Estimation of Main Effect When Covariates Have Non-Proportional Hazards

The Cox proportional hazards (PH) regression model has been widely used to analyze survival data in clinical trials and observational studies. In addition to estimating the main treatment or exposure group effect, it is common to adjust for additional covariates using the Cox model. It is well known that violation of the PH assumption can lead to estimates that are biased and difficult to interpret, and model checking has become a routine procedure. However, such checking might focus on the primary group comparisons, and the assumption can still be violated when adjusting for many of the potential covariates. We study the effect of violation of the PH assumption of the covariates on the estimation of the main group effect in the Cox model. The results are summarized in terms of the bias and the coverage properties of the confidence intervals. Overall in randomized clinical trials, the bias caused by misspecifying the PH assumption on the covariates is no more than 15% in absolute value regardless of sample size. In observational studies where the covariates are likely correlated with the group variable, however, the bias can be very severe. The coverage properties largely depend on sample size, as expected, as bias becomes dominating with increasing sample size. These findings should serve as cautionary notes when adjusting for potential confounders in observational studies, as the violation of PH assumption on the confounders can lead to erroneous results.     

A goodness-of-fit test for logistic-normal models using nonparametric smoothing method

Logistic-normal models can be applied for analysis of longitudinal binary data. The aim of this article is to propose a goodness-of-fit test using nonparametric smoothing techniques for checking the adequacy of logistic-normal models. Moreover, the leave-one-out cross-validation method for selecting the suitable bandwidth is developed. The quadratic form of the proposed test statistic based on smoothing residuals provides a global measure for checking the model with categorical and continuous covariates. The formulae of expectation and variance of the proposed statistics are derived, and their asymptotic distribution is approximated by a scaled chi-squared distribution. The power performance of the proposed test for detecting the interaction term or the squared term of continuous covariates is examined by simulation studies. A longitudinal dataset is utilized to illustrate the application of the proposed test.     

Comparison of the restricted mean survival time with the hazard ratio in superiority trials with a time‐to‐event end point

With the emergence of novel therapies exhibiting distinct mechanisms of action compared to traditional treatments, departure from the proportional hazard (PH) assumption in clinical trials with a time‐to‐event end point is increasingly common. In these situations, the hazard ratio may not be a valid statistical measurement of treatment effect, and the log‐rank test may no longer be the most powerful statistical test. The restricted mean survival time (RMST) is an alternative robust and clinically interpretable summary measure that does not rely on the PH assumption. We conduct extensive simulations to evaluate the performance and operating characteristics of the RMST‐based inference and against the hazard ratio–based inference, under various scenarios and design parameter setups. The log‐rank test is generally a powerful test when there is evident separation favoring 1 treatment arm at most of the time points across the Kaplan‐Meier survival curves, but the performance of the RMST test is similar. Under non‐PH scenarios where late separation of survival curves is observed, the RMST‐based test has better performance than the log‐rank test when the truncation time is reasonably close to the tail of the observed curves. Furthermore, when flat survival tail (or low event rate) in the experimental arm is expected, selecting the minimum of the maximum observed event time as the truncation timepoint for the RMST is not recommended. In addition, we recommend the inclusion of analysis based on the RMST curve over the truncation time in clinical settings where there is suspicion of substantial departure from the PH assumption.     

Goodness-of-Fit Tests for the Additive Risk Model with (p > 2)-Dimensional Time-Invariant Covariates

This paper presents methods for checking the goodness-of-fit of the additive risk model with p(> 2)-dimensional time-invariant covariates. The procedures are an extension of Kim and Lee (1996) who developed a test to assess the additive risk assumption for two-sample censored data. We apply the proposed tests to survival data from South Wales nikel refinery workers. Simulation studies are carried out to investigate the performance of the proposed tests for practical sample sizes.     

Bayesian Methods for Missing Covariates in Cure Rate Models

We propose methods for Bayesian inference for missing covariate data with a novel class of semi-parametric survival models with a cure fraction. We allow the missing covariates to be either categorical or continuous and specify a parametric distribution for the covariates that is written as a sequence of one dimensional conditional distributions. We assume that the missing covariates are missing at random (MAR) throughout. We propose an informative class of joint prior distributions for the regression coefficients and the parameters arising from the covariate distributions. The proposed class of priors are shown to be useful in recovering information on the missing covariates especially in situations where the missing data fraction is large. Properties of the proposed prior and resulting posterior distributions are examined. Also, model checking techniques are proposed for sensitivity analyses and for checking the goodness of fit of a particular model. Specifically, we extend the Conditional Predictive Ordinate (CPO) statistic to assess goodness of fit in the presence of missing covariate data. Computational techniques using the Gibbs sampler are implemented. A real data set involving a melanoma cancer clinical trial is examined to demonstrate the methodology.     

