Joint analysis of nonlinear heterogeneous longitudinal data and binary outcome: an application to AIDS clinical studies

Finite mixture models are currently used to analyze heterogeneous longitudinal data. By releasing the homogeneity restriction of nonlinear mixed-effects (NLME) models, finite mixture models not only can estimate model parameters but also cluster individuals into one of the pre-specified classes with class membership probabilities. This clustering may have clinical significance, which might be associated with a clinically important binary outcome. This article develops a joint modeling of a finite mixture of NLME models for longitudinal data in the presence of covariate measurement errors and a logistic regression for a binary outcome, linked by individual latent class indicators, under a Bayesian framework. Simulation studies are conducted to assess the performance of the proposed joint model and a naive two-step model, in which finite mixture model and logistic regression are fitted separately, followed by an application to a real data set from an AIDS clinical trial, in which the viral dynamics and dichotomized time to the first decline of CD4/CD8 ratio are analyzed jointly.     

A multiple imputation approach to nonlinear mixed-effects models with covariate measurement errors and missing values

In longitudinal studies, nonlinear mixed-effects models have been widely applied to describe the intra- and the inter-subject variations in data. The inter-subject variation usually receives great attention and it may be partially explained by time-dependent covariates. However, some covariates may be measured with substantial errors and may contain missing values. We proposed a multiple imputation method, implemented by a Markov Chain Monte-Carlo method along with Gibbs sampler, to address the covariate measurement errors and missing data in nonlinear mixed-effects models. The multiple imputation method is illustrated in a real data example. Simulation studies show that the multiple imputation method outperforms the commonly used naive methods.     

Missing time-dependent covariates in human immunodeficiency virus dynamic models

Summary. The study of human immunodeficiency virus dynamics is one of the most important areas in research into acquired immune deficiency syndrome in recent years. Non-linear mixed effects models have been proposed for modelling viral dynamic processes. A challenging problem in the modelling is to identify repeatedly measured (time-dependent), but possibly missing, immunologic or virologic markers (covariates) for viral dynamic parameters. For missing time-dependent covariates in non-linear mixed effects models, the commonly used complete-case, mean imputation and last value carried forward methods may give misleading results. We propose a three-step hierarchical multiple-imputation method, implemented by Gibbs sampling, which imputes the missing data at the individual level but can pool information across individuals. We compare various methods by Monte Carlo simulations and find that the multiple-imputation method proposed performs the best in terms of bias and mean-squared errors in the estimates of covariate coefficients. By applying the favoured multiple-imputation method to clinical data, we conclude that there is a negative correlation between the viral decay rate (a virological response parameter) and CD4 or CD8 cell counts during the treatment; this is counter-intuitive, but biologically interpretable on the basis of findings from other clinical studies. These results may have an important influence on decisions about treatment for acquired immune deficiency syndrome patients.     

Estimation and Inference in Two-Step Econometric Models

A commonly used procedure in a wide class of empirical applications is to impute unobserved regressors, such as expectations, from an auxiliary econometric model. This two-step (T-S) procedure fails to account for the fact that imputed regressors are measured with sampling error, so hypothesis tests based on the estimated covariance matrix of the second-step estimator are biased, even in large samples. We present a simple yet general method of calculating asymptotically correct standard errors in T-S models. The procedure may be applied even when joint estimation methods, such as full information maximum likelihood, are inappropriate or computationally infeasible. We present two examples from recent empirical literature in which these corrections have a major impact on hypothesis testing.     

A Parametric approach to the Estimation of Cointegration Vectors in Panel Data

In this article, a parametric framework for estimation and inference in cointegrated panel data models is considered that is based on a cointegrated VAR(p) model. A convenient two-step estimator is suggested where, in the first step, all individual specific parameters are estimated, and in the second step, the long-run parameters are estimated from a pooled least-squares regression. The two-step estimator and related test procedures can easily be modified to account for contemporaneously correlated errors, a feature that is often encountered in multi-country studies. Monte Carlo simulations suggest that the two-step estimator and related test procedures outperform semiparametric alternatives such as the fully modified OLS approach, especially if the number of time periods is small.     

