A New Estimator for Cox Proportional Hazard Regression Model in Presence of Collinearity

We propose a new approach to estimate the parameters of the Cox proportional hazards model in the presence of collinearity. Generally, a maximum partial likelihood estimator is used to estimate parameters for the Cox proportional hazards model. However, the maximum partial likelihood estimators can be seriously affected by the presence of collinearity since the parameter estimates result in large variances.

In this study, we develop a Liu-type estimator for Cox proportional hazards model parameters and compare it with a ridge regression estimator based on the scalar mean squared error (MSE). Finally, we evaluate its performance through a simulation study.     

Weighted Mean Survival Test Statistics: a Class of Distance Tests for Censored Survival Data

A class of test statistics is introduced which is sensitive against the alternative of stochastic ordering in the two-sample censored data problem. The test statistics for evaluating a cumulative weighted difference in survival distributions are developed while taking into account the imbalances in base-line covariates between two groups. This procedure can be used to test the null hypothesis of no treatment effect, especially when base-line hazards cross and prognostic covariates need to be adjusted. The statistics are semiparametric, not rank based, and can be written as integrated weighted differences in estimated survival functions, where these survival estimates are adjusted for covariate imbalances. The asymptotic distribution theory of the tests is developed, yielding test procedures that are shown to be consistent under a fixed alternative. The choice of weight function is discussed and relies on stability and interpretability considerations. An example taken from a clinical trial for acquired immune deficiency syndrome is presented.     

Validation of A Heteroscedastic Hazards Regression Model

A Cox-type regression model accommodating heteroscedasticity, with a power factor of the baseline cumulative hazard, is investigated for analyzing data with crossing hazards behavior. Since the approach of partial likelihood cannot eliminate the baseline hazard, an overidentified estimating equation (OEE) approach is introduced in the estimation procedure. Its by-product, a model checking statistic, is presented to test for the overall adequacy of the heteroscedastic model. Further, under the heteroscedastic model setting, we propose two statistics to test the proportional hazards assumption. Implementation of this model is illustrated in a data analysis of a cancer clinical trial.     

Weighting methods for ties between event times and covariate change times

Recent work has shown that the presence of ties between an outcome event and the time that a binary covariate changes or jumps can lead to biased estimates of regression coefficients in the Cox proportional hazards model. One proposed solution is the Equally Weighted method. The coefficient estimate of the Equally Weighted method is defined to be the average of the coefficient estimates of the Jump Before Event method and the Jump After Event method, where these two methods assume that the jump always occurs before or after the event time, respectively. In previous work, the bootstrap method was used to estimate the standard error of the Equally Weighted coefficient estimate. However, the bootstrap approach was computationally intensive and resulted in overestimation. In this article, two new methods for the estimation of the Equally Weighted standard error are proposed. Three alternative methods for estimating both the regression coefficient and the corresponding standard error are also proposed. All the proposed methods are easy to implement. The five methods are investigated using a simulation study and are illustrated using two real datasets.     

Comparison of goodness of fit tests for the cox proportional hazards model

The proportional hazards regression model of Cox(1972) is widely used in analyzing survival data. We examine several goodness of fit tests for checking the proportionality of hazards in the Cox model with two-sample censored data, and compare the performance of these tests by a simulation study. The strengths and weaknesses of the tests are pointed out. The effects of the extent of random censoring on the size and power are also examined. Results of a simulation study demonstrate that Gill and Schumacher's test is most powerful against a broad range of monotone departures from the proportional hazards assumption, but it may not perform as well fail for alternatives of nonmonotone hazard ratio. For the latter kind of alternatives, Andersen's test may detect patterns of irregular changes in hazards.     

