How can the magnitude of an intervention be quantified in a segmented time series regression?

I am attempting to replicate the methodology of Decline in pneumonia admissions after routine childhood immunisation with pneumococcal conjugate vaccine in the USA: a time-series analysis. There are several other published papers with similar methodology where the methods chapter is not informative. All of these papers cite Wagner et al., however that paper describes a much simpler linear model.

I have a 120 month time series of count data that exhibits strong seasonal variation, has a baseline negative trend and a known public health intervention at $t = 72$ that would be expected to decrease the counts (increase the negative trend). I have fitted this with a negative binomial model with AR(2) errors and dummy variables for months, pre-intervention trend, an intervention indicator and post-intervention trend. I did this in R statistics with the function glm.nb from the MASS package.

#In R version 3.3.1 with packages dplyr, MASS
#generate a comparable time-series ts() 
base <- rnbinom(n = 120, size = 1400, prob = 0.5)
season <- rep(c(600, 400, 150, 0, -50, -80, -300, -600, 50, 100, 200, 300), 10)
ts <- ts(base + season, start = c(2000,1), end = c(2009,12), frequency = 12)
#generate the independant variables
month.f <- factor(rep(1:12, 10))
dummy.months <- model.matrix(~month.f +0)
require(dplyr); lag1 <- lag(ts); lag2 <- lag(lag(ts))
time.interv <- 72
pre.interv.trend <- c(1:time.interv, rep(0, 48))
interv.indicator <- c(rep(0, time.interv), rep(1, 48))
post.interv.trend <- c(rep(0, time.interv), 1:48)
df <- cbind.data.frame(ts, dummy.months,lag1,lag2,interv.indicator,pre.interv.trend,post.interv.trend)
#the fitted model
require(MASS); fit <- glm.nb(ts ~. + 0, data = df)

I have attempted several approaches

  1. I have tried using the forecast package to forecast the pre-intervention time series and then subtract the observed values from the predicted. However, the 95%CI intervals became so large that there would have been no theoretical way for the observed time series to fall outside them.
  2. I have refit the model without the intervention variables and subtracted fit_intervention from fit_nonintervention. The refitted model exhibits fairly similar fitted values with an overall decreased model fit.

2 Answers 2


In general, evaluation of pre-post effects in time-series analysis is called interrupted time series. This is a very general modeling approach that tests the strong hypothesis:

$\mathcal{H}_0: \mu_{ijt} = f_i(t)$ versus $\mathcal{H}_1 : \mu_{ijt} = f_i(t) + \beta(t)X_{ijt} $

Where $X_{ijt}$ is the the treatment assignment for individual $i$ at time $t$. The easiest example is treating $\beta$ as a constant function and $X_{ijt}$ as a 0,1 indicator for 0: pre-intervention 1: peri-or post-intervention. Even if the actual "effect" of the intervention is different than this, this test is powered to detect differences in many types of scenarios, for instance, if $\beta(t)$ is any non-zero function, then a working constant parameter $\beta$ will estimate a time-averaged positive response to intervention and is non-zero.

A challenge in time-series analysis of pre-post interventions is using a parametric modeling approach for the auto-correlation. With many replicates of time and function, one can decompose the trend into lagged effects, seasonal effects etc. This would obviate the need for autocorrelation in the error term. Therefore it is not necessary to use forecast, but the model itself directly predicts what would have been observed in the post-intervention time period.

Consider the famous Air Passengers data in the datasets package in R.

## construct an analytic dataset to predict time trend using auto-regressive and seasonal components
AirPassengers <- data.frame('flights'=as.numeric(AirPassengers))
AirPassengers$month <- factor(month.name, levels=month.name)
AirPassengers$year <- rep(1949:1960, each=12)
AirPassengers$lag <- c(NA, AirPassengers$flights[-nrow(AirPassengers)])

plot(AirPassengers$flights, type='l')

AirPassengers$fitted <- exp(predict(lm(log(flights) ~ month + year, data=AirPassengers)))
lines(AirPassengers$fitted, col='red')

It's obvious this provides an excellent prediction of the time based trends. If, though, you were interested in a test of hypothesis as to whether "flying increased" post, say, 1955, you can update the dataset to include a 0/1 indicator for whether or not the time period is post that point and test its significance in a linear model.

