formulas requiring both group means apply when \(0<p<1\).
Common Pitfalls
- Using the observed mean difference as the causal effect. The difference \(m_1-m_0\) compares different groups. Without a treatment-assignment assumption, it need not equal \(E[Y(1)-Y(0)]\).
- Bounding only one missing potential outcome. Both \(Y(1)\) for untreated people and \(Y(0)\) for treated people are unobserved. Each must be included when bounding the average treatment effect.
- Reversing the endpoints when subtracting. A lower bound on a difference is the lower possible first term minus the upper possible second term; an upper bound uses the reverse combination.
- Treating the outcome range as a convenient analysis choice. The finite limits must be justified for the potential outcomes in the target population, not selected to make the interval narrow.
- Calling the identified set a confidence interval. The set expresses partial identification under assumptions. It does not by itself quantify sampling error.
Check Your Understanding
Answer each question, then compare your reasoning with the solutions.
- A treatment is given to 30% of a hypothetical population. The continuous outcome lies in \([0,20]\), with observed means \(m_1=8\) and \(m_0=10\). What are the worst-case bounds for the average treatment effect?
- For outcome limits \([L,U]\), why does the unconditional worst-case interval have width \(U-L\), regardless of the treatment proportion?
- In the first worked example, the observed treated-minus-untreated mean difference was \(-1.9\) pain-score points. Why is that not necessarily the average treatment effect?
- Suppose the scale is actually \([0,100]\), but the analysis incorrectly assumes \([0,50]\). What is the problem with the resulting bounds?
Solutions. (1) With \(p=0.30\), \(L=0\), \(U=20\), \(m_1=8\), and \(m_0=10\), the lower endpoint is \(0.30(8)+0.70(0)-[0.70(10)+0.30(20)]=2.4-13=-10.6\). The upper endpoint is \(0.30(8)+0.70(20)-[0.70(10)+0.30(0)]=2.4+14-7=9.4\). The bounds are \([-10.6,9.4]\) outcome units. (2) Subtracting the lower endpoint from the upper gives \((1-p)(U-L)+p(U-L)=U-L\). (3) The group mean difference compares outcomes observed for different people and does not reveal the missing potential outcomes; without an assumption about treatment assignment it need not equal the population average causal effect. (4) The assumed range excludes possible potential outcomes between 50 and 100. Bounds calculated from it may be too narrow and need not contain the true effect; the scale limits must be valid for the target population’s potential outcomes.