Two-step and likelihood methods for joint models of longitudinal and survival data

We compare the commonly used two-step methods and joint likelihood method for joint models of longitudinal and survival data via extensive simulations. The longitudinal models include LME, GLMM, and NLME models, and the survival models include Cox models and AFT models. We find that the full likelihood method outperforms the two-step methods for various joint models, but it can be computationally challenging when the dimension of the random effects in the longitudinal model is not small. We thus propose an approximate joint likelihood method which is computationally efficient. We find that the proposed approximation method performs well in the joint model context, and it performs better for more “continuous” longitudinal data. Finally, a real AIDS data example shows that patients with higher initial viral load or lower initial CD4 are more likely to drop out earlier during an anti-HIV treatment.     

A cautionary note on generalized linear models for covariance of unbalanced longitudinal data

Missing data in longitudinal studies can create enormous challenges in data analysis when coupled with the positive-definiteness constraint on a covariance matrix. For complete balanced data, the Cholesky decomposition of a covariance matrix makes it possible to remove the positive-definiteness constraint and use a generalized linear model setup to jointly model the mean and covariance using covariates (Pourahmadi, 2000). However, this approach may not be directly applicable when the longitudinal data are unbalanced, as coherent regression models for the dependence across all times and subjects may not exist. Within the existing generalized linear model framework, we show how to overcome this and other challenges by embedding the covariance matrix of the observed data for each subject in a larger covariance matrix and employing the familiar EM algorithm to compute the maximum likelihood estimates of the parameters and their standard errors. We illustrate and assess the methodology using real data sets and simulations.     

Approximate bounded influence estimation for longitudinal data with outliers and measurement errors

Mixed effects models or random effects models are popular for the analysis of longitudinal data. In practice, longitudinal data are often complex since there may be outliers in both the response and the covariates and there may be measurement errors. The likelihood method is a common approach for these problems but it can be computationally very intensive and sometimes may even be computationally infeasible. In this article, we consider approximate robust methods for nonlinear mixed effects models to simultaneously address outliers and measurement errors. The approximate methods are computationally very efficient. We show the consistency and asymptotic normality of the approximate estimates. The methods can also be extended to missing data problems. An example is used to illustrate the methods and a simulation is conducted to evaluate the methods.     

基于贝叶斯推断的HIV非线性混合效应联合模型研究

 在纵向数据研究中,混合效应模型的随机误差通常采用正态性假设。而诸如病毒载量和CD4细胞数目等病毒性数据通常呈现偏斜性,因此正态性假设可能影响模型结果甚至导致错误的结论。在HIV动力学研究中,病毒响应值往往与协变量相关,且协变量的测量值通常存在误差,为此论文中联立协变量过程建立具有偏正态分布的非线性混合效应联合模型,并用贝叶斯推断方法估计模型的参数。由于协变量能够解释个体内的部分变化,因此协变量过程的模型选择对病毒载量的拟合效果有重要的影响。该文提出了一次移动平均模型作为协变量过程的改进模型,比较后发现当协变量采用移动平均模型时,病毒载量模型的拟合效果更好。该结果对协变量模型的研究具有重要的指导意义。     

Modified first-difference estimator in a panel data model with unobservable factors both in the errors and the regressors when the time dimension is small

Panel data models with factor structures in both the errors and the regressors have received considerable attention recently. In these models, the errors and the regressors are correlated and the standard estimators are inconsistent. This paper shows that, for such models, a modified first-difference estimator (in which the time and the cross-sectional dimensions are interchanged) is consistent as the cross-sectional dimension grows but the time dimension is small. Although the estimator has a non standard asymptotic distribution, t and F tests have standard asymptotic distribution under the null hypothesis.     

Robust modelling of the relationship between CD4 and viral load for complex AIDS data

CD4 and viral load play important roles in HIV/AIDS studies, and the study of their relationship has received much attention with well-known results. However, AIDS datasets are often highly complex in the sense that they typically contain outliers, measurement errors, and missing data. These data complications can greatly affect statistical analysis results, but much of the literature fail to address these issues in data analysis. In this paper, we re-visit the important relationship between CD4 and viral load and propose methods which simultaneously address outliers, measurement errors, and missing data. We find that the strength of the relationship may be severely mis-estimated if measurement errors and outliers are ignored. The proposed methods are general and can be used in other settings, where jointly modelling several different types of longitudinal data is required in the presence of data complications.     

