Matching Methods for Obtaining Survival Functions to Estimate the Effect of a Time-Dependent Treatment

In observational studies of survival time featuring a binary time-dependent treatment, the hazard ratio (an instantaneous measure) is often used to represent the treatment effect. However, investigators are often more interested in the difference in survival functions. We propose semiparametric methods to estimate the causal effect of treatment among the treated with respect to survival probability. The objective is to compare post-treatment survival with the survival function that would have been observed in the absence of treatment. For each patient, we compute a prognostic score (based on the pre-treatment death hazard) and a propensity score (based on the treatment hazard). Each treated patient is then matched with an alive, uncensored and not-yet-treated patient with similar prognostic and/or propensity scores. The experience of each treated and matched patient is weighted using a variant of Inverse Probability of Censoring Weighting to account for the impact of censoring. We propose estimators of the treatment-specific survival functions (and their difference), computed through weighted Nelson–Aalen estimators. Closed-form variance estimators are proposed which take into consideration the potential replication of subjects across matched sets. The proposed methods are evaluated through simulation, then applied to estimate the effect of kidney transplantation on survival among end-stage renal disease patients using data from a national organ failure registry.     

A General Class of Semiparametric Transformation Frailty Models for Nonproportional Hazards Survival Data

Summary We propose a semiparametrically efficient estimation of a broad class of transformation regression models for nonproportional hazards data. Classical transformation models are to be viewed from a frailty model paradigm, and the proposed method provides a unified approach that is valid for both continuous and discrete frailty models. The proposed models are shown to be flexible enough to model long‐term follow‐up survival data when the treatment effect diminishes over time, a case for which the PH or proportional odds assumption is violated, or a situation in which a substantial proportion of patients remains cured after treatment. Estimation of the link parameter in frailty distribution, considered to be unknown and possibly dependent on a time‐independent covariates, is automatically included in the proposed methods. The observed information matrix is computed to evaluate the variances of all the parameter estimates. Our likelihood‐based approach provides a natural way to construct simple statistics for testing the PH and proportional odds assumptions for usual survival data or testing the short‐ and long‐term effects for survival data with a cure fraction. Simulation studies demonstrate that the proposed inference procedures perform well in realistic settings. Applications to two medical studies are provided.     

Estimating incident population distribution from prevalent data

A prevalent sample consists of individuals who have experienced disease incidence but not failure event at the sampling time. We discuss methods for estimating the distribution function of a random vector defined at baseline for an incident disease population when data are collected by prevalent sampling. Prevalent sampling design is often more focused and economical than incident study design for studying the survival distribution of a diseased population, but prevalent samples are biased by design. Subjects with longer survival time are more likely to be included in a prevalent cohort, and other baseline variables of interests that are correlated with survival time are also subject to sampling bias induced by the prevalent sampling scheme. Without recognition of the bias, applying empirical distribution function to estimate the population distribution of baseline variables can lead to serious bias. In this article, nonparametric and semiparametric methods are developed for distribution estimation of baseline variables using prevalent data.     

Accelerated failure time modeling via nonparametric mixtures

An accelerated failure time (AFT) model assuming a log-linear relationship between failure time and a set of covariates can be either parametric or semiparametric, depending on the distributional assumption for the error term. Both classes of AFT models have been popular in the analysis of censored failure time data. The semiparametric AFT model is more flexible and robust to departures from the distributional assumption than its parametric counterpart. However, the semiparametric AFT model is subject to producing biased results for estimating any quantities involving an intercept. Estimating an intercept requires a separate procedure. Moreover, a consistent estimation of the intercept requires stringent conditions. Thus, essential quantities such as mean failure times might not be reliably estimated using semiparametric AFT models, which can be naturally done in the framework of parametric AFT models. Meanwhile, parametric AFT models can be severely impaired by misspecifications. To overcome this, we propose a new type of the AFT model using a nonparametric Gaussian-scale mixture distribution. We also provide feasible algorithms to estimate the parameters and mixing distribution. The finite sample properties of the proposed estimators are investigated via an extensive stimulation study. The proposed estimators are illustrated using a real dataset.     

