Modeling multivariate survival data by a semiparametric random effects proportional odds model

In this article, the focus is on the analysis of multivariate survival time data with various types of dependence structures. Examples of multivariate survival data include clustered data and repeated measurements from the same subject, such as the interrecurrence times of cancer tumors. A random effect semiparametric proportional odds model is proposed as an alternative to the proportional hazards model. The distribution of the random effects is assumed to be multivariate normal and the random effect is assumed to act additively to the baseline log-odds function. This class of models, which includes the usual shared random effects model, the additive variance components model, and the dynamic random effects model as special cases, is highly flexible and is capable of modeling a wide range of multivariate survival data. A unified estimation procedure is proposed to estimate the regression and dependence parameters simultaneously by means of a marginal-likelihood approach. Unlike the fully parametric case, the regression parameter estimate is not sensitive to the choice of correlation structure of the random effects. The marginal likelihood is approximated by the Monte Carlo method. Simulation studies are carried out to investigate the performance of the proposed method. The proposed method is applied to two well-known data sets, including clustered data and recurrent event times data.     

Estimating regression parameters and degree of dependence for multivariate failure time data

Multivariate failure time data are frequently encountered in longitudinal studies when subjects may experience several events or when there is a grouping of individuals into a cluster. To take into account the dependence of the failure times within the unit (the individual or the cluster) as well as censoring, two multivariate generalizations of the Cox proportional hazards model are commonly used. The marginal hazard model is used when the purpose is to estimate mean regression parameters, while the frailty model is retained when the purpose is to assess the degree of dependence within the unit. We propose a new approach based on the combination of the two aforementioned models to estimate both these quantities. This two-step estimation procedure is quicker and more simple to implement than the EM algorithm used in frailty models estimation. Simulation results are provided to illustrate robustness, consistency, and large-sample properties of estimators. Finally, this method is exemplified on a diabetic retinopathy study in order to assess the effect of photocoagulation in delaying the onset of blindness as well as the dependence between the two eyes blindness times of a patient.     

Two‐stage estimation for multivariate recurrent event data with a dependent terminal event

Recurrent event data arise in longitudinal follow‐up studies, where each subject may experience the same type of events repeatedly. The work in this article is motivated by the data from a study of repeated peritonitis for patients on peritoneal dialysis. Due to the aspects of medicine and cost, the peritonitis cases were classified into two types: Gram‐positive and non‐Gram‐positive peritonitis. Further, since the death and hemodialysis therapy preclude the occurrence of recurrent events, we face multivariate recurrent event data with a dependent terminal event. We propose a flexible marginal model, which has three characteristics: first, we assume marginal proportional hazard and proportional rates models for terminal event time and recurrent event processes, respectively; second, the inter‐recurrences dependence and the correlation between the multivariate recurrent event processes and terminal event time are modeled through three multiplicative frailties corresponding to the specified marginal models; third, the rate model with frailties for recurrent events is specified only on the time before the terminal event. We propose a two‐stage estimation procedure for estimating unknown parameters. We also establish the consistency of the two‐stage estimator. Simulation studies show that the proposed approach is appropriate for practical use. The methodology is applied to the peritonitis cohort data that motivated this study.     

A mixed-effects regression model for longitudinal multivariate ordinal data

A mixed-effects item response theory model that allows for three-level multivariate ordinal outcomes and accommodates multiple random subject effects is proposed for analysis of multivariate ordinal outcomes in longitudinal studies. This model allows for the estimation of different item factor loadings (item discrimination parameters) for the multiple outcomes. The covariates in the model do not have to follow the proportional odds assumption and can be at any level. Assuming either a probit or logistic response function, maximum marginal likelihood estimation is proposed utilizing multidimensional Gauss-Hermite quadrature for integration of the random effects. An iterative Fisher scoring solution, which provides standard errors for all model parameters, is used. An analysis of a longitudinal substance use data set, where four items of substance use behavior (cigarette use, alcohol use, marijuana use, and getting drunk or high) are repeatedly measured over time, is used to illustrate application of the proposed model.     