For example:

AirPassengers$post <- AirPassengers$year >= 1955
fit <- lm(log(flights) ~ month + year + post, data=AirPassengers)
coeftest(fit, vcov. = vcovHC)['postTRUE', ]

Gives me:

> coeftest(fit, vcov. = vcovHC)['postTRUE', ]
  Estimate Std. Error    t value   Pr(>|t|) 
0.03720327 0.01783242 2.08627126 0.03890842 

Which is a nice example of a spurious finding, and a statistically significant effect that isn't practically significant. A more general test could be had by allowing heterogeneity between the month specific effects.

nullmodel <- lm(log(flights) ~ month + year, data=AirPassengers)
fullmodel <- lm(log(flights) ~ post*month + year, data=AirPassengers)
waldtest(nullmodel, fullmodel, vcov=vcovHC, test='Chisq')

Both of these are examples of the general approach to "interrupted time series" for segmented regression. It is a loosely defined term and I'm a little disappointed with how little detail the authors use in describing their exact approach in most cases.

  • $\begingroup$ I have residual question regarding this methodology. If I fit a linear model to the whole dataset, such as nullmodel in the example above, have I not incorporated the intervention effects into the baseline estimate? The nullmodel thus does not represent the data without the intervention, it represents the observed data with the intervention, except the intervention effect is hidden within the estimates for the other covariates. Then how could I possibly quantify the magnitude of the intervention effect if I am comparing 2 models that both represent the intervention except differently? $\endgroup$ Jul 23, 2016 at 19:03
  • $\begingroup$ @user6571411 in the spirit of null hypothesis testing, yes the null model incorporates data from both the pre and post period. Recall under the null there is no effect so that kind of model should be sane. But you compare this model to a larger one which allows for some differences between the pre and post period. If the full model provides substantially better fit, it is taken as evidence of a significant effect due to intervention. Recall a ttest is a linear model with an effect for group membership. The null model is estimated with no group assignment. $\endgroup$
    – AdamO
    Jul 23, 2016 at 20:23

Repeating your data-generating code for convenience ...

set.seed(101)  ## don't to forget to set the seed for reproducibility
##generate a comparable time-series ts() 
base <- rnbinom(n = 120, size = 1400, prob = 0.5)
season <- rep(c(600, 400, 150, 0, -50, -80, -300, -600, 50, 100, 200, 300), 10)

## dangerous to name your time-series the same as the ts() function
ts0 <- ts(base + season, start = c(2000,1), end = c(2009,12), frequency = 12)
##generate the independent variables
month.f <- factor(rep(1:12, 10))
dummy.months <- model.matrix(~month.f +0)
lag1 <- lag(ts0); lag2 <- lag(lag(ts0))
time.pre <- 72
time.post <- 48

I'm changing your dummy variables a little bit. For maximum interpretability I think you want to have the intercept and the pre-intervention slope applied all the way through the data set, so that the "intervention indicator" and the "post-intervention slope" represent differences from the pre-intervention behaviour.

pre.interv.trend <- 1:(time.pre+time.post)
interv.indicator <- c(rep(0, time.pre), rep(1, time.post))
post.interv.trend <- c(rep(0, time.pre), 1:time.post)
df <- data.frame(ts0, dummy.months,lag1,lag2,interv.indicator,

The fitted model:

    fit <- MASS::glm.nb(ts0 ~. + 0, data = df)

The terms we want to isolate (the only ones that represent the intervention effects):

    params <- c("interv.indicator","post.interv.trend")

Using predict(.,type="terms") almost but doesn't quite do what you want. It will get the right prediction, but the confidence intervals fail to take the covariance between the terms into account ...

    pp <- predict(fit,type="terms",terms=params,se.fit=TRUE)
    pp.fit <- rowSums(pp$fit)
    pp.se <- sqrt(rowSums(pp$se.fit^2))

This is a little bit more tedious but is actually correct ...

    m <- model.matrix(ts0~.+0,data=df)
    m2 <- m[,params]
    pred <- drop(m2 %*% coef(fit)[params])
    predsd <- sqrt(diag(m2 %*% vcov(fit)[params,params] %*% t(m2)))

Plot the results (thin lines ignore covariance, thick lines include it):

            ylab="intervention effect (link scale)")

enter image description here

  • $\begingroup$ Both your and @AdamO answers assume using the whole dataset. The papers I have studied seem to emphasize the "interrupted" aspect of this approach citing concerns that a certain transition period biases the pre-intervention fit. In my example above, the intervention isn't a single event on a specific date. There is a strong argument that some effect has already taken place between t = 60 and the chosen t = 72. However, there is an even stronger argument in favor of using t = 72 as the start date. What are your thoughts on this and would this change your approach? $\endgroup$ Jul 26, 2016 at 11:57

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