Joint analysis of longitudinal data and competing terminal events in the presence of dependent observation times with application to chronic kidney disease

In many prospective clinical and biomedical studies, longitudinal biomarkers are repeatedly measured as health indicators to evaluate disease progression when patients are followed up over a period of time. Patient visiting times can be referred to as informative observation times if they are assumed to carry information in addition to that of the longitudinal biomarker measures alone. Irregular visiting times may reflect compliance with physician instruction, disease progression and symptom severity. When the follow-up time may be stopped by competing terminal events, it is possible that patient observation times may correlate with the competing terminal events themselves, thus making the observation times difficult to assess. To explicitly account for the impact of competing terminal events and dependent observation times on the longitudinal data analysis in the context of such complex data, we propose a joint model using latent random effects to describe the association among them. A likelihood-based approach is derived for statistical inference. Extensive simulation studies reveal that the proposed approach performs well for practical situations, and an analysis of patients with chronic kidney disease in a cohort study is presented to illustrate the proposed method.     

Semiparametric analysis of longitudinal data with informative observation times and censoring times

We focus on regression analysis of irregularly observed longitudinal data which often occur in medical follow-up studies and observational investigations. The model for such data involves two processes: a longitudinal response process of interest and an observation process controlling observation times. Restrictive models and questionable assumptions, such as Poisson assumption and independent censoring time assumption, were posed in previous works for analysing longitudinal data. In this paper, we propose a more general model together with a robust estimation approach for longitudinal data with informative observation times and censoring times, and the asymptotic normalities of the proposed estimators are established. Both simulation studies and real data application indicate that the proposed method is promising.     

Joint modeling and estimation for longitudinal data with informative observation and terminal event times

ABSTRACT

In many longitudinal studies, there may exist informative observation times and a dependent terminal event that stops the follow-up. In this paper, we propose a joint model for analysis of longitudinal data with informative observation times and a dependent terminal event via two latent variables. Estimation procedures are developed for parameter estimation, and asymptotic properties of the proposed estimators are derived. Simulation studies demonstrate that the proposed method performs well for practical settings. An application to a bladder cancer study is illustrated.     

Regression analysis of longitudinal data with correlated censoring and observation times

Longitudinal data occur in many fields such as the medical follow-up studies that involve repeated measurements. For their analysis, most existing approaches assume that the observation or follow-up times are independent of the response process either completely or given some covariates. In practice, it is apparent that this may not be true. In this paper, we present a joint analysis approach that allows the possible mutual correlations that can be characterized by time-dependent random effects. Estimating equations are developed for the parameter estimation and the resulted estimators are shown to be consistent and asymptotically normal. The finite sample performance of the proposed estimators is assessed through a simulation study and an illustrative example from a skin cancer study is provided.     

Uncertainty and sensitivity analysis in the presence of stochastic and subjective uncertainty

Uncertainty and sensitivity analyses for systems that involve both stochastic (i.e., aleatory) and subjective (i.e., epistemic) uncertainty are discussed. In such analyses, the dependent variable is usually a complementary cumulative distribution function (CCDF) that arises from stochastic uncertainty; uncertainty analysis involves the determination of a distribution of CCDFs that results from subjective uncertainty, and sensitivity analysis involves the determination of the effects of subjective uncertainty in individual variables on this distribution of CCDFs. Uncertainty analysis is presented as an integration problem involving probability spaces for stochastic and subjective uncertainty. Approximation procedures for the underlying integrals are described that provide an assessment of the effects of stochastic uncertainty, an assessment of the effects of subjective uncertainty, and a basis for performing sensitivity studies. Extensive use is made of Latin hypercube sampling, importance sampling and regression-based sensitivity analysis techniques. The underlying ideas, which are initially presented in an abstract form, are central to the design and performance of real analyses. To emphasize the connection between concept and computational practice, these ideas are illustrated with an analysis involving the MACCS reactor accident consequence model a, performance assessment for the Waste Isolation Pilot Plant, and a probabilistic risk assessment for a nuclear power station.     

