A competing risks model for correlated data based on the subdistribution hazard

Family-based follow-up study designs are important in epidemiology as they enable investigations of disease aggregation within families. Such studies are subject to methodological complications since data may include multiple endpoints as well as intra-family correlation. The methods herein are developed for the analysis of age of onset with multiple disease types for family-based follow-up studies. The proposed model expresses the marginalized frailty model in terms of the subdistribution hazards (SDH). As with Pipper and Martinussen’s (Scand J Stat 30:509–521, 2003) model, the proposed multivariate SDH model yields marginal interpretations of the regression coefficients while allowing the correlation structure to be specified by a frailty term. Further, the proposed model allows for a direct investigation of the covariate effects on the cumulative incidence function since the SDH is modeled rather than the cause specific hazard. A simulation study suggests that the proposed model generally offers improved performance in terms of bias and efficiency when a sufficient number of events is observed. The proposed model also offers type I error rates close to nominal. The method is applied to a family-based study of breast cancer when death in absence of breast cancer is considered a competing risk.     

An Additive Genetic Gamma Frailty Model for Linkage Analysis of Diseases with Variable Age of Onset Using Nuclear Families

Many late-onset complex diseases exhibit variable age of onset. Efficiently incorporating age of onset information into linkage analysis can potentially increase the power of dissecting complex diseases. In this paper, we treat age of onset as a genetic trait with censored observations. We use multiple markers to infer the inheritance vector at the disease susceptibility (DS) locus in order to extract information about the inheritance pattern of the disease allele in a pedigree. Given the inheritance distribution at the DS locus, we define the genetic frailty for each individual within a nuclear family as the sum of frailties due to a putative major disease gene and a polygenic effect due to any remaining DS loci. Conditioning on these frailties we use the proportional hazards model for the risk of developing disease. We show that a test of linkage can be formulated as a test of zero variance due to a specific locus of the additive gamma frailties. Maximum likelihood estimation, using the EM algorithm, and likelihood ratio tests are employed for parameter estimation and tests of linkage. A simulation study presented indicates that the proposed method is well behaved and can be more powerful than the currently available allele-sharing based linkage methods. A breast cancer data example is used for illustration.     

Measuring and estimating the interaction between exposures on a dichotomous outcome for observational studies

In observational studies for the interaction between exposures on a dichotomous outcome of a certain population, usually one parameter of a regression model is used to describe the interaction, leading to one measure of the interaction. In this article we use the conditional risk of an outcome given exposures and covariates to describe the interaction and obtain five different measures of the interaction, that is, difference between the marginal risk differences, ratio of the marginal risk ratios, ratio of the marginal odds ratios, ratio of the conditional risk ratios, and ratio of the conditional odds ratios. These measures reflect different aspects of the interaction. By using only one regression model for the conditional risk, we obtain the maximum-likelihood (ML)-based point and interval estimates of these measures, which are most efficient due to the nature of ML. We use the ML estimates of the model parameters to obtain the ML estimates of these measures. We use the approximate normal distribution of the ML estimates of the model parameters to obtain approximate non-normal distributions of the ML estimates of these measures and then confidence intervals of these measures. The method can be easily implemented and is presented via a medical example.     

Matched case–control data analyses with missing covariates

We consider methods for analysing matched case–control data when some covariates ( W ) are completely observed but other covariates ( X ) are missing for some subjects. In matched case–control studies, the complete-record analysis discards completely observed subjects if none of their matching cases or controls are completely observed. We investigate an imputation estimate obtained by solving a joint estimating equation for log-odds ratios of disease and parameters in an imputation model. Imputation estimates for coefficients of W are shown to have smaller bias and mean-square error than do estimates from the complete-record analysis.     

