A Comparison of Methods for Analysing a Nested Frailty Model to Child Survival in Malawi

Demographic and Health Surveys collect child survival times that are clustered at the family and community levels. It is assumed that each cluster has a specific, unobservable, random frailty that induces an association in the survival times within the cluster. The Cox proportional hazards model, with family and community random frailties acting multiplicatively on the hazard rate, is presented. The estimation of the fixed effect and the association parameters of the modified model is then examined using the Gibbs sampler and the expectation–maximization (EM) algorithm. The methods are compared using child survival data collected in the 1992 Demographic and Health Survey of Malawi. The two methods lead to very similar estimates of fixed effect parameters. However, the estimates of random effect variances from the EM algorithm are smaller than those of the Gibbs sampler. Both estimation methods reveal considerable family variation in the survival of children, and very little variability over the communities.     

The Additive Genetic Gamma Frailty Model

In this paper the additive genetic gamma frailty model is defined. Individual frailties are correlated as a result of an additive genetic model. An algorithm to construct additive genetic gamma frailties for any pedigree is given so that the variance–covariance structure among individual frailties equals the numerator relationship matrix times a variance. The EM algorithm can be used to estimate the parameters in the model. Calculations are similar using the EM algorithm in the shared frailty model, however the E step is not correspondingly simple. This is illustrated re-analysing data, analysed by the shared frailty model in Nielsen et al . (1992), from the Danish adoptive register. Goodness of fit of the additive genetic gamma frailty model can be tested after analysing data with the correlated frailty model. Doing so, a "defect" in the often used and otherwise well behaving likelihood was found     

Using Frailties in the Accelerated Failure Time Model

The accelerated failuretime (AFT) model is an important alternative to the Cox proportionalhazards model (PHM) in survival analysis. For multivariate failuretime data we propose to use frailties to explicitly account forpossible correlations (and heterogeneity) among failure times.An EM-like algorithm analogous to that in the frailty model forthe Cox model is adapted. Through simulation it is shown thatits performance compares favorably with that of the marginalindependence approach. For illustration we reanalyze a real dataset.     

Graphical Tests for the Assumption of Gamma and Inverse Gaussian Frailty Distributions

The common choices of frailty distribution in lifetime data models include the Gamma and Inverse Gaussian distributions. We present diagnostic plots for these distributions when frailty operates in a proportional hazards framework. Firstly, we present plots based on the form of the unconditional survival function when the baseline hazard is assumed to be Weibull. Secondly, we base a plot on a closure property that applies for any baseline hazard, namely, that the frailty distribution among survivors at time t has the same form as the original distribution, with the same shape parameter but different scale parameter. We estimate the shape parameter at different values of t and examine whether it is constant, that is, whether plotted values form a straight line parallel to the time axis. We provide simulation results assuming Weibull baseline hazard and an example to illustrate the methods.     

Modelling Converging Hazards in Survival Analysis

The Cox proportional hazards model has become the standard model for survival analysis. It is often seen as the null model in that "... explicit excuses are now needed to use different models" (Keiding, Proceedings of the XIXth International Biometric Conference, Cape Town, 1998). However, converging hazards also occur frequently in survival analysis. The Burr model, which may be derived as the marginal from a gamma frailty model, is one commonly used tool to model converging hazards. We outline this approach and introduce a mixed model which extends the Burr model and allows for both proportional and converging hazards. Although a semi-parametric model in its own right, we demonstrate how the mixed model can be derived via a gamma frailty interpretation, suggesting an E-M fitting procedure. We illustrate the modelling techniques using data on survival of hospice patients.     

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.     

