Aligning time origins in observational survival studies with time-dependent covariates
In many clinical studies, defining a clear time origin is essential: eligibility, treatment assignment, and the beginning of follow-up are ideally synchronized. In analyses based on observational data, however, these time points are often misaligned. This misalignment can create periods during which events cannot occur by design, effectively introducing a form of left-truncation or guaranteed survival that biases effect estimates.




