Generalized estimating equations for ordinal categorical data: arbitrary patterns of missing responses and missingness in a key covariate

We propose methods for regression analysis of repeatedly measured ordinal categorical data when there is nonmonotone missingness in these responses and when a key covariate is missing depending on observables. The methods use ordinal regression models in conjunction with generalized estimating equations (GEEs). We extend the GEE methodology to accommodate arbitrary patterns of missingness in the responses when this missingness is independent of the unobserved responses. We further extend the methodology to provide correction for possible bias when missingness in knowledge of a key covariate may depend on observables. The approach is illustrated with the analysis of data from a study in diagnostic oncology in which multiple correlated receiver operating characteristic curves are estimated and corrected for possible verification bias when the true disease status is missing depending on observables.