A dynamic Mover–Stayer model for recurrent event processes subject to resolution

In studies of affective disorder, individuals are often observed to experience recurrent symptomatic exacerbations warranting hospitalization. Interest may lie in modeling the occurrence of such exacerbations over time and identifying associated risk factors. In some patients, recurrent exacerbations are temporally clustered following disease onset, but cease to occur after a period of time. We develop a dynamic Mover–Stayer model in which a canonical binary variable associated with each event indicates whether the underlying disease has resolved. An individual whose disease process has not resolved will experience events following a standard point process model governed by a latent intensity. When the disease process resolves, the complete data intensity becomes zero and no further event will occur. An expectation–maximization algorithm is described for parametric and semiparametric model fitting based on a discrete time dynamic Mover–Stayer model and a latent intensity-based model of the underlying point process.     

Recurrent time-to-event models with ordinal outcomes

A model to accommodate time-to-event ordinal outcomes was proposed by Berridge and Whitehead. Very few studies have adopted this approach, despite its appeal in incorporating several ordered categories of event outcome. More recently, there has been increased interest in utilizing recurrent events to analyze practical endpoints in the study of disease history and to help quantify the changing pattern of disease over time. For example, in studies of heart failure, the analysis of a single fatal event no longer provides sufficient clinical information to manage the disease. Similarly, the grade/frequency/severity of adverse events may be more important than simply prolonged survival in studies of toxic therapies in oncology. We propose an extension of the ordinal time-to-event model to allow for multiple/recurrent events in the case of marginal models (where all subjects are at risk for each recurrence, irrespective of whether they have experienced previous recurrences) and conditional models (subjects are at risk of a recurrence only if they have experienced a previous recurrence). These models rely on marginal and conditional estimates of the instantaneous baseline hazard and provide estimates of the probabilities of an event of each severity for each recurrence over time. We outline how confidence intervals for these probabilities can be constructed and illustrate how to fit these models and provide examples of the methods, together with an interpretation of the results.     

Modeling the Effects of Genetic Factors on Late-Onset Diseases in Cohort Studies

Many late-onset diseases are caused by what appears to be a combination of a genetic predisposition to disease and environmental factors. The use of existing cohort studies provides an opportunity to infer genetic predisposition to disease on a representative sample of a study population, now that many such studies are gathering genetic information on the participants. One feature to using existing cohorts is that subjects may be censored due to death prior to genetic sampling, thereby adding a layer of complexity to the analysis. We develop a statistical framework to infer parameters of a latent variables model for disease onset. The latent variables model describes the role of genetic and modifiable risk factors on the onset ages of multiple diseases, and accounts for right-censoring of disease onset ages. The framework also allows for missing genetic information by inferring a subject's unknown genotype through appropriately incorporated covariate information. The model is applied to data gathered in the Framingham Heart Study for measuring the effect of different Apo-E genotypes on the occurrence of various cardiovascular disease events.     

Vector-borne infectious disease mapping with stochastic difference equations: an analysis of dengue disease in Malaysia

Few publications consider the estimation of relative risk for vector-borne infectious diseases. Most of these articles involve exploratory analysis that includes the study of covariates and their effects on disease distribution and the study of geographic information systems to integrate patient-related information. The aim of this paper is to introduce an alternative method of relative risk estimation based on discrete time–space stochastic SIR-SI models (susceptible–infective–recovered for human populations; susceptible–infective for vector populations) for the transmission of vector-borne infectious diseases, particularly dengue disease. First, we describe deterministic compartmental SIR-SI models that are suitable for dengue disease transmission. We then adapt these to develop corresponding discrete time–space stochastic SIR-SI models. Finally, we develop an alternative method of estimating the relative risk for dengue disease mapping based on these models and apply them to analyse dengue data from Malaysia. This new approach offers a better model for estimating the relative risk for dengue disease mapping compared with the other common approaches, because it takes into account the transmission process of the disease while allowing for covariates and spatial correlation between risks in adjacent regions.     

Spatio-temporal modelling using B-spline for disease mapping: analysis of childhood cancer trends

To examine childhood cancer diagnoses in the province of Alberta, Canada during 1983–2004, we construct a generalized additive mixed model for the analysis of geographic and temporal variability of cancer ratios. In this model, spatially correlated random effects and temporal components are adopted. The interaction between space and time is also accommodated. Spatio-temporal models that use conditional autoregressive smoothing across the spatial dimension and B-spline over the temporal dimension are considered. We study the patterns of incidence ratios over time and identify areas with consistently high ratio estimates as areas for potential further investigation. We apply the method of penalized quasi-likelihood to estimate the model parameters. We illustrate this approach using a yearly data set of childhood cancer diagnoses in the province of Alberta, Canada during 1983–2004.     