Joint modeling of longitudinal data with a dependent terminal event

ABSTRACT

Longitudinal data often arise in longitudinal follow-up studies, and there may exist a dependent terminal event such as death that stops the follow-up. In this article, we propose a new joint modeling for the analysis of longitudinal data with informative observation times via a dependent terminal event and two latent variables. Estimating equations are developed for parameter estimation, and asymptotic properties of the resulting estimators are established. In addition, a generalization of the joint model with time-varying coefficients for the longitudinal response variable is considered, and goodness-of-fit methods for assessing the adequacy of the model are also provided. The proposed method works well in our simulation studies, and is applied to a data set from a bladder cancer study.     

Analysis of longitudinal health-related quality of life data with terminal events

Longitudinal health-related quality of life data arise naturally from studies of progressive and neurodegenerative diseases. In such studies, patients’ mental and physical conditions are measured over their follow-up periods and the resulting data are often complicated by subject-specific measurement times and possible terminal events associated with outcome variables. Motivated by the “Predictor’s Cohort” study on patients with advanced Alzheimer disease, we propose in this paper a semiparametric modeling approach to longitudinal health-related quality of life data. It builds upon and extends some recent developments for longitudinal data with irregular observation times. The new approach handles possibly dependent terminal events. It allows one to examine time-dependent covariate effects on the evolution of outcome variable and to assess nonparametrically change of outcome measurement that is due to factors not incorporated in the covariates. The usual large-sample properties for parameter estimation are established. In particular, it is shown that relevant parameter estimators are asymptotically normal and the asymptotic variances can be estimated consistently by the simple plug-in method. A general procedure for testing a specific parametric form in the nonparametric component is also developed. Simulation studies show that the proposed approach performs well for practical settings. The method is applied to the motivating example.     

Joint analysis of longitudinal measurements and survival times with a cure fraction based on partly linear mixed and semiparametric cure models

In a joint analysis of longitudinal quality of life (QoL) scores and relapse-free survival (RFS) times from a clinical trial on early breast cancer conducted by the Canadian Cancer Trials Group, we observed a complicated trajectory of QoL scores and existence of long-term survivors. Motivated by this observation, we proposed in this paper a flexible joint model for the longitudinal measurements and survival times. A partly linear mixed effect model is used to capture the complicated but smooth trajectory of longitudinal measurements and approximated by B-splines and a semiparametric mixture cure model with the B-spline baseline hazard to model survival times with a cure fraction. These two models are linked by shared random effects to explore the dependence between longitudinal measurements and survival times. A semiparametric inference procedure with an EM algorithm is proposed to estimate the parameters in the joint model. The performance of proposed procedures are evaluated by simulation studies and through the application to the analysis of data from the clinical trial which motivated this research.     

Tracing studies and analysis of the effect of loss to follow-up on mortality estimation from patient registry data

Summary. Before patient registries are used for studies of the long-term mortality that is associated with chronic medical conditions, the potential bias resulting from patients who become lost to follow-up must be investigated. A study design, used for a systemic lupus erythematosus patient registry, is described. The design involves tracing patients who are defined as 'lost to follow-up' according to specific criteria. This provides supplementary information on the mortality experience of patients who are lost to (regular) follow-up. Some methods of analysis are described, based on comparing the mortality experience of patients when under regular follow-up with the experience of patients after they are deemed to be lost to follow-up. The effect of loss to follow-up, death reporting and visits to the clinic on estimation procedures is illustrated and recommendations are made for patient registries which are to be used in mortality studies.     

Checking the Grouped Data Version of the Cox Model for Interval-grouped Survival Data

Abstract.  Epidemiology research often entails the analysis of failure times subject to grouping. In large cohorts interval grouping also offers a feasible choice of data reduction to actually facilitate an analysis of the data. Based on an underlying Cox proportional hazards model for the exact failure times one may deduce a grouped data version of this model which may then be used to analyse the data. The model bears a lot of resemblance to a generalized linear model, yet due to the nature of data one also needs to incorporate censoring. In the case of non-trivial censoring this precludes model checking procedures based on ordinary residuals as calculation of these requires knowledge of the censoring distribution. In this paper, we represent interval grouped data in a dynamical way using a counting process approach. This enables us to identify martingale residuals which can be computed without knowledge of the censoring distribution. We use these residuals to construct graphical as well as numerical model checking procedures. An example from epidemiology is provided.     