Choice of Parametric Accelerated Life and Proportional Hazards Models for Survival Data: Asymptotic Results

We discuss the impact of misspecifying fully parametric proportional hazards and accelerated life models. For the uncensored case, misspecified accelerated life models give asymptotically unbiased estimates of covariate effect, but the shape and scale parameters depend on the misspecification. The covariate, shape and scale parameters differ in the censored case. Parametric proportional hazards models do not have a sound justification for general use: estimates from misspecified models can be very biased, and misleading results for the shape of the hazard function can arise. Misspecified survival functions are more biased at the extremes than the centre. Asymptotic and first order results are compared. If a model is misspecified, the size of Wald tests will be underestimated. Use of the sandwich estimator of standard error gives tests of the correct size, but misspecification leads to a loss of power. Accelerated life models are more robust to misspecification because of their log-linear form. In preliminary data analysis, practitioners should investigate proportional hazards and accelerated life models; software is readily available for several such models.     

Maximum Likelihood Estimation for Cox's Regression Model Under Case–Cohort Sampling

Abstract.  Case–cohort sampling aims at reducing the data sampling and costs of large cohort studies. It is therefore important to estimate the parameters of interest as efficiently as possible. We present a maximum likelihood estimator (MLE) for a case–cohort study based on the proportional hazards assumption. The estimator shows finite sample properties that improve on those by the Self & Prentice [Ann. Statist. 16 (1988)] estimator. The size of the gain by the MLE varies with the level of the disease incidence and the variability of the relative risk over the considered population. The gain tends to be small when the disease incidence is low. The MLE is found by a simple EM algorithm that is easy to implement. Standard errors are estimated by a profile likelihood approach based on EM-aided differentiation.     

A multicollinearity diagnostic for models fit to censored data

A multicollinearity diagnostic is discussed for parametric models fit to censored data. The models considered include the Weibull, exponential and lognormal models as well as the Cox proportional hazards model. This diagnostic is an extension of the diagnostic proposed by Belsley, Kuh, and Welsch (1980). The diagnostic is based on the condition indicies and variance proportions of the variance covariance matrix. Its use and properties are studied through a series of examples. The effect of centering variables included in model is also discussed.     

Semiparametric Efficient Estimation in the Generalized Odds-Rate Class of Regression Models for Right-Censored Time-to-Event Data

The generalized odds-rate class of regression models for time to event data is indexed by a non-negative constant and assumes thatg(S(t|Z)) = (t) + Zwhere g(s) = log(^-1(s-) for > 0, g₀(s) = log(- log s), S(t|Z) is the survival function of the time to event for an individual with qx1 covariate vector Z, is a qx1 vector of unknown regression parameters, and (t) is some arbitrary increasing function of t. When =0, this model is equivalent to the proportional hazards model and when =1, this model reduces to the proportional odds model. In the presence of right censoring, we construct estimators for and exp((t)) and show that they are consistent and asymptotically normal. In addition, we show that the estimator for is semiparametric efficient in the sense that it attains the semiparametric variance bound.     

Parameter Orthogonality in Mixed Regression Models for Survival Data

The implications of parameter orthogonality for the robustness of survival regression models are considered. The question of which of the proportional hazards or the accelerated life families of models would be more appropriate for analysis is usually ignored, and the proportional hazards family is applied, particularly in medicine, for convenience. Accelerated life models have conventionally been used in reliability applications. We propose a one-parameter family mixture survival model which includes both the accelerated life and the proportional hazards models. By orthogonalizing relative to the mixture parameter, we can show that, for small effects of the covariates, the regression parameters under the alternative families agree to within a constant. This recovers a known misspecification result. We use notions of parameter orthogonality to explore robustness to other types of misspecification including misspecified base-line hazards. The results hold in the presence of censoring. We also study the important question of when proportionality matters.     