Comparison of Mixed-Effects Models for Skew-Normal Responses with an Application to AIDS Data: A Bayesian Approach

The potency of antiretroviral agents in AIDS clinical trials can be assessed on the basis of a viral response such as viral decay rate or change in viral load (number of HIV RNA copies in plasma). Linear, nonlinear, and nonparametric mixed-effects models have been proposed to estimate such parameters in viral dynamic models. However, there are two critical questions that stand out: whether these models achieve consistent estimates for viral decay rates, and which model is more appropriate for use in practice. Moreover, one often assumes that a model random error is normally distributed, but this assumption may be unrealistic, obscuring important features of within- and among-subject variations. In this article, we develop a skew-normal (SN) Bayesian linear mixed-effects (SN-BLME) model, an SN Bayesian nonlinear mixed-effects (SN-BNLME) model, and an SN Bayesian semiparametric nonlinear mixed-effects (SN-BSNLME) model that relax the normality assumption by considering model random error to have an SN distribution. We compare the performance of these SN models, and also compare their performance with the corresponding normal models. An AIDS dataset is used to test the proposed models and methods. It was found that there is a significant incongruity in the estimated viral decay rates. The results indicate that SN-BSNLME model is preferred to the other models, implying that an arbitrary data truncation is not necessary. The findings also suggest that it is important to assume a model with an SN distribution in order to achieve reasonable results when the data exhibit skewness.     

Robust estimation of mean and covariance for longitudinal data with dropouts

In this paper, we study estimation of linear models in the framework of longitudinal data with dropouts. Under the assumptions that random errors follow an elliptical distribution and all the subjects share the same within-subject covariance matrix which does not depend on covariates, we develop a robust method for simultaneous estimation of mean and covariance. The proposed method is robust against outliers, and does not require to model the covariance and missing data process. Theoretical properties of the proposed estimator are established and simulation studies show its good performance. In the end, the proposed method is applied to a real data analysis for illustration.     

A Bayesian approach in differential equation dynamic models incorporating clinical factors and covariates

A virologic marker, the number of HIV RNA copies or viral load, is currently used to evaluate antiretroviral (ARV) therapies in AIDS clinical trials. This marker can be used to assess the antiviral potency of therapies, but may be easily affected by clinical factors such as drug exposures and drug resistance as well as baseline characteristics during the long-term treatment evaluation process. HIV dynamic studies have significantly contributed to the understanding of HIV pathogenesis and ARV treatment strategies. Viral dynamic models can be formulated through differential equations, but there has been only limited development of statistical methodologies for estimating such models or assessing their agreement with observed data. This paper develops mechanism-based nonlinear differential equation models for characterizing long-term viral dynamics with ARV therapy. In this model we not only incorporate clinical factors (drug exposures, and susceptibility), but also baseline covariate (baseline viral load, CD4 count, weight, or age) into a function of treatment efficacy. A Bayesian nonlinear mixed-effects modeling approach is investigated with application to an AIDS clinical trial study. The effects of confounding interaction of clinical factors with covariate-based models are compared using the deviance information criteria (DIC), a Bayesian version of the classical deviance for model assessment, designed from complex hierarchical model settings. Relationships between baseline covariate combined with confounding clinical factors and drug efficacy are explored. In addition, we compared models incorporating each of four baseline covariates through DIC and some interesting findings are presented. Our results suggest that modeling HIV dynamics and virologic responses with consideration of time-varying clinical factors as well as baseline characteristics may play an important role in understanding HIV pathogenesis, designing new treatment strategies for long-term care of AIDS patients.     

Some asymptotic results for semiparametric nonlinear mixed-effects models with incomplete data

In modeling complex longitudinal data, semiparametric nonlinear mixed-effects (SNLME) models are very flexible and useful. Covariates are often introduced in the models to partially explain the inter-individual variations. In practice, data are often incomplete in the sense that there are often measurement errors and missing data in longitudinal studies. The likelihood method is a standard approach for inference for these models but it can be computationally very challenging, so computationally efficient approximate methods are quite valuable. However, the performance of these approximate methods is often based on limited simulation studies, and theoretical results are unavailable for many approximate methods. In this article, we consider a computationally efficient approximate method for a class of SNLME models with incomplete data and investigate its theoretical properties. We show that the estimates based on the approximate method are consistent and asymptotically normally distributed.     