A Bayesian nonparametric model for zero‐inflated outcomes: Prediction,clustering, and causal estimation

Researchers are often interested in predicting outcomes, detecting distinct subgroups of their data, or estimating causal treatment effects. Pathological data distributions that exhibit skewness and zero‐inflation complicate these tasks—requiring highly flexible, data‐adaptive modeling. In this paper, we present a multipurpose Bayesian nonparametric model for continuous, zero‐inflated outcomes that simultaneously predicts structural zeros, captures skewness, and clusters patients with similar joint data distributions. The flexibility of our approach yields predictions that capture the joint data distribution better than commonly used zero‐inflated methods. Moreover, we demonstrate that our model can be coherently incorporated into a standardization procedure for computing causal effect estimates that are robust to such data pathologies. Uncertainty at all levels of this model flow through to the causal effect estimates of interest—allowing easy point estimation, interval estimation, and posterior predictive checks verifying positivity, a required causal identification assumption. Our simulation results show point estimates to have low bias and interval estimates to have close to nominal coverage under complicated data settings. Under simpler settings, these results hold while incurring lower efficiency loss than comparator methods. We use our proposed method to analyze zero‐inflated inpatient medical costs among endometrial cancer patients receiving either chemotherapy or radiation therapy in the SEER‐Medicare database.     

K‐Sample comparisons using propensity analysis

In this paper, we investigate K‐group comparisons on survival endpoints for observational studies. In clinical databases for observational studies, treatment for patients are chosen with probabilities varying depending on their baseline characteristics. This often results in noncomparable treatment groups because of imbalance in baseline characteristics of patients among treatment groups. In order to overcome this issue, we conduct propensity analysis and match the subjects with similar propensity scores across treatment groups or compare weighted group means (or weighted survival curves for censored outcome variables) using the inverse probability weighting (IPW). To this end, multinomial logistic regression has been a popular propensity analysis method to estimate the weights. We propose to use decision tree method as an alternative propensity analysis due to its simplicity and robustness. We also propose IPW rank statistics, called Dunnett‐type test and ANOVA‐type test, to compare 3 or more treatment groups on survival endpoints. Using simulations, we evaluate the finite sample performance of the weighted rank statistics combined with these propensity analysis methods. We demonstrate these methods with a real data example. The IPW method also allows us for unbiased estimation of population parameters of each treatment group. In this paper, we limit our discussions to survival outcomes, but all the methods can be easily modified for any type of outcomes, such as binary or continuous variables.     

Ultra-high dimensional variable selection for doubly robust causal inference

Causal inference has been increasingly reliant on observational studies with rich covariate information. To build tractable causal procedures, such as the doubly robust estimators, it is imperative to first extract important features from high or even ultra-high dimensional data. In this paper, we propose causal ball screening for confounder selection from modern ultra-high dimensional data sets. Unlike the familiar task of variable selection for prediction modeling, our confounder selection procedure aims to control for confounding while improving efficiency in the resulting causal effect estimate. Previous empirical and theoretical studies suggest excluding causes of the treatment that are not confounders. Motivated by these results, our goal is to keep all the predictors of the outcome in both the propensity score and outcome regression models. A distinctive feature of our proposal is that we use an outcome model-free procedure for propensity score model selection, thereby maintaining double robustness in the resulting causal effect estimator. Our theoretical analyses show that the proposed procedure enjoys a number of properties, including model selection consistency and pointwise normality. Synthetic and real data analysis show that our proposal performs favorably with existing methods in a range of realistic settings. Data used in preparation of this paper were obtained from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database.     

Fitting Survival Data to a Piecewise Linear Hazard Rate in the Presence of Covariates

This paper extends the work of KODLIN (1967), who proposed a method for analyzing patient survival data wherein the hazard rate was linearly related to the survival time. The present paper extends Kodlin's model to permit maximum likelihood estimation of the parameters so that covariate effects are included and the slope and intercept parameters are allowed to change over fixed intervals of the time domain of study. An illustration of the method using multiple myeloma data is given and the results are compared with those of Kodlin's model, the Feigl-Zelen, Zippin-Armitage model, the exponential model, and Cox's proportional hazards model.     