Cox regression analysis in presence of collinearity: an application to assessment of health risks associated with occupational radiation exposure

This paper considers the analysis of time to event data in the presence of collinearity between covariates. In linear and logistic regression models, the ridge regression estimator has been applied as an alternative to the maximum likelihood estimator in the presence of collinearity. The advantage of the ridge regression estimator over the usual maximum likelihood estimator is that the former often has a smaller total mean square error and is thus more precise. In this paper, we generalized this approach for addressing collinearity to the Cox proportional hazards model. Simulation studies were conducted to evaluate the performance of the ridge regression estimator. Our approach was motivated by an occupational radiation study conducted at Oak Ridge National Laboratory to evaluate health risks associated with occupational radiation exposure in which the exposure tends to be correlated with possible confounders such as years of exposure and attained age. We applied the proposed methods to this study to evaluate the association of radiation exposure with all-cause mortality.     

Duration of Accrual and Follow-up for Two-Stage Clinical Trials

Group sequential trialswith time to event end points can be complicated to design. Notonly are there unlimited choices for the number of events requiredat each stage, but for each of these choices, there are unlimitedcombinations of accrual and follow-up at each stage that providethe required events. Methods are presented for determining optimalcombinations of accrual and follow-up for two-stage clinicaltrials with time to event end points. Optimization is based onminimizing the expected total study length as a function of theexpected accrual duration or sample size while providing an appropriateoverall size and power. Optimal values of expected accrual durationand minimum expected total study length are given assuming anexponential proportional hazards model comparing two treatmentgroups. The expected total study length can be substantiallydecreased by including a follow-up period during which accrualis suspended. Conditions that warrant an interim follow-up periodare considered, and the gain in efficiency achieved by includingan interim follow-up period is quantified. The gain in efficiencyshould be weighed against the practical difficulties in implementingsuch designs. An example is given to illustrate the use of thesetechniques in designing a clinical trial to compare two chemotherapyregimens for lung cancer. Practical considerations of includingan interim follow-up period are discussed.     

Estimation of the mean quality-adjusted survival using a multistate model for the sojourn times

In clinical trials, it may be of interest taking into account physical and emotional well-being in addition to survival when comparing treatments. Quality-adjusted survival time has the advantage of incorporating information about both survival time and quality-of-life. In this paper, we discuss the estimation of the expected value of the quality-adjusted survival, based on multistate models for the sojourn times in health states. Semiparametric and parametric (with exponential distribution) approaches are considered. A simulation study is presented to evaluate the performance of the proposed estimator and the jackknife resampling method is used to compute bias and variance of the estimator.     

Hypotheses Tests of Strain-specific Vaccine Efficacy Adjusted for Covariate Effects

In the evaluation of efficacy of a vaccine to protect against disease caused by finitely many diverse infectious pathogens, it is often important to assess if vaccine protection depends on variations of the exposing pathogen. This problem can be formulated under a competing risks model where the endpoint event is the infection and the cause of failure is the infecting strain type determined after the infection is diagnosed. The strain-specific vaccine efficacy is defined as one minus the cause-specific hazard ratio (vaccine/placebo). This paper develops some simple procedures for testing if the vaccine affords protection against various strains and if and how the strain-specific vaccine efficacy depends on the type of exposing strain, adjusting for covariate effects. The Cox proportional hazards model is used to relate the cause-specific outcomes to explanatory variables. The finite sample properties of proposed tests are studied through simulations and are shown to have good performances. The tests developed are applied to the data collected from an oral cholera vaccine trial.     

On a measure of information gain for regression models in survival analysis

Papers dealing with measures of predictive power in survival analysis have seen their independence of censoring, or their estimates being unbiased under censoring, as the most important property. We argue that this property has been wrongly understood. Discussing the so-called measure of information gain, we point out that we cannot have unbiased estimates if all values, greater than a given time τ, are censored. This is due to the fact that censoring before τ has a different effect than censoring after τ. Such τ is often introduced by design of a study. Independence can only be achieved under the assumption of the model being valid after τ, which is impossible to verify. But if one is willing to make such an assumption, we suggest using multiple imputation to obtain a consistent estimate. We further show that censoring has different effects on the estimation of the measure for the Cox model than for parametric models, and we discuss them separately. We also give some warnings about the usage of the measure, especially when it comes to comparing essentially different models.     