Association models for a multivariate binary response

Models for a multivariate binary response are parameterized by univariate marginal probabilities and dependence ratios of all orders. The w-order dependence ratio is the joint success probability of w binary responses divided by the joint success probability assuming independence. This parameterization supports likelihood-based inference for both regression parameters, relating marginal probabilities to explanatory variables, and association model parameters, relating dependence ratios to simple and meaningful mechanisms. Five types of association models are proposed, where responses are (1) independent given a necessary factor for the possibility of a success, (2) independent given a latent binary factor, (3) independent given a latent beta distributed variable, (4) follow a Markov chain, and (5) follow one of two first-order Markov chains depending on the realization of a binary latent factor. These models are illustrated by reanalyzing three data sets, foremost a set of binary time series on auranofin therapy against arthritis. Likelihood-based approaches are contrasted with approaches based on generalized estimating equations. Association models specified by dependence ratios are contrasted with other models for a multivariate binary response that are specified by odds ratios or correlation coefficients.     

A marginal mixed baseline hazards model for multivariate failure time data

In multivariate failure time data analysis, a marginal regression modeling approach is often preferred to avoid assumptions on the dependence structure among correlated failure times. In this paper, a marginal mixed baseline hazards model is introduced. Estimating equations are proposed for the estimation of the marginal hazard ratio parameters. The proposed estimators are shown to be consistent and asymptotically Gaussian with a robust covariance matrix that can be consistently estimated. Simulation studies indicate the adequacy of the proposed methodology for practical sample sizes. The methodology is illustrated with a data set from the Framingham Heart Study.     

A multivariate growth curve model for pregnancy

A model is proposed for consecutive multivariate observations of pregnancy-related quantities for a particular mother assuming proportionally with an underlying univariate growth process. Apart from the longitudinal aspect of the multivariate time series, the cross-sectional distribution of growth curves is also discussed. The model is examined as regards problems of estimation and model checking, and the results are applied to data consisting of bivariate time series of symphyseal fundal distances and fetal weight estimates from 91 mothers. We find some evidence in the data on departures from the model.     

Regression analysis of multivariate interval-censored failure time data with application to tumorigenicity experiments

This paper discusses multivariate interval-censored failure time data that occur when there exist several correlated survival times of interest and only interval-censored data are available for each survival time. Such data occur in many fields. One is tumorigenicity experiments, which usually concern different types of tumors, tumors occurring in different locations of animals, or together. For regression analysis of such data, we develop a marginal inference approach using the additive hazards model and apply it to a set of bivariate interval-censored data arising from a tumorigenicity experiment. Simulation studies are conducted for the evaluation of the presented approach and suggest that the approach performs well for practical situations.     

A marginalized conditional linear model for longitudinal binary data when informative dropout occurs in continuous time

Within the pattern-mixture modeling framework for informative dropout, conditional linear models (CLMs) are a useful approach to deal with dropout that can occur at any point in continuous time (not just at observation times). However, in contrast with selection models, inferences about marginal covariate effects in CLMs are not readily available if nonidentity links are used in the mean structures. In this article, we propose a CLM for long series of longitudinal binary data with marginal covariate effects directly specified. The association between the binary responses and the dropout time is taken into account by modeling the conditional mean of the binary response as well as the dependence between the binary responses given the dropout time. Specifically, parameters in both the conditional mean and dependence models are assumed to be linear or quadratic functions of the dropout time; and the continuous dropout time distribution is left completely unspecified. Inference is fully Bayesian. We illustrate the proposed model using data from a longitudinal study of depression in HIV-infected women, where the strategy of sensitivity analysis based on the extrapolation method is also demonstrated.     

Nonparametric estimation of the survival function for ordered multivariate failure time data: A comparative study

In longitudinal studies of disease, patients may experience several events through a follow‐up period. In these studies, the sequentially ordered events are often of interest and lead to problems that have received much attention recently. Issues of interest include the estimation of bivariate survival, marginal distributions, and the conditional distribution of gap times. In this work, we consider the estimation of the survival function conditional to a previous event. Different nonparametric approaches will be considered for estimating these quantities, all based on the Kaplan–Meier estimator of the survival function. We explore the finite sample behavior of the estimators through simulations. The different methods proposed in this article are applied to a dataset from a German Breast Cancer Study. The methods are used to obtain predictors for the conditional survival probabilities as well as to study the influence of recurrence in overall survival.     