North Atlantic climate variation influences survival in adult fulmars

There is increasing evidence that large scale climate variation influences reproductive parameters of seabirds, but fewer studies have investigated possible effects on adult survival. Previous work has shown that climate variation reflected by the winter North Atlantic oscillation (WNAO) influences reproductive success in northern fulmars. Here, we use a 34 year long (1962–1995) individual‐based data set to investigate inter‐annual and inter‐individual variation in adult survival in this species. Breeding success in the previous and current seasons, and both the WNAO and one‐year lagged WNAO indexes, were considered as potential sources of inter‐annual variation in survival and recapture probabilities. Sex and an index of body size were considered as potential sources of inter‐individual variation in survival and recapture probabilities. Body size effects were not significant, but males and females differed in both their survival and recapture probabilities. Probability of recapture of females was positively correlated with breeding success in both the current and previous breeding seasons, whereas male recapture probabilities were correlated only with previous breeding success. Male and female survival decreased over the study period, suggesting that there had been a degradation of environmental conditions. This hypothesis was supported by the detection of a negative correlation between survival and the WNAO, which, in turn, showed a positive increase over this period. The negative correlation between female adult survival and WNAO did not result only from the long term behaviour of the two time series, but persisted for higher frequency fluctuations. In contrast, the correlation between male survival and WNAO seemed to result only from the long term behaviour of the two time series. Despite uncertainties over causal mechanisms, these findings add to the body of evidence that large scale climate variation could dramatically affect seabird population dynamics. Furthermore our results suggest that climate variation can differentially influence individuals with distinct phenotypic characteristics.     

Survival estimates of bird species across altered habitats in the tropical Andes

The probability of long‐term persistence of a population is strongly determined by adult survival rates, but estimates of survival are currently lacking for most species of birds in the tropical Andes, a global biodiversity hotspot. We calculated apparent survival rates of birds in the Ecuadorian tropical Andes using a moderately long‐term (11 yr) capture–recapture dataset from three habitats that varied in how much they had been modified by human activities (native forest, introduced forest, and shrubs). We fit mark–recapture models for 28 species with habitat as a covariable. For all species, recapture rates between sampling sessions were low and varied from 0.04 for Rainbow Starfrontlets (Coeligena iris) to 0.41 for Stripe‐headed Brushfinches (Arremon assimilis) when averaged across all occupied habitats. Annual survival rates varied from 0.07 for Black‐crested Warblers (Margarornis squamiger) to 0.75 for Violet‐throated Metaltails (Metallura baroni). We found no significant differences in survival rates either among habitats or species grouped by habitat specialization. Because we found similar survival rates in native forest and human‐modified habitats, our results support those of recent studies concerning the potential value of secondary habitats for the conservation of some species of birds in the tropics. However, our conclusions are tempered by the uncertainty around the estimates of survival rates. Despite the relatively long‐term nature of our study, obtaining survival estimates for bird species in this region was challenging, and either more years of study or modification of field protocols may be needed to obtain more precise survival estimates.     

Bayesian propensity scores for high‐dimensional causal inference: A comparison of drug‐eluting to bare‐metal coronary stents

High‐dimensional data provide many potential confounders that may bolster the plausibility of the ignorability assumption in causal inference problems. Propensity score methods are powerful causal inference tools, which are popular in health care research and are particularly useful for high‐dimensional data. Recent interest has surrounded a Bayesian treatment of propensity scores in order to flexibly model the treatment assignment mechanism and summarize posterior quantities while incorporating variance from the treatment model. We discuss methods for Bayesian propensity score analysis of binary treatments, focusing on modern methods for high‐dimensional Bayesian regression and the propagation of uncertainty. We introduce a novel and simple estimator for the average treatment effect that capitalizes on conjugacy of the beta and binomial distributions. Through simulations, we show the utility of horseshoe priors and Bayesian additive regression trees paired with our new estimator, while demonstrating the importance of including variance from the treatment regression model. An application to cardiac stent data with almost 500 confounders and 9000 patients illustrates approaches and facilitates comparison with existing alternatives. As measured by a falsifiability endpoint, we improved confounder adjustment compared with past observational research of the same problem.     

