On Estimation of Relative Risk in Case Control Studies

An estimator of relative risk in a case control study has been proposed in terms of observed cell frequencies and the probability of disease. The bias of the usual estimator i.e odds ratio as compared to the new estimator has been workedout. The expression of Mean Square Error of proposed estimator has been derived in situations where probability of disease is exactly known and when it is estimated through an independent survey. It has been observed that there is a serious error using odds ratio as an estimate of relative risk when probability of disease is not negligible. In such situations the proposed estimator can be used with advantage.     

Analysis of case-control age-at-onset data using a modified case-cohort method

Case-control designs are widely used in rare disease studies. In a typical case-control study, data are collected from a sample of all available subjects who have experienced a disease (cases) and a sub-sample of subjects who have not experienced the disease (controls) in a study cohort. Cases are oversampled in case-control studies. Logistic regression is a common tool to estimate the relative risks of the disease with respect to a set of covariates. Very often in such a study, information of ages-at-onset of the disease for all cases and ages at survey of controls are known. Standard logistic regression analysis using age as a covariate is based on a dichotomous outcome and does not efficiently use such age-at-onset (time-to-event) information. We propose to analyze age-at-onset data using a modified case-cohort method by treating the control group as an approximation of a subcohort assuming rare events. We investigate the asymptotic bias of this approximation and show that the asymptotic bias of the proposed estimator is small when the disease rate is low. We evaluate the finite sample performance of the proposed method through a simulation study and illustrate the method using a breast cancer case-control data set.     

Analysis of Multiply Matched Retrospective Studies When Risk Factor Under Study is Discrete,With Two or More Levels

The odds ratio is known to closely approximate the relative risk when the disease is rare. Logistic regression models are often used to estimate such odds ratios, but here a different model is used which avoids the assumptions implicit in logistic modelling; it also has the advantage of providing a test of homogeneity for odds rat os in situations where the logistic model cannot.     

Estimation of Heritability in Heteroscedastic One‐Way Unbalanced Random Model

A modified estimator of heritability is proposed under heteroscedastic one way unbalanced random model. The distribution, moments and probability of permissible values (PPV) for conventional and modified estimators are derived. The behaviour of two estimators has been investigated, numerically, to devise a suitable estimator of heritability under variance heterogeneity. The numerical results reveal that under balanced case the heteroscedasticity affects the bias, MSE and PPV of conventional estimator, marginally. In case of unbalanced situations, the conventional estimator underestimates the parameter when more variable group has more observations and overestimates when more variable group has less observations, MSE of the conventional estimator decreases when more variable group has more observations and increases when more variable group has less observations and PPV is marginally decreased. The MSE and PPV are comparable for two estimators while the bias of modified estimator is less than the conventional estimator particularly for small and medium values of the parameter. These results suggest the use of modified estimator with equal or more observations for more variable group in presence of variance heterogeneity.     

Cox Regression in Nested Case–Control Studies with Auxiliary Covariates

Summary Nested case–control (NCC) design is a popular sampling method in large epidemiological studies for its cost effectiveness to investigate the temporal relationship of diseases with environmental exposures or biological precursors. Thomas' maximum partial likelihood estimator is commonly used to estimate the regression parameters in Cox's model for NCC data. In this article, we consider a situation in which failure/censoring information and some crude covariates are available for the entire cohort in addition to NCC data and propose an improved estimator that is asymptotically more efficient than Thomas' estimator. We adopt a projection approach that, heretofore, has only been employed in situations of random validation sampling and show that it can be well adapted to NCC designs where the sampling scheme is a dynamic process and is not independent for controls. Under certain conditions, consistency and asymptotic normality of the proposed estimator are established and a consistent variance estimator is also developed. Furthermore, a simplified approximate estimator is proposed when the disease is rare. Extensive simulations are conducted to evaluate the finite sample performance of our proposed estimators and to compare the efficiency with Thomas' estimator and other competing estimators. Moreover, sensitivity analyses are conducted to demonstrate the behavior of the proposed estimator when model assumptions are violated, and we find that the biases are reasonably small in realistic situations. We further demonstrate the proposed method with data from studies on Wilms' tumor.     

