Bivariate frailty model for the analysis of multivariate survival time

Because of limitations of the univariate frailty model in analysis of multivariate survival data, a bivariate frailty model is introduced for the analysis of bivariate survival data. This provides tremendous flexibility especially in allowing negative associations between subjects within the same cluster. The approach involves incorporating into the model two possibly correlated frailties for each cluster. The bivariate lognormal distribution is used as the frailty distribution. The model is then generalized to multivariate survival data with two distinguished groups and also to alternating process data. A modified EM algorithm is developed with no requirement of specification of the baseline hazards. The estimators are generalized maximum likelihood estimators with subject-specific interpretation. The model is applied to a mental health study on evaluation of health policy effects for inpatient psychiatric care.     

Some recent developments for regression analysis of multivariate failure time data

Cox's seminal 1972 paper on regression methods for possibly censored failure time data popularized the use of time to an event as a primary response in prospective studies. But one key assumption of this and other regression methods is that observations are independent of one another. In many problems, failure times are clustered into small groups where outcomes within a group are correlated. Examples include failure times for two eyes from one person or for members of the same family.This paper presents a survey of models for multivariate failure time data. Two distinct classes of models are considered: frailty and marginal models. In a frailty model, the correlation is assumed to derive from latent variables (frailties) common to observations from the same cluster. Regression models are formulated for the conditional failure time distribution given the frailties. Alternatively, marginal models describe the marginal failure time distribution of each response while separately modelling the association among responses from the same cluster.We focus on recent extensions of the proportional hazards model for multivariate failure time data. Model formulation, parameter interpretation and estimation procedures are considered.     

Estimation of the basic reproduction number for infectious diseases from age-stratified serological survey data

The basic reproduction number of an infection, R ₀, is the average number of secondary infections generated by a single typical infective individual in a totally susceptible population. It is directly related to the effort required to eliminate infection. We consider statistical methods for estimating R ₀ from age-stratified serological survey data. The main difficulty is indeterminacy, since the contacts between individuals of different ages are not observed. We show that, given an estimate of the average age-specific hazard of infection, a particular leading left eigenfunction is required to specify R ₀. We review existing methods of estimation in the light of this indeterminacy. We suggest using data from several infections transmitted via the same route, and we propose that the choice of model be guided by a criterion based on similarity of their contact functions. This approach also allows model uncertainty to be taken into account. If one infection induces no lasting immunity, we show that the only additional assumption required to estimate R ₀ is that the contact function is symmetric. When matched data on two or more infections transmitted by the same route are available, the methods may be extended to incorporate the effect of individual heterogeneity. The approach can also be applied in partially vaccinated populations and to populations comprising loosely linked communities. The methods are illustrated with data on hepatitis A, mumps, rubella, parvovirus, Haemophilus influenzae type b and measles infection.     

Serum sex steroid hormones and frailty in older American men of the Third National Health and Nutrition Examination Survey (NHANES III)

Objective: To determine whether frailty is associated with circulating total and free testosterone, total and free estradiol, and sex hormone-binding globulin (SHBG) in older men. Methods: With NHANES III data of 461 men aged 60 years and older, we used logistic regression to analyze the associations between serum concentrations of sex steroid hormones, SHBG and frailty. Participants meeting any three or more of the five frailty criteria were classified as “frail”, all others were considered as non-frail. Results: 2.5% of men were frail. Men with SHBG ≥66 nmol/L had three times the odds of frailty (OR = 2.97; 95% CI 1.28–6.86) compared to men with SHBG <66 nmol/L. Men with free testosterone levels below 243 pmol/L had an increased odds of frailty (OR = 3.92; 95% CI 1.29–11.89). None of these associations was statistically significant after additionally adjusting for body mass index, smoking and history of cardiovascular diseases (CVD). Total testosterone, and total and free estradiol serum levels were not statistically significantly associated with frailty. Conclusions: In this US nationally representative study of older men, low free testosterone and high SHBG serum levels were associated with a significantly increased odds of frailty after adjustment for age and race/ethnicity. These associations may, however, be explained by confounding due to obesity, smoking, and the higher prevalence of CVD in frail men or by low hormones or high SHBG mediating the association between obesity, smoking, CVD and frailty.     