Characterizations and ordering properties based on log-odds functions

In this paper, we obtain some general results on characterizations of probability distributions from relationships between conditional moment, failure rate, and log-odds rate functions. We also study stochastic orders and classes based on the log-odds rate function and some relationships with usual stochastic orderings and classes. Some characterizations and ordering properties are obtained by using weighted distributions.     

Analysis of familial aggregation in the presence of varying family sizes

Summary.  Family studies are frequently undertaken as the first step in the search for genetic and/or environmental determinants of disease. Significant familial aggregation of disease is suggestive of a genetic aetiology for the disease and may lead to more focused genetic analysis. Of course, it may also be due to shared environmental factors. Many methods have been proposed in the literature for the analysis of family studies. One model that is appealing for the simplicity of its computation and the conditional interpretation of its parameters is the quadratic exponential model. However, a limiting factor in its application is that it is not reproducible , meaning that all families must be of the same size. To increase the applicability of this model, we propose a hybrid approach in which analysis is based on the assumption of the quadratic exponential model for a selected family size and combines a missing data approach for smaller families with a marginalization approach for larger families. We apply our approach to a family study of colorectal cancer that was sponsored by the Cancer Genetics Network of the National Institutes of Health. We investigate the properties of our approach in simulation studies. Our approach applies more generally to clustered binary data.     

A method for simulating familial disease data with variable age at onset and genetic and environmental effects

The field of genetic epidemiology is growing rapidly with the realization that many important diseases are influenced by both genetic and environmental factors. For this reason, pedigree data are becoming increasingly valuable as a means of studying patterns of disease occurrence. Analysis of pedigree data is complicated by the lack of independence among family members and by the non-random sampling schemes used to ascertain families. An additional complicating factor is the variability in age at disease onset from one person to another. In developing statistical methods for analysing pedigree data, analytic results are often intractable, making simulation studies imperative for assessing the performance of proposed methods and estimators. In this paper, an algorithm is presented for simulating disease data in pedigrees, incorporating variable age at onset and genetic and environmental effects. Computational formulas are developed in the context of a proportional hazards model and assuming single ascertainment of families, but the methods can be easily generalized to alternative models. The algorithm is computationally efficient, making multi-dataset simulation studies feasible. Numerical examples are provided to demonstrate the methods.     

The analysis of ratios and cross-product ratios of poisson variates with application to incidence rates

The incidence of most diseases is low enough that in. large populations the number of new cases may be considered a Poisson variate. This paper explores models and methods for analyzing such data Specific cases are the estimation and testing of ratios and the cross-product ratios, both simple and stratified* We assume the Poisson means are exponential functions of the relevant parameters. The resulting sets of sufficient statistics are partitioned into a test statistic and a vector of statistics related to the nuisance parameters . The methods derived are based on the conditional distribution of the test statistic given the other sufficient statistics. The analyses of stratified cross-product ratios are seen to be analogues of the noncentral distribution associated with theanalysis of the common odds ratio in several 2×2 tables. The various methods are illustrated in numerical examples involving incidence rates of cancer in two metropolitan areas adjusting for both age and sex.     

Discrete‐time survival trees

Tree‐based methods are frequently used in studies with censored survival time. Their structure and ease of interpretability make them useful to identify prognostic factors and to predict conditional survival probabilities given an individual's covariates. The existing methods are tailor‐made to deal with a survival time variable that is measured continuously. However, survival variables measured on a discrete scale are often encountered in practice. The authors propose a new tree construction method specifically adapted to such discrete‐time survival variables. The splitting procedure can be seen as an extension, to the case of right‐censored data, of the entropy criterion for a categorical outcome. The selection of the final tree is made through a pruning algorithm combined with a bootstrap correction. The authors also present a simple way of potentially improving the predictive performance of a single tree through bagging. A simulation study shows that single trees and bagged‐trees perform well compared to a parametric model. A real data example investigating the usefulness of personality dimensions in predicting early onset of cigarette smoking is presented. The Canadian Journal of Statistics 37: 17‐32; 2009 © 2009 Statistical Society of Canada     