Survival Analysis with Error‐Prone Time‐Varying Covariates: A Risk Set Calibration Approach

Summary Occupational, environmental, and nutritional epidemiologists are often interested in estimating the prospective effect of time‐varying exposure variables such as cumulative exposure or cumulative updated average exposure, in relation to chronic disease endpoints such as cancer incidence and mortality. From exposure validation studies, it is apparent that many of the variables of interest are measured with moderate to substantial error. Although the ordinary regression calibration (ORC) approach is approximately valid and efficient for measurement error correction of relative risk estimates from the Cox model with time‐independent point exposures when the disease is rare, it is not adaptable for use with time‐varying exposures. By recalibrating the measurement error model within each risk set, a risk set regression calibration (RRC) method is proposed for this setting. An algorithm for a bias‐corrected point estimate of the relative risk using an RRC approach is presented, followed by the derivation of an estimate of its variance, resulting in a sandwich estimator. Emphasis is on methods applicable to the main study/external validation study design, which arises in important applications. Simulation studies under several assumptions about the error model were carried out, which demonstrated the validity and efficiency of the method in finite samples. The method was applied to a study of diet and cancer from Harvard's Health Professionals Follow‐up Study (HPFS).     

On the use of concordant pairs in matched case-control studies

A new estimator of the common odds ratio in one-to-one matched case-control studies is proposed. The connection between this estimator and the James-Stein estimating procedure is highlighted through the argument of estimating functions. Comparisons are made between this estimator, the conditional maximum likelihood estimator, and the estimator ignoring the matching in terms of finite sample bias, mean squared error, coverage probability, and length of confidence interval. In many situations, the new estimator is found to be more efficient than the conditional maximum likelihood estimator without being as biased as the estimator that ignores matching. The extension to multiple risk factors is also outlined.     

The Petersen–Lincoln Estimator and its Extension to Estimate the Size of a Shared Population

The Petersen–Lincoln estimator has been used to estimate the size of a population in a single mark release experiment. However, the estimator is not valid when the capture sample and recapture sample are not independent. We provide an intuitive interpretation for “independence” between samples based on 2 × 2 categorical data formed by capture/non‐capture in each of the two samples. From the interpretation, we review a general measure of “dependence” and quantify the correlation bias of the Petersen–Lincoln estimator when two types of dependences (local list dependence and heterogeneity of capture probability) exist. An important implication in the census undercount problem is that instead of using a post enumeration sample to assess the undercount of a census, one should conduct a prior enumeration sample to avoid correlation bias. We extend the Petersen–Lincoln method to the case of two populations. This new estimator of the size of the shared population is proposed and its variance is derived. We discuss a special case where the correlation bias of the proposed estimator due to dependence between samples vanishes. The proposed method is applied to a study of the relapse rate of illicit drug use in Taiwan. (© 2008 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)     

A Class of Ratio-Cum-Product-Type Estimator

The problem of estimating the population mean using an auxiliary information has been dealt with in literature quite extensively. Ratio, product, linear regression and ratio-type estimators are well known. A class of ratio-cum-product-type estimator is proposed in this paper. Its bias and variance to the first order of approximation are obtained. For an appropriate weight ‘a’ and good range of α-values, it is found that the proposed estimator is superior than a set of estimators (i.e., sample mean, usual ratio and product estimators, SRIVASTAVA's (1967) estimator, CHAKRABARTY's (1979) estimator and a product-type estimator) which are, in fact, the particular cases of it. At optimum value of α, the proposed estimator is as efficient as linear regression estimator.     

Stein‐Rule Estimation in Mixed Regression Models

This paper considers a Stein‐rule mixed regression estimator for estimating a normal linear regression model in the presence of stochastic linear constraints. We derive the small disturbance asymptotic bias and risk of the proposed estimator, and analytically compare its risk with other related estimators. A Monte‐Carlo experiment investigates the empirical risk performance of the proposed estimator.     

Inference for the proportional hazards model with misclassified discrete-valued covariates

We consider the Cox proportional hazards model with discrete-valued covariates subject to misclassification. We present a simple estimator of the regression parameter vector for this model. The estimator is based on a weighted least squares analysis of weighted-averaged transformed Kaplan-Meier curves for the different possible configurations of the observed covariate vector. Optimal weighting of the transformed Kaplan-Meier curves is described. The method is designed for the case in which the misclassification rates are known or are estimated from an external validation study. A hybrid estimator for situations with an internal validation study is also described. When there is no misclassification, the regression coefficient vector is small in magnitude, and the censoring distribution does not depend on the covariates, our estimator has the same asymptotic covariance matrix as the Cox partial likelihood estimator. We present results of a finite-sample simulation study under Weibull survival in the setting of a single binary covariate with known misclassification rates. In this simulation study, our estimator performed as well as or, in a few cases, better than the full Weibull maximum likelihood estimator. We illustrate the method on data from a study of the relationship between trans-unsaturated dietary fat consumption and cardiovascular disease incidence.     