Bayesian Modeling of Recurrent Event Data with Dependent Censoring

The recurrent-event setting, where the subjects experience multiple occurrences of the event of interest, are encountered in many biomedical applications. In analyzing recurrent event data, non informative censoring is often assumed for the implementation of statistical methods. However, when a terminating event such as death serves as part of the censoring mechanism, validity of the censoring assumption may be violated because recurrence can be a powerful risk factor for death. We consider joint modeling of recurrent event process and terminating event under a Bayesian framework in which a shared frailty is used to model the association between the intensity of the recurrent event process and the hazard of the terminating event. Our proposed model is implemented on data from a well-known cancer study.     

Testing Heterogeneity for Frailty Distribution in Shared Frailty Model

Abstract

The frailties, representing extra variations due to unobserved measurements, are often assumed to be iid in shared frailty models. In medical applications, however, a speculation can arise that a data set might violate the iid assumption. In this paper we investigate this conjecture through an analysis of the kidney infection data in McGilchrist and Aisbett (McGilchrist, C. A., Aisbett, C. W. (1991). Regression with frailty in survival analysis. Biometrics 47:461–466). As a test procedure, we consider the cusum of squares test which is frequently used for monitoring a variance change in statistical models. Our result strongly sustains the heterogeneity of the frailty distribution.     

Pseudo-full likelihood estimation for prospective survival analysis with a general semiparametric shared frailty model: Asymptotic theory

In this work we present a simple estimation procedure for a general frailty model for analysis of prospective correlated failure times. Earlier work showed this method to perform well in a simulation study. Here we provide rigorous large-sample theory for the proposed estimators of both the regression coefficient vector and the dependence parameter, including consistent variance estimators.     

Frailty regression models in mixture distributions

We propose frailty regression models in mixture distributions and assume the distribution of frailty as gamma or positive stable or power variance function distribution. We consider Weibull mixture as an example. There are some interesting situations like survival times in genetic epidemiology, dental implants of patients and twin births (both monozygotic and dizygotic) where genetic behavior (which is unknown and random) of patients follows a known frailty distribution. These are the situations which motivate to study this particular model.     

Posterior consistency in frailty models and simulation studies to test the presence of random effects

The estimation of random effects in frailty models is an important problem in survival analysis. Testing for the presence of random effects can be essential to improving model efficiency. Posterior consistency in dispersion parameters and coefficients of the frailty model was demonstrated in theory and simulations using the posterior induced by Cox’s partial likelihood and simple priors. We also conducted simulation studies to test for the presence of random effects; the proposed method performed well in several simulations. Data analysis was also conducted. The proposed method is easily tractable and can be used to develop various methods for Bayesian inference in frailty models.     

Validation of prognostic indices using the frailty model

A major issue when proposing a new prognostic index is its generalisibility to daily clinical practice. Validation is therefore required. Most validation techniques assess whether “on average” the results obtained by the prognostic index in classifying patients in a new sample of patients are similar to the results obtained in the construction set. We introduce a new important aspect of the generalisibility of a prognostic index: the heterogeneity of the prognostic index risk group hazard ratios over different centers. If substantial variability between centers exists, the prognostic index may have no discriminatory capability in some of the centers. To model such heterogeneity, we use a frailty model including a random center effect and a random prognostic index by center interaction. Statistical inference is based on a Bayesian approach using a Laplacian approximation for the marginal posterior distribution of the variances of the random effects. We investigate different ways to summarize the information available from this marginal posterior distribution. Our approach is applied to a real bladder cancer database for which we demonstrate how to investigate and interpret heterogeneity in prognostic index effect over centers.