Proportional hazards and threshold regression: their theoretical and practical connections

Proportional hazards (PH) regression is a standard methodology for analyzing survival and time-to-event data. The proportional hazards assumption of PH regression, however, is not always appropriate. In addition, PH regression focuses mainly on hazard ratios and thus does not offer many insights into underlying determinants of survival. These limitations have led statistical researchers to explore alternative methodologies. Threshold regression (TR) is one of these alternative methodologies (see Lee and Whitmore, Stat Sci 21:501–513, 2006, for a review). The connection between PH regression and TR has been examined in previous published work but the investigations have been limited in scope. In this article, we study the connections between these two regression methodologies in greater depth and show that PH regression is, for most purposes, a special case of TR. We show two methods of construction by which TR models can yield PH functions for survival times, one based on altering the TR time scale and the other based on varying the TR boundary. We discuss how to estimate the TR time scale and boundary, with or without the PH assumption. A case demonstration is used to highlight the greater understanding of scientific foundations that TR can offer in comparison to PH regression. Finally, we discuss the potential benefits of positioning PH regression within the first-hitting-time context of TR regression.     

On proportional hazards assumption under the random effects models

The proportional hazards mixed-effects model (PHMM) was proposed to handle dependent survival data. Motivated by its application in genetic epidemiology, we study the interpretation of its parameter estimates under violations of the proportional hazards assumption. The estimated fixed effect turns out to be an averaged regression effect over time, while the estimated variance component could be unaffected, inflated or attenuated depending on whether the random effect is on the baseline hazard, and whether the non-proportional regression effect decreases or increases over time. Using the conditional distribution of the covariates we define the standardized covariate residuals, which can be used to check the proportional hazards assumption. The model checking technique is illustrated on a multi-center lung cancer trial.     

Grouped penalization estimation of the osteoporosis data in the traditional Chinese medicine

Both continuous and categorical covariates are common in traditional Chinese medicine (TCM) research, especially in the clinical syndrome identification and in the risk prediction research. For groups of dummy variables which are generated by the same categorical covariate, it is important to penalize them group-wise rather than individually. In this paper, we discuss the group lasso method for a risk prediction analysis in TCM osteoporosis research. It is the first time to apply such a group-wise variable selection method in this field. It may lead to new insights of using the grouped penalization method to select appropriate covariates in the TCM research. The introduced methodology can select categorical and continuous variables, and estimate their parameters simultaneously. In our application of the osteoporosis data, four covariates (including both categorical and continuous covariates) are selected out of 52 covariates. The accuracy of the prediction model is excellent. Compared with the prediction model with different covariates, the group lasso risk prediction model can significantly decrease the error rate and help TCM doctors to identify patients with a high risk of osteoporosis in clinical practice. Simulation results show that the application of the group lasso method is reasonable for the categorical covariates selection model in this TCM osteoporosis research.     

Entropy-based model-free feature screening for ultrahigh-dimensional multiclass classification

Most feature screening methods for ultrahigh-dimensional classification explicitly or implicitly assume the covariates are continuous. However, in the practice, it is quite common that both categorical and continuous covariates appear in the data, and applicable feature screening method is very limited. To handle this non-trivial situation, we propose an entropy-based feature screening method, which is model free and provides a unified screening procedure for both categorical and continuous covariates. We establish the sure screening and ranking consistency properties of the proposed procedure. We investigate the finite sample performance of the proposed procedure by simulation studies and illustrate the method by a real data analysis.     

Using the EM-algorithm for survival data with incomplete categorical covariates

Incomplete covariate data is a common occurrence in many studies in which the outcome is survival time. With generalized linear models, when the missing covariates are categorical, a useful technique for obtaining parameter estimates is the EM by the method of weights proposed in Ibrahim (1990). In this article, we extend the EM by the method of weights to survival outcomes whose distributions may not fall in the class of generalized linear models. This method requires the estimation of the parameters of the distribution of the covariates. We present a clinical trials example with five covariates, four of which have some missing values.     

