Scalable Counterfactual Risk Estimation for Rare Events in Longitudinal Data

Longitudinal treatment decisions from multivariate time-series data require predicting potential outcomes under future treatment sequences in the presence of time-varying confounding, heterogeneous patient dynamics, and limited domain-specific data. Existing longitudinal causal estimators typically address this problem by training a new model for each cohort or simulator. We introduce Causal Longitudinal Prior-Fitted Networks (CausalLongPFN), a prior-fitted network for time-series causal inference in longitudinal treatment-response data and zero-shot in-context counterfactual outcome prediction. The model is pretrained entirely on synthetic episodes sampled from a broad prior over temporal structural causal models, exposing it to treatment-confounder feedback, latent heterogeneity, nonlinear state evolution, delayed effects, and cumulative treatment responses. At test time, CausalLongPFN remains frozen and is used zero-shot: it conditions on support trajectories, a query history, and a planned future treatment sequence, and returns a predictive distribution over future outcomes without gradient updates or propensity-model fitting. Multi-step predictions are obtained by recursively applying the one-step predictor under the specified treatment sequence. We evaluate the model on branchable cancer, HIV, and warfarin benchmarks with ground-truth counterfactual labels, and on factual-only rolling-origin prediction in MIMIC-III ICU trajectories. CausalLongPFN is competitive with domain-trained longitudinal baselines on counterfactual benchmarks and performs strongly on factual MIMIC-III prediction, suggesting that broad synthetic causal pretraining can provide a frozen, amortized alternative for zero-shot longitudinal treatment-response prediction when repeated domain-specific training is costly or impractical.

Estimating how an outcome responds to a continuous treatment (the Average Dose-Response Function, or ADRF) is a core causal-inference primitive. However, when outcomes possess heavy tails, standard robust double machine learning (DML) deliberately suppresses these extremes to stabilize the bulk average. In high-stakes settings, such as financial returns or climate losses, this omitted 1-in-1000 extreme event is the actual target quantity. Furthermore, current methods that read the tail from a model's residuals suffer from circular dependence, causing tail shape inferences to shift drastically based solely on whether the core estimator is switched between Huber and Welsch. The research proposes an ADRF estimator that emits a structured tail-shape output alongside the standard point estimate. Its tail diagnostic (PDHTE+JK) evaluates the per-treatment tail shape from the outcome centered by a pilot median, successfully breaking the circular dependence and rendering the diagnostic invariant to the choice of core method. The output encompasses four treatment-conditional quantities: tail shape $\hatξ(t)$, deep-tail return levels $\hat{Q}_α(t)$, conditional shortfalls $\hat{S}_α(t)$, the recovered mean ADRF, and an explicit refusal mechanism that declines extrapolation when extreme-value modeling is unsupported by the data. Compared to kernel-weighted quantile regression (QR), the proposed estimator reduces deep-tail ($α=0.001$) return-level MAE by 11% and conditional-shortfall MAE by 25.5% across a heavy-tailed panel. It also achieves a 20-29% MAE reduction in sample-scarce regimes ($n\le2000$). On freMTPL2 motor-insurance claims, it successfully triggered an explicit extrapolation refusal on the log-claim scale, which neither QR nor loss-only DML can produce.

Longitudinal causal studies often record histories as irregular functional fragments: laboratory values, physiologic signals, sensor streams, and image-derived summaries measured at unequal and informative times. Standard doubly robust estimators usually require scalar summaries, whereas sequence learners optimize prediction losses that need not stabilize the efficient influence function. We propose Doubly Robust Functional Representation Learning (DR-FRL), a cross-fitted workflow that turns irregular histories into estimand-targeted states for observed-history regimes. Functional and temporal encoders map point clouds and prior histories into states; nuisance heads estimate outcome, treatment, and censoring functions; and EIF-targeted validation, calibration, overlap, tail, and ablation diagnostics assess whether the state supports the estimating equation. If the selected state preserves the nuisance information needed by the EIF, representation error enters the same second-order product remainder as ordinary nuisance error, and the mean estimator is asymptotically linear under explicit rate, overlap, calibration, and stability conditions. Catoni aggregation is treated separately as a bounded-influence point estimator, not a replacement for Wald inference. Simulations show gains when functional confounding is high-dimensional, measurement is informative, support is weak, or pseudo-outcomes are heavy-tailed. A VitalDB audit shows that DR-FRL can use irregular laboratory point clouds and deliver a useful negative finding: for this ICU-disposition endpoint, scalar laboratory summaries already carry much endpoint-relevant information.