Bespoke Instruments: A new tool for addressing unmeasured confounders

Suppose that an investigator is interested in quantifying an exposure-disease causal association in a setting where the exposure, disease, and some potential confounders of the association of interest have been measured. However, there remains concern about residual confounding of the association of interest by unmeasured confounders. We propose an approach to account for residual bias due to unmeasured confounders. The proposed approach uses a measured confounder to derive a “bespoke” instrumental variable that is tailored to the study population and is used to control for bias due to residual confounding. The approach may provide a useful tool for assessing and accounting for bias due to residual confounding. We provide a formal description of the conditions for identification of causal effects, illustrate the method using simulations, and provide an empirical example concerning mortality among Japanese atomic bomb survivors.