An improved comorbidity summary score for measuring disease burden and predicting mortality with applications to two national cohorts

Abstract

Research involving administrative healthcare data to study patient outcomes requires the investigator to account for the patient’s disease burden in order to reduce the potential for biased results. Here we develop a comorbidity summary score based on variable importance measures derived from several statistical and machine learning methods and show it has superior predictive performance to the Elixhauser and Charlson indices when used to predict 1-year, 5-year, and 10-year mortality. We used two large Veterans Administration cohorts to develop and validate the summary score and compared predictive performance using the area under ROC curve (AUC) and the Brier score.     

Detection and Interpretation of a Multivariate Signal Using Combined Charts

A control procedure is presented in this article that is based on jointly using two separate control statistics in the detection and interpretation of signals in a multivariate normal process. The procedure detects the following three situations: (i) a mean vector shift without a shift in the covariance matrix; (ii) a shift in process variation (covariance matrix) without a mean vector shift; and (iii) both a simultaneous shift in the mean vector and covariance matrix as the result of a change in the parameters of some key process variables. It is shown that, following the occurrence of a signal on either of the separate control charts, the values from both of the corresponding signaling statistics can be decomposed into interpretable elements. Viewing the two decompositions together helps one to specifically identify the individual components and associated variables that are being affected. These components may include individual means or variances of the process variables as well as the correlations between or among variables. An industrial data set is used to illustrate the procedure.     

Maximum likelihood ridge displays

I illustrate likelihood methods for estimating the consequences of shrinkage along any ridge path as well as methods for picking a two-hyperparameter path of optimal curvature and the optimal point on that path. In addition to my published "classical" methods, I also illustrate both the empirical Bayes and the random coefficient maximum likelihood approaches. Traces of risks for known parameters and losses for simulated responses are followed by traces of estimates that can reveal the same general information.     

The pitman nearness criterion and its determination

A general method for determining Pitman Nearness is given In the case of univariate estimators. This method is then applied to some estimation problems. The concept of Pitman Nearness is also generalized to the multivariate case. The James-Stein estimators are used to illustrate the multivariate comparison.     

A test for variance-covarianch parameters in normal linear models

This paper derives a test statistic for the variance-covariance parameters which is a quadratic function of their MINQUE (Minimum Norm Quadratic Unbiased Estimation) estimates. The test is a Wald-type test, and its development closely parallels the theory used to derive a similar test for the coefficients in linear models. In fact, the derivation proceeds by first setting up the estimation problem in a derived linear model in which the dispersion parameters are the coefficients. The test statistic is shown to be the sum of the squares of independent standardized x² variables.     

Strong laws of large numbers for dependent heterogeneous processes: a synthesis of recent and new results

This paper surveys recent developments in the strong law of large numbers for dependent heterogeneous processes. We prove a generalised version of a recent strong law for Lz-mixingales, and also a new strong law for Lpmixingales. These results greatly relax the dependence and heterogeneity conditions relative to those currently cited, and introduce explicit trade-offs between dependence and heterogeneity. The results are applied to proving strong laws for near-epoch dependent functions of mixing processes. We contrast several methods for obtaining these results, including mapping directly to the mixingale properties, and applying a truncation argument.     

Kolmogorov-type tests of goodness-of-fit against stochastic ordering

This article addresses the problem of testing the null hypothesis H₀ that a random sample of size n is from a distribution with the completely specified continuous cumulative distribution function F_n(x). Kolmogorov-type tests for H₀ are based on the statistics C⁺ _n = Sup[F_n(x)?F₀(x)] and C^? _n=Sup[F₀(x)?F_n(x)], where F_n(x) is an empirical distribution function. Let F(x) be the true cumulative distribution function, and consider the ordered alternative H₁: F(x)≥F₀(x) for all x and with strict inequality for some x. Although it is natural to reject H₀ and accept H₁ if C ⁺ _n is large, this article shows that a test that is superior in some ways rejects F₀ and accepts H₁ if C^mdash _n is small. Properties of the two tests are compared based on theoretical results and simulated results.     

Umvu estimators for the population mean and variance based on random effects models for lognormal data

Cross-classified data are often obtained in controlled experimental situations and in epidemiologic studies. As an example of the latter, occupational health studies sometimes require personal exposure measurements on a random sample of workers from one or more job groups, in one or more plant locations, on several different sampling dates. Because the marginal distributions of exposure data from such studies are generally right-skewed and well-approximated as lognormal, researchers in this area often consider the use of ANOVA models after a logarithmic transformation. While it is then of interest to estimate original-scale population parameters (e.g., the overall mean and variance), standard candidates such as maximum likelihood estimators (MLEs) can be unstable and highly biased. Uniformly minimum variance unbiased (UMVU) cstiniators offer a viable alternative, and are adaptable to sampling schemes that are typiral of experimental or epidemiologic studies. In this paper, we provide UMVU estimators for the mean and variance under two random effects ANOVA models for logtransformed data. We illustrate substantial mean squared error gains relative to the MLE when estimating the mean under a one-way classification. We illustrate that the results can readily be extended to encompass a useful class of purely random effects models, provided that the study data are balanced.     

The effects of covariate adjustment in generalized linear models

Results from classical linear regression regarding the effects of covariate adjustment, with respect to the issues of confounding, the precision with which an exposure effect can be estimated, and the efficiency of hypothesis tests for no treatment effect in randomized experiments, are often assumed to apply more generally to other types of regression models. In this paper results pertaining to several generalized linear models involving a dichotomous response variable are given, demonstrating that with respect to the issues of confounding and precision, for models having a linear or log link function the results of classical linear regression do generally apply, whereas for other models, including those having a logit, probit, log-log, complementary log-log, or generalized logistic link function, the results of classical linear regression do not always apply. It is also shown, however, that for any link function, covariate adjustment results in improved efficiency of hypothesis tests for no treatment effect in randomized experiments, and hence that the classical linear regression results regarding efficiency do apply for all models having a dichotomous response variable.     

On the Choice of Functional Forms: Summary of a Monte Carlo Experiment

The use of flexible functional forms is a standard practice in applied econometrics. Many flexible forms have been proposed. In this study, we investigate the behavior of three of them—the translog, the symmetric McFadden, and the symmetric generalized Barnett. Based on Monte Carlo experiments, we assess the ability of these forms to test theoretical properties and to measure technological characteristics.