A Bayesian model for measurement and misclassification errors alongside missing data,with an application to higher education participation in Australia

In this paper we consider the impact of both missing data and measurement errors on a longitudinal analysis of participation in higher education in Australia. We develop a general method for handling both discrete and continuous measurement errors that also allows for the incorporation of missing values and random effects in both binary and continuous response multilevel models. Measurement errors are allowed to be mutually dependent and their distribution may depend on further covariates. We show that our methodology works via two simple simulation studies. We then consider the impact of our measurement error assumptions on the analysis of the real data set.     

Two-step estimation of functional linear models with applications to longitudinal data

Functional linear models are useful in longitudinal data analysis. They include many classical and recently proposed statistical models for longitudinal data and other functional data. Recently, smoothing spline and kernel methods have been proposed for estimating their coefficient functions nonparametrically but these methods are either intensive in computation or inefficient in performance. To overcome these drawbacks, in this paper, a simple and powerful two-step alternative is proposed. In particular, the implementation of the proposed approach via local polynomial smoothing is discussed. Methods for estimating standard deviations of estimated coefficient functions are also proposed. Some asymptotic results for the local polynomial estimators are established. Two longitudinal data sets, one of which involves time-dependent covariates, are used to demonstrate the approach proposed. Simulation studies show that our two-step approach improves the kernel method proposed by Hoover and co-workers in several aspects such as accuracy, computational time and visual appeal of the estimators.     

Bayesian generalized varying coefficient models for longitudinal proportional data with errors-in-covariates

This paper is motivated from a neurophysiological study of muscle fatigue, in which biomedical researchers are interested in understanding the time-dependent relationships of handgrip force and electromyography measures. A varying coefficient model is appealing here to investigate the dynamic pattern in the longitudinal data. The response variable in the study is continuous but bounded on the standard unit interval (0, 1) over time, while the longitudinal covariates are contaminated with measurement errors. We propose a generalization of varying coefficient models for the longitudinal proportional data with errors-in-covariates. We describe two estimation methods with penalized splines, which are formalized under a Bayesian inferential perspective. The first method is an adaptation of the popular regression calibration approach. The second method is based on a joint likelihood under the hierarchical Bayesian model. A simulation study is conducted to evaluate the efficacy of the proposed methods under different scenarios. The analysis of the neurophysiological data is presented to demonstrate the use of the methods.     

Zero-inflated and overdispersed: what's one to do?

Zero-inflated Poisson (ZIP) and zero-inflated negative binomial (ZINB) models are recommended for handling excessive zeros in count data. For various reasons, researchers may not address zero inflation. This paper helps educate researchers on (1) the importance of accounting for zero inflation and (2) the consequences of misspecifying the statistical model. Using simulations, we found that when the zero inflation in the data was ignored, estimation was poor and statistically significant findings were missed. When overdispersion within the zero-inflated data was ignored, poor estimation and inflated Type I errors resulted. Recommendations on when to use the ZINB and ZIP models are provided. In an illustration using a two-step model selection procedure (likelihood ratio test and the Vuong test), the ZIP model was correctly identified only when the distributions had moderate means and sample sizes and did not correctly identify the ZINB model or the zero inflation in the ZIP and ZINB distributions.     

Local Box–Cox transformation on time-varying parametric models for smoothing estimation of conditional CDF with longitudinal data

Nonparametric estimation and inferences of conditional distribution functions with longitudinal data have important applications in biomedical studies, such as epidemiological studies and longitudinal clinical trials. Estimation approaches without any structural assumptions may lead to inadequate and numerically unstable estimators in practice. We propose in this paper a nonparametric approach based on time-varying parametric models for estimating the conditional distribution functions with a longitudinal sample. Our model assumes that the conditional distribution of the outcome variable at each given time point can be approximated by a parametric model after local Box–Cox transformation. Our estimation is based on a two-step smoothing method, in which we first obtain the raw estimators of the conditional distribution functions at a set of disjoint time points, and then compute the final estimators at any time by smoothing the raw estimators. Applications of our two-step estimation method have been demonstrated through a large epidemiological study of childhood growth and blood pressure. Finite sample properties of our procedures are investigated through a simulation study. Application and simulation results show that smoothing estimation from time-variant parametric models outperforms the existing kernel smoothing estimator by producing narrower pointwise bootstrap confidence band and smaller root mean squared error.