Composite conditional likelihood for sparse clustered data

Summary.  Sparse clustered data arise in finely stratified genetic and epidemiologic studies and pose at least two challenges to inference. First, it is difficult to model and interpret the full joint probability of dependent discrete data, which limits the utility of full likelihood methods. Second, standard methods for clustered data, such as pairwise likelihood and the generalized estimating function approach, are unsuitable when the data are sparse owing to the presence of many nuisance parameters. We present a composite conditional likelihood for use with sparse clustered data that provides valid inferences about covariate effects on both the marginal response probabilities and the intracluster pairwise association. Our primary focus is on sparse clustered binary data, in which case the method proposed utilizes doubly discordant quadruplets drawn from each stratum to conduct inference about the intracluster pairwise odds ratios.     

Algorithms for approximate conditional inference

This paper presents a method for listing the sample space for a conditional distribution in a discrete generalized linear model. This tabulation is used in conjunction with saddlepoint methods to approximate the associated conditional probabilities. These probabilities are used to calculate conditional p-values.     

Parametric modelling of prevalent cohort data with uncertainty in the measurement of the initial onset date

In prevalent cohort studies with follow-up, if disease duration is the focus, the date of onset must be obtained retrospectively. For some diseases, such as Alzheimer’s disease, the very notion of a date of onset is unclear, and it can be assumed that the reported date of onset acts only as a proxy for the unknown true date of onset. When adjusting for onset dates reported with error, the features of left-truncation and potential right-censoring of the failure times must be modeled appropriately. Under the assumptions of a classical measurement error model for the onset times and an underlying parametric failure time model, we propose a maximum likelihood estimator for the failure time distribution parameters which requires only the observed backward recurrence times. Costly and time-consuming follow-up may therefore be avoided. We validate the maximum likelihood estimator on simulated datasets under varying parameter combinations and apply the proposed method to the Canadian Study of Health and Aging dataset.

     

Ascertainment-Adjusted Maximum Likelihood Estimation for the Additive Genetic Gamma Frailty Model

The additive genetic gamma frailty model has been proposed for genetic linkage analysis for complex diseases to account for variable age of onset and possible covariates effects. To avoid ascertainment biases in parameter estimates, retrospective likelihood ratio tests are often used, which may result in loss of efficiency due to conditioning. This paper considers when the sibships are ascertained by having at least two affected sibs with the disease before a given age and provides two approaches for estimating the parameters in the additive gamma frailty model. One approach is based on the likelihood function conditioning on the ascertainment event, the other is based on maximizing a full ascertainment-adjusted likelihood. Explicit forms for these likelihood functions are derived. Simulation studies indicate that when the baseline hazard function can be correctly pre-specified, both approaches give accurate estimates of the model parameters. However, when the baseline hazard function has to be estimated simultaneously, only the ascertainment-adjusted likelihood method gives an unbiased estimate of the parameters. These results imply that the ascertainment-adjusted likelihood ratio test in the context of the additive genetic gamma frailty may be used for genetic linkage analysis.     

Regression analysis of zero-inflated time-series counts: application to air pollution related emergency room visit data

Time-series count data with excessive zeros frequently occur in environmental, medical and biological studies. These data have been traditionally handled by conditional and marginal modeling approaches separately in the literature. The conditional modeling approaches are computationally much simpler, whereas marginal modeling approaches can link the overall mean with covariates directly. In this paper, we propose new models that can have conditional and marginal modeling interpretations for zero-inflated time-series counts using compound Poisson distributed random effects. We also develop a computationally efficient estimation method for our models using a quasi-likelihood approach. The proposed method is illustrated with an application to air pollution-related emergency room visits. We also evaluate the performance of our method through simulation studies.