On Estimation and Tests of Time-Varying Effects in the Proportional Hazards Model

Abstract.  Cox's proportional hazards model is routinely used in many applied fields, some times, however, with too little emphasis on the fit of the model. In this paper, we suggest some new tests for investigating whether or not covariate effects vary with time. These tests are a natural and integrated part of an extended version of the Cox model. An important new feature of the suggested test is that time constancy for a specific covariate is examined in a model, where some effects of other covariates are allowed to vary with time and some are constant; thus making successive testing of time-dependency possible. The proposed techniques are illustrated with the well-known Mayo liver disease data, and a small simulation study investigates the finite sample properties of the tests.     

Parametric Analysis for Matched Pair Survival Data

Hougaard's (1986) bivariate Weibull distribution with positive stable frailties is applied to matched pairs survival data when either or both components of the pair may be censored and covariate vectors may be of arbitrary fixed length. When there is no censoring, we quantify the corresponding gain in Fisher information over a fixed-effects analysis. With the appropriate parameterization, the results take a simple algebraic form. An alternative marginal (independence working model) approach to estimation is also considered. This method ignores the correlation between the two survival times in the derivation of the estimator, but provides a valid estimate of standard error. It is shown that when both the correlation between the two survival times is high, and the ratio of the within-pair variability to the between-pair variability of the covariates is high, the fixed-effects analysis captures most of the information about the regression coefficient but the independence working model does badly. When the correlation is low, and/or most of the variability of the covariates occurs between pairs, the reverse is true. The random effects model is applied to data on skin grafts, and on loss of visual acuity among diabetics. In conclusion some extensions of the methods are indicated and they are placed in a wider context of Generalized Estimating Equation methodology.     

A semi-Markov multistate model for estimation of the mean quality-adjusted survival for non-progressive processes

We discuss the estimation of the expected value of the quality-adjusted survival, based on multistate models. We generalize an earlier work, considering the sojourn times in health states are not identically distributed, for a given vector of covariates. Approaches based on semiparametric and parametric (exponential and Weibull distributions) methodologies are considered. A simulation study is conducted to evaluate the performance of the proposed estimator and the jackknife resampling method is used to estimate the variance of such estimator. An application to a real data set is also included.     

A Generalized Log-Normal Model for Grouped Survival Data

It is common to have experiments in which it is not possible to observe the exact lifetimes but only the interval where they occur. This sort of data presents a high number of ties and it is called grouped or interval-censored survival data. Regression methods for grouped data are available in the statistical literature. The regression structure considers modeling the probability of a subject's survival past a visit time conditional on his survival at the previous visit. Two approaches are presented: assuming that lifetimes come from (1) a continuous proportional hazards model and (2) a logistic model. However, there may be situations in which none of the models are adequate for a particular data set. This article proposes the generalized log-normal model as an alternative model for discrete survival data. This model was introduced by Chen (1995 Chen , G. ( 1995 ). Generalized Log-normal distributions with reliability application . Comput. Stat. Data Anal. 19 : 300 – 319 . [Google Scholar]) and it is extended in this article for grouped survival data. A real example related to a Chagas disease illustrates the proposed model.     

A Note on the Estimate of Treatment Effect from a Cox Regression Model When the Proportionality Assumption Is Violated

ABSTRACT

Cox proportional hazards regression model has been widely used to estimate the effect of a prognostic factor on a time-to-event outcome. In a survey of survival analyses in cancer journals, it was found that only 5% of studies using Cox proportional hazards model attempted to verify the underlying assumption. Usually an estimate of the treatment effect from fitting a Cox model was reported without validation of the proportionality assumption. It is not clear how such an estimate should be interpreted if the proportionality assumption is violated. In this article, we show that the estimate of treatment effect from a Cox regression model can be interpreted as a weighted average of the log-scaled hazard ratio over the duration of study. A hypothetic example is used to explain the weights.