Joint Analysis of Survival Time and Longitudinal Categorical Outcomes

In biomedical or public health research, it is common for both survival time and longitudinal categorical outcomes to be collected for a subject, along with the subject’s characteristics or risk factors. Investigators are often interested in finding important variables for predicting both survival time and longitudinal outcomes which could be correlated within the same subject. Existing approaches for such joint analyses deal with continuous longitudinal outcomes. New statistical methods need to be developed for categorical longitudinal outcomes. We propose to simultaneously model the survival time with a stratified Cox proportional hazards model and the longitudinal categorical outcomes with a generalized linear mixed model. Random effects are introduced to account for the dependence between survival time and longitudinal outcomes due to unobserved factors. The Expectation–Maximization (EM) algorithm is used to derive the point estimates for the model parameters, and the observed information matrix is adopted to estimate their asymptotic variances. Asymptotic properties for our proposed maximum likelihood estimators are established using the theory of empirical processes. The method is demonstrated to perform well in finite samples via simulation studies. We illustrate our approach with data from the Carolina Head and Neck Cancer Study (CHANCE) and compare the results based on our simultaneous analysis and the separately conducted analyses using the generalized linear mixed model and the Cox proportional hazards model. Our proposed method identifies more predictors than by separate analyses.     

Modeling longitudinal data with ordinal response by varying coefficients

This paper presents a smooth regression model for ordinal data with longitudinal dependence structure. A marginal model with cumulative logit link is applied to cope with the ordinal scale and the main and covariate effects in the model are allowed to vary with time. Local fitting is pursued and asymptotic properties of the estimates are discussed. In a second step, the longitudinal dependence of the observations is considered. Cumulative log odds ratios are fitted locally, which allows investigation of how the longitudinal dependence of the ordinal observations changes with time.     

Hierarchical multivariate mixture generalized linear models for the analysis of spatial data: An application to disease mapping

Disease mapping of a single disease has been widely studied in the public health setup. Simultaneous modeling of related diseases can also be a valuable tool both from the epidemiological and from the statistical point of view. In particular, when we have several measurements recorded at each spatial location, we need to consider multivariate models in order to handle the dependence among the multivariate components as well as the spatial dependence between locations. It is then customary to use multivariate spatial models assuming the same distribution through the entire population density. However, in many circumstances, it is a very strong assumption to have the same distribution for all the areas of population density. To overcome this issue, we propose a hierarchical multivariate mixture generalized linear model to simultaneously analyze spatial Normal and non‐Normal outcomes. As an application of our proposed approach, esophageal and lung cancer deaths in Minnesota are used to show the outperformance of assuming different distributions for different counties of Minnesota rather than assuming a single distribution for the population density. Performance of the proposed approach is also evaluated through a simulation study.     

A joint model for repeated events of different types and multiple longitudinal outcomes with application to a follow‐up study of patients after kidney transplant

This paper presents an extension of the joint modeling strategy for the case of multiple longitudinal outcomes and repeated infections of different types over time, motivated by postkidney transplantation data. Our model comprises two parts linked by shared latent terms. On the one hand is a multivariate mixed linear model with random effects, where a low‐rank thin‐plate spline function is incorporated to collect the nonlinear behavior of the different profiles over time. On the other hand is an infection‐specific Cox model, where the dependence between different types of infections and the related times of infection is through a random effect associated with each infection type to catch the within dependence and a shared frailty parameter to capture the dependence between infection types. We implemented the parameterization used in joint models which uses the fitted longitudinal measurements as time‐dependent covariates in a relative risk model. Our proposed model was implemented in OpenBUGS using the MCMC approach.     

Regression analysis of multivariate panel count data

We consider panel count data which are frequently obtained in prospective studies involving recurrent events that are only detected and recorded at periodic assessment times. The data take the form of counts of the cumulative number of events detected at each inspection time, along with explanatory covariates. Examples arise in diverse areas such as epidemiological studies, medical follow-up studies, reliability studies, and tumorigenicity experiments. This article is concerned with regression analysis of multivariate panel count data which arise if more than one type of recurrent event is of interest and individuals are only observed intermittently. We present a class of marginal mean models which leave the dependence structures for related types of recurrent events completely unspecified. Estimating equations are developed for regression parameters, and the resulting estimates are shown to be consistent and asymptotically normal. Simulation studies show that the proposed estimation procedures work well for practical situations. The methodology is applied to a motivating study of patients with psoriatic arthritis in which the events of interest are the onset of joint damage according to 2 different criteria.     