Semiparametric analysis of panel count data with correlated observation and follow-up times

This paper discusses regression analysis of panel count data that often arise in longitudinal studies concerning occurrence rates of certain recurrent events. Panel count data mean that each study subject is observed only at discrete time points rather than under continuous observation. Furthermore, both observation and follow-up times can vary from subject to subject and may be correlated with the recurrent events. For inference, we propose some shared frailty models and estimating equations are developed for estimation of regression parameters. The proposed estimates are consistent and have asymptotically a normal distribution. The finite sample properties of the proposed estimates are investigated through simulation and an illustrative example from a cancer study is provided.     

Regression Analysis of Longitudinal Data with Time‐Dependent Covariates and Informative Observation Times

Abstract. Longitudinal data frequently occur in many studies, and longitudinal responses may be correlated with observation times. In this paper, we propose a new joint modelling for the analysis of longitudinal data with time‐dependent covariates and possibly informative observation times via two latent variables. For inference about regression parameters, estimating equation approaches are developed and asymptotic properties of the proposed estimators are established. In addition, a lack‐of‐fit test is presented for assessing the adequacy of the model. The proposed method performs well in finite‐sample simulation studies, and an application to a bladder tumour study is provided.     

Ordering and selecting components in multivariate or functional data linear prediction

Summary.  The problem of component choice in regression-based prediction has a long history. The main cases where important choices must be made are functional data analysis, and problems in which the explanatory variables are relatively high dimensional vectors. Indeed, principal component analysis has become the basis for methods for functional linear regression. In this context the number of components can also be interpreted as a smoothing parameter, and so the viewpoint is a little different from that for standard linear regression. However, arguments for and against conventional component choice methods are relevant to both settings and have received significant recent attention. We give a theoretical argument, which is applicable in a wide variety of settings, justifying the conventional approach. Although our result is of minimax type, it is not asymptotic in nature; it holds for each sample size. Motivated by the insight that is gained from this analysis, we give theoretical and numerical justification for cross-validation choice of the number of components that is used for prediction. In particular we show that cross-validation leads to asymptotic minimization of mean summed squared error, in settings which include functional data analysis.     

Estimation of the bivariate distribution function for censored gap times

In many medical studies, patients may experience several events during follow-up. The times between consecutive events (gap times) are often of interest and lead to problems that have received much attention recently. In this work, we consider the estimation of the bivariate distribution function for censored gap times. Some related problems such as the estimation of the marginal distribution of the second gap time and the conditional distribution are also discussed. In this article, we introduce a nonparametric estimator of the bivariate distribution function based on Bayes’ theorem and Kaplan–Meier survival function and explore the behavior of the four estimators through simulations. Real data illustration is included.     

Analysis of Panel Count Data with Dependent Observation Times

In this article, a semiparametric approach is proposed for the regression analysis of panel count data. Panel count data commonly arise in clinical trials and demographical studies where the response variable is the number of multiple recurrences of the event of interest and observation times are not fixed, varying from subject to subject. It is assumed that two processes exist in this data: the first is for a recurrent event and the second is for observation time. Many studies have been done to estimate mean function and regression parameters under the independency between recurrent event process and observation time process. In this article, the same statistical inference is studied, but the situation where these two processes may be related is also considered. The mixed Poisson process is applied for the recurrent event processes, and a frailty intensity function for the observation time is also used, respectively. Simulation studies are conducted to study the performance of the suggested methods. The bladder tumor data are applied to compare previous studie' results.     

Likelihood estimation for a longitudinal negative binomial regression model with missing outcomes

Joint damage in psoriatic arthritis can be measured by clinical and radiological methods, the former being done more frequently during longitudinal follow-up of patients. Motivated by the need to compare findings based on the different methods with different observation patterns, we consider longitudinal data where the outcome variable is a cumulative total of counts that can be unobserved when other, informative, explanatory variables are recorded. We demonstrate how to calculate the likelihood for such data when it is assumed that the increment in the cumulative total follows a discrete distribution with a location parameter that depends on a linear function of explanatory variables. An approach to the incorporation of informative observation is suggested. We present analyses based on an observational database from a psoriatic arthritis clinic. Although the use of the new statistical methodology has relatively little effect in this example, simulation studies indicate that the method can provide substantial improvements in bias and coverage in some situations where there is an important time varying explanatory variable.     