A Weibull Regression Model with Gamma Frailties for Multivariate Survival Data

Frequently in the analysis of survival data, survival times within the same group are correlated due to unobserved co-variates. One way these co-variates can be included in the model is as frailties. These frailty random block effects generate dependency between the survival times of the individuals which are conditionally independent given the frailty. Using a conditional proportional hazards model, in conjunction with the frailty, a whole new family of models is introduced. By considering a gamma frailty model, often the issue is to find an appropriate model for the baseline hazard function. In this paper a flexible baseline hazard model based on a correlated prior process is proposed and is compared with a standard Weibull model. Several model diagnostics methods are developed and model comparison is made using recently developed Bayesian model selection criteria. The above methodologies are applied to the McGilchrist and Aisbett (1991) kidney infection data and the analysis is performed using Markov Chain Monte Carlo methods. This revised version was published online in July 2006 with corrections to the Cover Date.     

Graphical Tests for the Frailty Distribution in the Shared Frailty Model

We extend a diagnostic plot for the frailty distribution in proportional hazards models to the case of shared frailty. The plot is based on a closure property of exponential family failure distributions with canonical statistics z and g(z), namely that the frailty distribution among survivors at time t has the same form, with the same values of the parameters associated with g(z). We extend this property to shared frailty, considering various definitions of a “surviving” cluster at time t. We illustrate the effectiveness of the method in the case where the “death” of the cluster is defined by the first death among its members.     

A Non-parametric Frailty Model for Temporally Clustered Multivariate Failure Times

Abstract A model is introduced here for multivariate failure time data arising from heterogenous populations. In particular, we consider a situation in which the failure times of individual subjects are often temporally clustered, so that many failures occur during a relatively short age interval. The clustering is modelled by assuming that the subjects can be divided into ‘internally homogenous’ latent classes, each such class being then described by a time‐dependent frailty profile function. As an example, we reanalysed the dental caries data presented earlier in Härkänen et al. [Scand. J. Statist. 27 (2000) 577], as it turned out that our earlier model could not adequately describe the observed clustering.     

Frailty modeling for clustered survival data: an application to birth interval in Bangladesh

The present work demonstrates an application of random effects model for analyzing birth intervals that are clustered into geographical regions. Observations from the same cluster are assumed to be correlated because usually they share certain unobserved characteristics between them. Ignoring the correlations among the observations may lead to incorrect standard errors of the estimates of parameters of interest. Beside making the comparisons between Cox's proportional hazards model and random effects model for analyzing geographically clustered time-to-event data, important demographic and socioeconomic factors that may affect the length of birth intervals of Bangladeshi women are also reported in this paper.     

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.     

Local Linear Estimation for Time-Dependent Coefficients in Cox's Regression Models

This article develops a local partial likelihood technique to estimate the time-dependent coefficients in Cox's regression model. The basic idea is a simple extension of the local linear fitting technique used in the scatterplot smoothing. The coefficients are estimated locally based on the partial likelihood in a window around each time point. Multiple time-dependent covariates are incorporated in the local partial likelihood procedure. The procedure is useful as a diagnostic tool and can be used in uncovering time-dependencies or departure from the proportional hazards model. The programming involved in the local partial likelihood estimation is relatively simple and it can be modified with few efforts from the existing programs for the proportional hazards model. The asymptotic properties of the resulting estimator are established and compared with those from the local constant fitting. A consistent estimator of the asymptotic variance is also proposed. The approach is illustrated by a real data set from the study of gastric cancer patients and a simulation study is also presented.     

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.     

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.     

Empirical Likelihood Inference for the Cox Model with Time-dependent Coefficients via Local Partial Likelihood

Abstract.  The Cox model with time-dependent coefficients has been studied by a number of authors recently. In this paper, we develop empirical likelihood (EL) pointwise confidence regions for the time-dependent regression coefficients via local partial likelihood smoothing. The EL simultaneous confidence bands for a linear combination of the coefficients are also derived based on the strong approximation methods. The EL ratio is formulated through the local partial log-likelihood for the regression coefficient functions. Our numerical studies indicate that the EL pointwise/simultaneous confidence regions/bands have satisfactory finite sample performances. Compared with the confidence regions derived directly based on the asymptotic normal distribution of the local constant estimator, the EL confidence regions are overall tighter and can better capture the curvature of the underlying regression coefficient functions. Two data sets, the gastric cancer data and the Mayo Clinic primary biliary cirrhosis data, are analysed using the proposed method.     