Confidence Intervals of the Attributable Risk under Cross‐Sectional Sampling with Confounders

Since it can account for both the strength of the association between exposure to a risk factor and the underlying disease of interest and the prevalence of the risk factor, the attributable risk (AR) is probably the most commonly used epidemiologic measure for public health administrators to locate important risk factors. This paper discusses interval estimation of the AR in the presence of confounders under cross‐sectional sampling. This paper considers four asymptotic interval estimators which are direct generalizations of those originally proposed for the case of no confounders, and employs Monte Carlo simulation to evaluate the finite‐sample performance of these estimators in a variety of situations. This paper finds that interval estimators using Wald's test statistic and a quadratic equation suggested here can consistently perform reasonably well with respect to the coverage probability in all the situations considered here. This paper notes that the interval estimator using the logarithmic transformation, that is previously found to consistently perform well for the case of no confounders, may have the coverage probability less than the desired confidence level when the underlying common prevalence rate ratio (RR) across strata between the exposure and the non‐exposure is large (≥4). This paper further notes that the interval estimator using the logit transformation is inappropriate for use when the underlying common RR ≐ 1. On the other hand, when the underlying common RR is large (≥4), this interval estimator is probably preferable to all the other three estimators. When the sample size is large (≥400) and the RR ≥ 2 in the situations considered here, this paper finds that all the four interval estimators developed here are essentially equivalent with respect to both the coverage probability and the average length.     

Use of Polytomous Logistic Model in Matched Case-Control Studies

Binary logistic model has been found useful for estimating odds ratio in case of dichotomous exposure variable under matched case-control retrospective design. We describe the use of polytomous logistic model for estimating odds ratios when the exposure of prime interests, relative to disease incidence, has more than two levels. An illustrative example is presented and discussed.     

Exploiting gene-environment independence for analysis of case-control studies: an empirical Bayes-type shrinkage estimator to trade-off between bias and efficiency

Summary .   Standard prospective logistic regression analysis of case–control data often leads to very imprecise estimates of gene-environment interactions due to small numbers of cases or controls in cells of crossing genotype and exposure. In contrast, under the assumption of gene-environment independence, modern "retrospective" methods, including the "case-only" approach, can estimate the interaction parameters much more precisely, but they can be seriously biased when the underlying assumption of gene-environment independence is violated. In this article, we propose a novel empirical Bayes-type shrinkage estimator to analyze case–control data that can relax the gene-environment independence assumption in a data-adaptive fashion. In the special case, involving a binary gene and a binary exposure, the method leads to an estimator of the interaction log odds ratio parameter in a simple closed form that corresponds to an weighted average of the standard case-only and case–control estimators. We also describe a general approach for deriving the new shrinkage estimator and its variance within the retrospective maximum-likelihood framework developed by Chatterjee and Carroll (2005, Biometrika 92, 399–418). Both simulated and real data examples suggest that the proposed estimator strikes a balance between bias and efficiency depending on the true nature of the gene-environment association and the sample size for a given study.     

Estimation of Relative Risk Under M to R Matching

Estimation of the relative risk from a rare disease is carried out using M:R matching. Both conditional and unconditional likelihood methods are used, leading in each case to the same estimate; a non-iterative estimate is always available under M:R matching, M ≦2. The method also enables the testing of homogeneity even when information on the matching variate is unavailable and this is an advantage over logistic regression methods.     

Clustered restricted mean survival time regression

For multicenter randomized trials or multilevel observational studies, the Cox regression model has long been the primary approach to study the effects of covariates on time-to-event outcomes. A critical assumption of the Cox model is the proportionality of the hazard functions for modeled covariates, violations of which can result in ambiguous interpretations of the hazard ratio estimates. To address this issue, the restricted mean survival time (RMST), defined as the mean survival time up to a fixed time in a target population, has been recommended as a model-free target parameter. In this article, we generalize the RMST regression model to clustered data by directly modeling the RMST as a continuous function of restriction times with covariates while properly accounting for within-cluster correlations to achieve valid inference. The proposed method estimates regression coefficients via weighted generalized estimating equations, coupled with a cluster-robust sandwich variance estimator to achieve asymptotically valid inference with a sufficient number of clusters. In small-sample scenarios where a limited number of clusters are available, however, the proposed sandwich variance estimator can exhibit negative bias in capturing the variability of regression coefficient estimates. To overcome this limitation, we further propose and examine bias-corrected sandwich variance estimators to reduce the negative bias of the cluster-robust sandwich variance estimator. We study the finite-sample operating characteristics of proposed methods through simulations and reanalyze two multicenter randomized trials.     