A Study of Log-Logistic Model in Survival Analysis

In survival analysis when the mortality reaches a peak after some finite period and then slowly declines, it is appropriate to use a model which has a nonmonotonic failure rate. In this paper we study the log-logistic model whose failure rate exhibits the above behavior and its mean residual life behaves in the reverse fashion. The maximum likelihood estimation of the parameters is examined and it is proved analytically that unique maximum likelihood estimates exist for the parameters. A lung cancer data set is analyzed. Confidence intervals for the parameters as well as for the critical points of the failure rate and mean residual life functions are obtained for the high performance status (PS) and low PS subgroups, where the term performance status is a measure of general medical status.     

Generalizing treatment effects with incomplete covariates: Identifying assumptions and multiple imputation algorithms

We focus on the problem of generalizing a causal effect estimated on a randomized controlled trial (RCT) to a target population described by a set of covariates from observational data. Available methods such as inverse propensity sampling weighting are not designed to handle missing values, which are however common in both data sources. In addition to coupling the assumptions for causal effect identifiability and for the missing values mechanism and to defining appropriate estimation strategies, one difficulty is to consider the specific structure of the data with two sources and treatment and outcome only available in the RCT. We propose three multiple imputation strategies to handle missing values when generalizing treatment effects, each handling the multisource structure of the problem differently (separate imputation, joint imputation with fixed effect, joint imputation ignoring source information). As an alternative to multiple imputation, we also propose a direct estimation approach that treats incomplete covariates as semidiscrete variables. The multiple imputation strategies and the latter alternative rely on different sets of assumptions concerning the impact of missing values on identifiability. We discuss these assumptions and assess the methods through an extensive simulation study. This work is motivated by the analysis of a large registry of over 20,000 major trauma patients and an RCT studying the effect of tranexamic acid administration on mortality in major trauma patients admitted to intensive care units. The analysis illustrates how the missing values handling can impact the conclusion about the effect generalized from the RCT to the target population.     

Multiple imputation approach for interval‐censored time to HIV RNA viral rebound within a mixed effects Cox model

We present a method to fit a mixed effects Cox model with interval‐censored data. Our proposal is based on a multiple imputation approach that uses the truncated Weibull distribution to replace the interval‐censored data by imputed survival times and then uses established mixed effects Cox methods for right‐censored data. Interval‐censored data were encountered in a database corresponding to a recompilation of retrospective data from eight analytical treatment interruption (ATI) studies in 158 human immunodeficiency virus (HIV) positive combination antiretroviral treatment (cART) suppressed individuals. The main variable of interest is the time to viral rebound, which is defined as the increase of serum viral load (VL) to detectable levels in a patient with previously undetectable VL, as a consequence of the interruption of cART. Another aspect of interest of the analysis is to consider the fact that the data come from different studies based on different grounds and that we have several assessments on the same patient. In order to handle this extra variability, we frame the problem into a mixed effects Cox model that considers a random intercept per subject as well as correlated random intercept and slope for pre‐cART VL per study. Our procedure has been implemented in R using two packages: truncdist and coxme , and can be applied to any data set that presents both interval‐censored survival times and a grouped data structure that could be treated as a random effect in a regression model. The properties of the parameter estimators obtained with our proposed method are addressed through a simulation study.     

A sensitivity analysis approach for the causal hazard ratio in randomized and observational studies

The hazard ratio (HR) is often reported as the main causal effect when studying survival data. Despite its popularity, the HR suffers from an unclear causal interpretation. As already pointed out in the literature, there is a built-in selection bias in the HR, because similarly to the truncation by death problem, the HR conditions on post-treatment survival. A recently proposed alternative, inspired by the Survivor Average Causal Effect, is the causal HR, defined as the ratio between hazards across treatment groups among the study participants that would have survived regardless of their treatment assignment. We discuss the challenge in identifying the causal HR and present a sensitivity analysis identification approach in randomized controlled trials utilizing a working frailty model. We further extend our framework to adjust for potential confounders using inverse probability of treatment weighting. We present a Cox-based and a flexible non-parametric kernel-based estimation under right censoring. We study the finite-sample properties of the proposed estimation methods through simulations. We illustrate the utility of our framework using two real-data examples.     