Linear censored regression models with skew scale mixtures of normal distributions

A special source of difficulty in the statistical analysis is the possibility that some subjects may not have a complete observation of the response variable. Such incomplete observation of the response variable is called censoring. Censorship can occur for a variety of reasons, including limitations of measurement equipment, design of the experiment, and non-occurrence of the event of interest until the end of the study. In the presence of censoring, the dependence of the response variable on the explanatory variables can be explored through regression analysis. In this paper, we propose to examine the censorship problem in context of the class of asymmetric, i.e., we have proposed a linear regression model with censored responses based on skew scale mixtures of normal distributions. We develop a Monte Carlo EM (MCEM) algorithm to perform maximum likelihood inference of the parameters in the proposed linear censored regression models with skew scale mixtures of normal distributions. The MCEM algorithm has been discussed with an emphasis on the skew-normal, skew Student-t-normal, skew-slash and skew-contaminated normal distributions. To examine the performance of the proposed method, we present some simulation studies and analyze a real dataset.     

Regression analysis of panel count data with covariate-dependent observation and censoring times

Panel count data often occur in a long-term study where the primary end point is the time to a specific event and each subject may experience multiple recurrences of this event. Furthermore, suppose that it is not feasible to keep subjects under observation continuously and the numbers of recurrences for each subject are only recorded at several distinct time points over the study period. Moreover, the set of observation times may vary from subject to subject. In this paper, regression methods, which are derived under simple semiparametric models, are proposed for the analysis of such longitudinal count data. Especially, we consider the situation when both observation and censoring times may depend on covariates. The new procedures are illustrated with data from a well-known cancer study.     

Bias in the last observation carried forward method under informative dropout

Subject dropout is an inevitable problem in longitudinal studies. It makes the analysis challenging when the main interest is the change in outcome from baseline to endpoint of study. The last observation carried forward (LOCF) method is a very common approach for handling this problem. It assumes that the last measured outcome is frozen in time after the point of dropout, an unrealistic assumption given any time trends. Though existence and direction of the bias can sometimes be anticipated, the more important statistical question involves the actual magnitude of the bias and this requires computation. This paper provides explicit expressions for the exact bias in the LOCF estimates of mean change and its variance when the longitudinal data follow a linear mixed-effects model with linear time trajectories. General dropout patterns are considered that may depend on treatment group, subject-specific trajectories and follow different time to dropout distributions. In our case studies, the magnitude of bias for mean change estimators linearly increases as time to dropout decreases. The bias depends heavily on the dropout interval. The variance term is always underestimated.     

The analysis of incomplete data using stochastic covariates

In the development of many diseases there are often associated random variables which continuously reflect the progress of a subject towards the final expression of the disease (failure). At any given time these processes, which we call stochastic covariates, may provide information about the current hazard and the remaining time to failure. Likewise, in situations when the specific times of key prior events are not known, such as the time of onset of an occult tumour or the time of infection with HIV-1, it may be possible to identify a stochastic covariate which reveals, indirectly, when the event of interest occurred. The analysis of carcinogenicity trials which involve occult tumours is usually based on the time of death or sacrifice and an indicator of tumour presence for each animal in the experiment. However, the size of an occult tumour observed at the endpoint represents data concerning tumour development which may convey additional information concerning both the tumour incidence rate and the rate of death to which tumour-bearing animals are subject. We develop a stochastic model for tumour growth and suggest different ways in which the effect of this growth on the hazard of failure might be modelled. Using a combined model for tumour growth and additive competing risks of death, we show that if this tumour size information is used, assumptions concerning tumour lethality, the context of observation or multiple sacrifice times are no longer necessary in order to estimate the tumour incidence rate. Parametric estimation based on the method of maximum likelihood is outlined and is applied to simulated data from the combined model. The results of this limited study confirm that use of the stochastic covariate tumour size results in more precise estimation of the incidence rate for occult tumours.