A novel penalized inverse-variance weighted estimator for Mendelian randomization with applications to COVID-19 outcomes

Mendelian randomization utilizes genetic variants as instrumental variables (IVs) to estimate the causal effect of an exposure variable on an outcome of interest even in the presence of unmeasured confounders. However, the popular inverse-variance weighted (IVW) estimator could be biased in the presence of weak IVs, a common challenge in MR studies. In this article, we develop a novel penalized inverse-variance weighted (pIVW) estimator, which adjusts the original IVW estimator to account for the weak IV issue by using a penalization approach to prevent the denominator of the pIVW estimator from being close to zero. Moreover, we adjust the variance estimation of the pIVW estimator to account for the presence of balanced horizontal pleiotropy. We show that the recently proposed debiased IVW (dIVW) estimator is a special case of our proposed pIVW estimator. We further prove that the pIVW estimator has smaller bias and variance than the dIVW estimator under some regularity conditions. We also conduct extensive simulation studies to demonstrate the performance of the proposed pIVW estimator. Furthermore, we apply the pIVW estimator to estimate the causal effects of five obesity-related exposures on three coronavirus disease 2019 (COVID-19) outcomes. Notably, we find that hypertensive disease is associated with an increased risk of hospitalized COVID-19; and peripheral vascular disease and higher body mass index are associated with increased risks of COVID-19 infection, hospitalized COVID-19, and critically ill COVID-19.     

On pooling across strata when frequency matching has been followed in a cohort study

In a study designed to assess the relationship between a dichotomous exposure and the eventual occurrence of a dichotomous outcome, frequency matching has been proposed as a way to balance the exposure cohorts with respect to the sampling distribution of potential confounding factors. This paper discusses the pooled estimator for the log relative risk, and provides an estimator for its variance which takes into account the dependency in the pooled outcomes induced by frequency matching. The pooled estimator has asymptotic relative efficiency less than but close to 1, relative to the usual, inverse variance weighted, stratified estimator. Simulations suggest, however, that the pooled estimator is likely to outperform the stratified estimator when samples are of moderate size. This estimator carries the added advantage that it consistently estimates a meaningful population parameter under heterogeneity of the relative risk across strata.     

Extended Mantel-Haenszel estimating procedure for multivariate logistic regression models

A class of estimating functions is proposed for the estimation of multivariate relative risk in stratified case-control studies. It reduces to the well-known Mantel-Haenszel estimator when there is a single binary risk factor. Large-sample properties of the solutions to the proposed estimating equations are established for two distinct situations. Efficiency calculations suggest that the proposed estimators are nearly fully efficient relative to the conditional maximum likelihood estimator for the parameters considered. Application of the proposed method to family data and longitudinal data, where the conditional likelihood approach fails, is discussed. Two examples from case-control studies and one example from a study on familial aggregation are presented.     

To Control False Positives in Gene-Gene Interaction Analysis: Two Novel Conditional Entropy-Based Approaches

Genome-wide analysis of gene-gene interactions has been recognized as a powerful avenue to identify the missing genetic components that can not be detected by using current single-point association analysis. Recently, several model-free methods (e.g. the commonly used information based metrics and several logistic regression-based metrics) were developed for detecting non-linear dependence between genetic loci, but they are potentially at the risk of inflated false positive error, in particular when the main effects at one or both loci are salient. In this study, we proposed two conditional entropy-based metrics to challenge this limitation. Extensive simulations demonstrated that the two proposed metrics, provided the disease is rare, could maintain consistently correct false positive rate. In the scenarios for a common disease, our proposed metrics achieved better or comparable control of false positive error, compared to four previously proposed model-free metrics. In terms of power, our methods outperformed several competing metrics in a range of common disease models. Furthermore, in real data analyses, both metrics succeeded in detecting interactions and were competitive with the originally reported results or the logistic regression approaches. In conclusion, the proposed conditional entropy-based metrics are promising as alternatives to current model-based approaches for detecting genuine epistatic effects.