Estimations of the joint distribution of failure time and failure type with dependent truncation

In biomedical studies involving survival data, the observation of failure times is sometimes accompanied by a variable which describes the type of failure event (Kalbeisch and Prentice, 2002). This paper considers two specific challenges which are encountered in the joint analysis of failure time and failure type. First, because the observation of failure times is subject to left truncation, the sampling bias extends to the failure type which is associated with the failure time. An analytical challenge is to deal with such sampling bias. Second, in case that the joint distribution of failure time and failure type is allowed to have a temporal trend, it is of interest to estimate the joint distribution of failure time and failure type nonparametrically. This paper develops statistical approaches to address these two analytical challenges on the basis of prevalent survival data. The proposed approaches are examined through simulation studies and illustrated by using a real data set.     

Mean residual life cure models for right-censored data with and without length-biased sampling

We propose a semiparametric mean residual life mixture cure model for right-censored survival data with a cured fraction. The model employs the proportional mean residual life model to describe the effects of covariates on the mean residual time of uncured subjects and the logistic regression model to describe the effects of covariates on the cure rate. We develop estimating equations to estimate the proposed cure model for the right-censored data with and without length-biased sampling, the latter is often found in prevalent cohort studies. In particular, we propose two estimating equations to estimate the effects of covariates in the cure rate and a method to combine them to improve the estimation efficiency. The consistency and asymptotic normality of the proposed estimates are established. The finite sample performance of the estimates is confirmed with simulations. The proposed estimation methods are applied to a clinical trial study on melanoma and a prevalent cohort study on early-onset type 2 diabetes mellitus.     

Buckley-James-type estimator with right-censored and length-biased data

We present a natural generalization of the Buckley-James-type estimator for traditional survival data to right-censored length-biased data under the accelerated failure time (AFT) model. Length-biased data are often encountered in prevalent cohort studies and cancer screening trials. Informative right censoring induced by length-biased sampling creates additional challenges in modeling the effects of risk factors on the unbiased failure times for the target population. In this article, we evaluate covariate effects on the failure times of the target population under the AFT model given the observed length-biased data. We construct a Buckley-James-type estimating equation, develop an iterative computing algorithm, and establish the asymptotic properties of the estimators. We assess the finite-sample properties of the proposed estimators against the estimators obtained from the existing methods. Data from a prevalent cohort study of patients with dementia are used to illustrate the proposed methodology.     

Frailty‐Based Competing Risks Model for Multivariate Survival Data

Summary In this work, we provide a new class of frailty‐based competing risks models for clustered failure times data. This class is based on expanding the competing risks model of Prentice et al. (1978, Biometrics 34 , 541–554) to incorporate frailty variates, with the use of cause‐specific proportional hazards frailty models for all the causes. Parametric and nonparametric maximum likelihood estimators are proposed. The main advantages of the proposed class of models, in contrast to the existing models, are: (1) the inclusion of covariates; (2) the flexible structure of the dependency among the various types of failure times within a cluster; and (3) the unspecified within‐subject dependency structure. The proposed estimation procedures produce the most efficient parametric and semiparametric estimators and are easy to implement. Simulation studies show that the proposed methods perform very well in practical situations.     

Scalable estimation and regularization for the logistic normal multinomial model

Clustered multinomial data are prevalent in a variety of applications such as microbiome studies, where metagenomic sequencing data are summarized as multinomial counts for a large number of bacterial taxa per subject. Count normalization with ad hoc zero adjustment tends to result in poor estimates of abundances for taxa with zero or small counts. To account for heterogeneity and overdispersion in such data, we suggest using the logistic normal multinomial (LNM) model with an arbitrary correlation structure to simultaneously estimate the taxa compositions by borrowing information across subjects. We overcome the computational difficulties in high dimensions by developing a stochastic approximation EM algorithm with Hamiltonian Monte Carlo sampling for scalable parameter estimation in the LNM model. The ill‐conditioning problem due to unstructured covariance is further mitigated by a covariance‐regularized estimator with a condition number constraint. The advantages of the proposed methods are illustrated through simulations and an application to human gut microbiome data.