Bayesian testing for independence of two categorical variables under two-stage cluster sampling with covariates

We consider Bayesian testing for independence of two categorical variables with covariates for a two-stage cluster sample. This is a difficult problem because we have a complex sample (i.e. cluster sample), not a simple random sample. Our approach is to convert the cluster sample with covariates into an equivalent simple random sample without covariates, which provides a surrogate of the original sample. Then, this surrogate sample is used to compute the Bayes factor to make an inference about independence. We apply our methodology to the data from the Trend in International Mathematics and Science Study [30] for fourth grade US students to assess the association between the mathematics and science scores represented as categorical variables. We show that if there is strong association between two categorical variables, there is no significant difference between the tests with and without the covariates. We also performed a simulation study to further understand the effect of covariates in various situations. We found that for borderline cases (moderate association between the two categorical variables), there are noticeable differences in the test with and without covariates.     

A log rank type test in observational survival studies with stratified sampling

In randomized clinical trials, the log rank test is often used to test the null hypothesis of the equality of treatment-specific survival distributions. In observational studies, however, the ordinary log rank test is no longer guaranteed to be valid. In such studies we must be cautious about potential confounders; that is, the covariates that affect both the treatment assignment and the survival distribution. In this paper, two cases were considered: the first is when it is believed that all the potential confounders are captured in the primary database, and the second case where a substudy is conducted to capture additional confounding covariates. We generalize the augmented inverse probability weighted complete case estimators for treatment-specific survival distribution proposed in Bai et al. (Biometrics 69:830–839, 2013) and develop the log rank type test in both cases. The consistency and double robustness of the proposed test statistics are shown in simulation studies. These statistics are then applied to the data from the observational study that motivated this research.     

Diagnostic tests for bias of estimating equations in weighted regression with missing covariates

The authors propose two tests, one parametric and the other semiparametric, for testing bias of estimating equations in weighted regression with partially missing covariates when the primary regression model is correctly specified. More generally, the proposed tests may be thought of as a diagnostic tool for the combined package of the primary regression model and the missingness assumptions. The asymptotic null distributions of the two test statistics are derived under the assumption of missingness at random for the partially missing covariates. A small scale simulation study completes the work.     

Global and local tests to assess stationarity of Markov transition models

We present global and local likelihood-based tests to evaluate stationarity in transition models. Three motivational studies are considered. A simulation study was carried out to assess the performance of the proposed tests. The results showed that they present good performance with the control of the type-I error, especially for ordinal responses, and control of the type-II error, especially for the nominal case. Asymptotically they are close to the classical test performance. They can be executed in a single framework without the need to estimate the transition probabilities, incorporating both categorical and continuous covariates, and used to identify sources of non-stationarity.     

Partial orders with respect to continuous covariates and tests for the proportional hazards model

Several omnibus tests of the proportional hazards assumption have been proposed in the literature. In the two-sample case, tests have also been developed against ordered alternatives like monotone hazard ratio and monotone ratio of cumulative hazards. Here we propose a natural extension of these partial orders to the case of continuous and potentially time varying covariates, and develop tests for the proportional hazards assumption against such ordered alternatives. The work is motivated by applications in biomedicine and economics where covariate effects often decay over lifetime. The proposed tests do not make restrictive assumptions on the underlying regression model, and are applicable in the presence of time varying covariates, multiple covariates and frailty. Small sample performance and an application to real data highlight the use of the framework and methodology to identify and model the nature of departures from proportionality.     

Missing covariates in generalized linear models when the missing data mechanism is non-ignorable

We propose a method for estimating parameters in generalized linear models with missing covariates and a non-ignorable missing data mechanism. We use a multinomial model for the missing data indicators and propose a joint distribution for them which can be written as a sequence of one-dimensional conditional distributions, with each one-dimensional conditional distribution consisting of a logistic regression. We allow the covariates to be either categorical or continuous. The joint covariate distribution is also modelled via a sequence of one-dimensional conditional distributions, and the response variable is assumed to be completely observed. We derive the E- and M-steps of the EM algorithm with non-ignorable missing covariate data. For categorical covariates, we derive a closed form expression for the E- and M-steps of the EM algorithm for obtaining the maximum likelihood estimates (MLEs). For continuous covariates, we use a Monte Carlo version of the EM algorithm to obtain the MLEs via the Gibbs sampler. Computational techniques for Gibbs sampling are proposed and implemented. The parametric form of the assumed missing data mechanism itself is not `testable' from the data, and thus the non-ignorable modelling considered here can be viewed as a sensitivity analysis concerning a more complicated model. Therefore, although a model may have `passed' the tests for a certain missing data mechanism, this does not mean that we have captured, even approximately, the correct missing data mechanism. Hence, model checking for the missing data mechanism and sensitivity analyses play an important role in this problem and are discussed in detail. Several simulations are given to demonstrate the methodology. In addition, a real data set from a melanoma cancer clinical trial is presented to illustrate the methods proposed.     