Generalized hierarchical multivariate CAR models for areal data

In the fields of medicine and public health, a common application of areal data models is the study of geographical patterns of disease. When we have several measurements recorded at each spatial location (for example, information on p>/= 2 diseases from the same population groups or regions), we need to consider multivariate areal data models in order to handle the dependence among the multivariate components as well as the spatial dependence between sites. In this article, we propose a flexible new class of generalized multivariate conditionally autoregressive (GMCAR) models for areal data, and show how it enriches the MCAR class. Our approach differs from earlier ones in that it directly specifies the joint distribution for a multivariate Markov random field (MRF) through the specification of simpler conditional and marginal models. This in turn leads to a significant reduction in the computational burden in hierarchical spatial random effect modeling, where posterior summaries are computed using Markov chain Monte Carlo (MCMC). We compare our approach with existing MCAR models in the literature via simulation, using average mean square error (AMSE) and a convenient hierarchical model selection criterion, the deviance information criterion (DIC; Spiegelhalter et al., 2002, Journal of the Royal Statistical Society, Series B64, 583-639). Finally, we offer a real-data application of our proposed GMCAR approach that models lung and esophagus cancer death rates during 1991-1998 in Minnesota counties.     

Stability of exploratory multivariate data modeling in longitudinal data

Exploratory data-driven multivariate analysis provides a means of investigating underlying structure in complex data. To explore the stability of multivariate data modeling, we have applied a common method of multivariate modeling (factor analysis) to the Genetic Analysis Workshop 13 (GAW13) Framingham Heart Study data. Given the longitudinal nature of the data, multivariate models were generated independently for a number of different time points (corresponding to cross-sectional clinic visits for the two cohorts), and compared. In addition, each multivariate model was used to generate factor scores, which were then used as a quantitative trait in variance component-based linkage analysis to investigate the stability of linkage signals over time. We found surprisingly good correlation between factor models (i.e., predicted factor structures), maximum LOD scores, and locations of maximum LOD scores (0.81< rho <0.94 for factor scores; rho >0.99 for peak locations; and 0.67< rho <0.93 for peak LOD scores). Furthermore, the regions implicated by linkage analysis with these factor scores have also been observed in other studies, further validating our exploratory modeling.     

On cross-odds ratio for multivariate competing risks data

The cross-odds ratio is defined as the ratio of the conditional odds of the occurrence of one cause-specific event for one subject given the occurrence of the same or a different cause-specific event for another subject in the same cluster over the unconditional odds of occurrence of the cause-specific event. It is a measure of the association between the correlated cause-specific failure times within a cluster. The joint cumulative incidence function can be expressed as a function of the marginal cumulative incidence functions and the cross-odds ratio. Assuming that the marginal cumulative incidence functions follow a generalized semiparametric model, this paper studies the parametric regression modeling of the cross-odds ratio. A set of estimating equations are proposed for the unknown parameters and the asymptotic properties of the estimators are explored. Non-parametric estimation of the cross-odds ratio is also discussed. The proposed procedures are applied to the Danish twin data to model the associations between twins in their times to natural menopause and to investigate whether the association differs among monozygotic and dizygotic twins and how these associations have changed over time.     

An information ratio-based goodness-of-fit test for copula models on censored data

Copula is a popular method for modeling the dependence among marginal distributions in multivariate censored data. As many copula models are available, it is essential to check if the chosen copula model fits the data well for analysis. Existing approaches to testing the fitness of copula models are mainly for complete or right-censored data. No formal goodness-of-fit (GOF) test exists for interval-censored or recurrent events data. We develop a general GOF test for copula-based survival models using the information ratio (IR) to address this research gap. It can be applied to any copula family with a parametric form, such as the frequently used Archimedean, Gaussian, and D-vine families. The test statistic is easy to calculate, and the test procedure is straightforward to implement. We establish the asymptotic properties of the test statistic. The simulation results show that the proposed test controls the type-I error well and achieves adequate power when the dependence strength is moderate to high. Finally, we apply our method to test various copula models in analyzing multiple real datasets. Our method consistently separates different copula models for all these datasets in terms of model fitness.