A Proportional Hazards Regression Model for the Subdistribution with Covariates‐adjusted Censoring Weight for Competing Risks Data

With competing risks data, one often needs to assess the treatment and covariate effects on the cumulative incidence function. Fine and Gray proposed a proportional hazards regression model for the subdistribution of a competing risk with the assumption that the censoring distribution and the covariates are independent. Covariate‐dependent censoring sometimes occurs in medical studies. In this paper, we study the proportional hazards regression model for the subdistribution of a competing risk with proper adjustments for covariate‐dependent censoring. We consider a covariate‐adjusted weight function by fitting the Cox model for the censoring distribution and using the predictive probability for each individual. Our simulation study shows that the covariate‐adjusted weight estimator is basically unbiased when the censoring time depends on the covariates, and the covariate‐adjusted weight approach works well for the variance estimator as well. We illustrate our methods with bone marrow transplant data from the Center for International Blood and Marrow Transplant Research. Here, cancer relapse and death in complete remission are two competing risks.     

A Likelihood Based Estimating Equation for the Clayton–Oakes Model with Marginal Proportional Hazards

Multivariate failure time data arise when data consist of clusters in which the failure times may be dependent. A popular approach to such data is the marginal proportional hazards model with estimation under the working independence assumption. In this paper, we consider the Clayton–Oakes model with marginal proportional hazards and use the full model structure to improve on efficiency compared with the independence analysis. We derive a likelihood based estimating equation for the regression parameters as well as for the correlation parameter of the model. We give the large sample properties of the estimators arising from this estimating equation. Finally, we investigate the small sample properties of the estimators through Monte Carlo simulations.     

Effect of censoring on adjusting for covariates in comparison of survival times

The increase in the variance of the estimate of treatment effect which results from omitting a dichotomous or continuous covariate is quantified as a function of censoring. The efficiency of not adjusting for a covariate is measured by the ratio of the variance obtained with and without adjustment for the covariate. The variance is derived using the Weibull proportional hazards model. Under random censoring, the efficiency of not adjusting for a continuous covariate is an increasing function of the percentage of censored observations.     

Using the Score Test to Identify the Longitudinal Biomarker Considering Accelerate Failure Time Model with the Frailty in Survival Analysis

Quality of life (QOL) is looked upon as a multidimensional entity comprising physical, psychological, social, and medical parameters. QOL is a good prognostic factor for the cancer patients. In this article, we want to determine if QOL is a good biomarker as a surrogate to indicate the survival time of gastric cancer patients. We conducted a single institutional trial and examines QOL of gastric cancer patients receiving the different surgery. In this trial, QOL is a longitudinal measurement. The accelerated failure time model can be used to deal with survival data when the proportionality assumption fails to capture the relationship between the survival time and covariates. In this article, similar to Henderson et al. (2000 Henderson , R. , Diggle , P. , Dobson , A. ( 2000 ). Joint modelling of longitudinal measurements and event time data . Biostatistics 1 ( 4 ): 465 – 480 .[Crossref], [PubMed] , [Google Scholar], 2002 Henderson , R. , Diggle , P. J. , Dobson , A. ( 2002 ). Identification and efficacy of longitudinal markers for survival . Biostatistics 3 ( 1 ): 33 – 50 .[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]), a joint likelihood function combines the likelihood functions of the longitudinal biomarkers and the survival times under the accelerated failure time assumption. We introduce a method employing a frailty model to identify longitudinal biomarkers or surrogates for a time to event outcome. We allow random effects to be present in both the longitudinal biomarker and underlying survival function. The random effects in the biomarker are introduced via an explicit term while the random effect in the underlying survival function is introduced by the inclusion of frailty into the model. We will introduce a method to identify longitudinal biomarkers or surrogates for a time to event outcome based on the accelerated failure time assumption.