Test of Association Between Two Ordinal Variables While Adjusting for Covariates

We propose a new set of test statistics to examine the association between two ordinal categorical variables X and Y after adjusting for continuous and/or categorical covariates Z. Our approach first fits multinomial (e.g., proportional odds) models of X and Y, separately, on Z. For each subject, we then compute the conditional distributions of X and Y given Z. If there is no relationship between X and Y after adjusting for Z, then these conditional distributions will be independent, and the observed value of (X, Y) for a subject is expected to follow the product distribution of these conditional distributions. We consider two simple ways of testing the null of conditional independence, both of which treat X and Y equally, in the sense that they do not require specifying an outcome and a predictor variable. The first approach adds these product distributions across all subjects to obtain the expected distribution of (X, Y) under the null and then contrasts it with the observed unconditional distribution of (X, Y). Our second approach computes "residuals" from the two multinomial models and then tests for correlation between these residuals; we define a new individual-level residual for models with ordinal outcomes. We present methods for computing p-values using either the empirical or asymptotic distributions of our test statistics. Through simulations, we demonstrate that our test statistics perform well in terms of power and Type I error rate when compared to proportional odds models which treat X as either a continuous or categorical predictor. We apply our methods to data from a study of visual impairment in children and to a study of cervical abnormalities in human immunodeficiency virus (HIV)-infected women. Supplemental materials for the article are available online.     

Generalized accelerated failure time spatial frailty model for arbitrarily censored data

Flexible incorporation of both geographical patterning and risk effects in cancer survival models is becoming increasingly important, due in part to the recent availability of large cancer registries. Most spatial survival models stochastically order survival curves from different subpopulations. However, it is common for survival curves from two subpopulations to cross in epidemiological cancer studies and thus interpretable standard survival models can not be used without some modification. Common fixes are the inclusion of time-varying regression effects in the proportional hazards model or fully nonparametric modeling, either of which destroys any easy interpretability from the fitted model. To address this issue, we develop a generalized accelerated failure time model which allows stratification on continuous or categorical covariates, as well as providing per-variable tests for whether stratification is necessary via novel approximate Bayes factors. The model is interpretable in terms of how median survival changes and is able to capture crossing survival curves in the presence of spatial correlation. A detailed Markov chain Monte Carlo algorithm is presented for posterior inference and a freely available function frailtyGAFT is provided to fit the model in the R package spBayesSurv. We apply our approach to a subset of the prostate cancer data gathered for Louisiana by the surveillance, epidemiology, and end results program of the National Cancer Institute.     

Penalized pseudo-likelihood hazard estimation: A fast alternative to penalized likelihood

Penalized likelihood method has been developed previously for hazard function estimation using standard left-truncated, right-censored lifetime data with covariates, and the functional ANOVA structures built into the log hazard allows for versatile nonparametric modeling in the setting. The computation of the method can be time-consuming in the presence of continuous covariates; however, due to the repeated numerical integrations involved. Adapting a device developed by Jeon and Lin [An effective method for high dimensional log-density ANOVA estimation, with application to nonparametric graphical model building. Statist. Sinica 16, 353–374] for penalized likelihood density estimation, we explore an alternative approach to hazard estimation where the log likelihood is replaced by some computationally less demanding pseudo-likelihood. An assortment of issues are addressed concerning the practical implementations of the approach including the selection of smoothing parameters, and extensive simulations are presented to assess the inferential efficiency of the “pseudo” method as compared to the “real” one. Also noted is an asymptotic theory concerning the convergence rates of the estimates parallel to that for the original penalized likelihood estimation.     

Non-ignorable missing covariate data in survival analysis: a case-study of an International Breast Cancer Study Group trial

Summary.  Non-ignorable missing data, a serious problem in both clinical trials and observational studies, can lead to biased inferences. Quality-of-life measures have become increasingly popular in clinical trials. However, these measures are often incompletely observed, and investigators may suspect that missing quality-of-life data are likely to be non-ignorable. Although several recent references have addressed missing covariates in survival analysis, they all required the assumption that missingness is at random or that all covariates are discrete. We present a method for estimating the parameters in the Cox proportional hazards model when missing covariates may be non-ignorable and continuous or discrete. Our method is useful in reducing the bias and improving efficiency in the presence of missing data. The methodology clearly specifies assumptions about the missing data mechanism and, through sensitivity analysis, helps investigators to understand the potential effect of missing data on study results.