Confidence Interval for Rate Ratio in a 2 × 2 Table with Structural Zero: An Application in Assessing False-Negative Rate Ratio When Combining Two Diagnostic Tests

Summary . In this article, we consider problems with correlated data that can be summarized in a 2 × 2 table with structural zero in one of the off‐diagonal cells. Data of this kind sometimes appear in infectious disease studies and two‐step procedure studies. Lui (1998, Biometrics 54, 706–711) considered confidence interval estimation of rate ratio based on Fieller‐type, Wald‐type, and logarithmic transformation statistics. We reexamine the same problem under the context of confidence interval construction on false‐negative rate ratio in diagnostic performance when combining two diagnostic tests. We propose a score statistic for testing the null hypothesis of nonunity false‐negative rate ratio. Score test–based confidence interval construction for false‐negative rate ratio will also be discussed. Simulation studies are conducted to compare the performance of the new derived score test statistic and existing statistics for small to moderate sample sizes. In terms of confidence interval construction, our asymptotic score test–based confidence interval estimator possesses significantly shorter expected width with coverage probability being close to the anticipated confidence level. In terms of hypothesis testing, our asymptotic score test procedure has actual type I error rate close to the pre‐assigned nominal level. We illustrate our methodologies with real examples from a clinical laboratory study and a cancer study.     

Exact unconditional inference for risk ratio in a correlated 2 x 2 table with structural zero

In this article, we consider small-sample statistical inference for rate ratio (RR) in a correlated 2 x 2 table with a structural zero in one of the off-diagonal cells. Existing Wald's test statistic and logarithmic transformation test statistic will be adopted for this purpose. Hypothesis testing and confidence interval construction based on large-sample theory will be reviewed first. We then propose reliable small-sample exact unconditional procedures for hypothesis testing and confidence interval construction. We present empirical results to evince the better confidence interval performance of our proposed exact unconditional procedures over the traditional large-sample procedures in small-sample designs. Unlike the findings given in Lui (1998, Biometrics 54, 706-711), our empirical studies show that the existing asymptotic procedures may not attain a prespecified confidence level even in moderate sample-size designs (e.g., n = 50). Our exact unconditional procedures on the other hand do not suffer from this problem. Hence, the asymptotic procedures should be applied with caution. We propose two approximate unconditional confidence interval construction methods that outperform the existing asymptotic ones in terms of coverage probability and expected interval width. Also, we empirically demonstrate that the approximate unconditional tests are more powerful than their associated exact unconditional tests. A real data set from a two-step tuberculosis testing study is used to illustrate the methodologies.     

Statistical analysis of noninferiority trials with a rate ratio in small-sample matched-pair designs

Testing of noninferiority has become increasingly important in modern medicine as a means of comparing a new test procedure to a currently available test procedure. Asymptotic methods have recently been developed for analyzing noninferiority trials using rate ratios under the matched-pair design. In small samples, however, the performance of these asymptotic methods may not be reliable, and they are not recommended. In this article, we investigate alternative methods that are desirable for assessing noninferiority trials, using the rate ratio measure under small-sample matched-pair designs. In particular, we propose an exact and an approximate exact unconditional test, along with the corresponding confidence intervals based on the score statistic. The exact unconditional method guarantees the type I error rate will not exceed the nominal level. It is recommended for when strict control of type I error (protection against any inflated risk of accepting inferior treatments) is required. However, the exact method tends to be overly conservative (thus, less powerful) and computationally demanding. Via empirical studies, we demonstrate that the approximate exact score method, which is computationally simple to implement, controls the type I error rate reasonably well and has high power for hypothesis testing. On balance, the approximate exact method offers a very good alternative for analyzing correlated binary data from matched-pair designs with small sample sizes. We illustrate these methods using two real examples taken from a crossover study of soft lenses and a Pneumocystis carinii pneumonia study. We contrast the methods with a hypothetical example.     

Testing the non-unity of rate ratio under inverse sampling

Inverse sampling is considered to be a more appropriate sampling scheme than the usual binomial sampling scheme when subjects arrive sequentially, when the underlying response of interest is acute, and when maximum likelihood estimators of some epidemiologic indices are undefined. In this article, we study various statistics for testing non-unity rate ratios in case-control studies under inverse sampling. These include the Wald, unconditional score, likelihood ratio and conditional score statistics. Three methods (the asymptotic, conditional exact, and Mid-P methods) are adopted for P-value calculation. We evaluate the performance of different combinations of test statistics and P-value calculation methods in terms of their empirical sizes and powers via Monte Carlo simulation. In general, asymptotic score and conditional score tests are preferable for their actual type I error rates are well controlled around the pre-chosen nominal level, and their powers are comparatively the largest. The exact version of Wald test is recommended if one wants to control the actual type I error rate at or below the pre-chosen nominal level. If larger power is expected and fluctuation of sizes around the pre-chosen nominal level are allowed, then the Mid-P version of Wald test is a desirable alternative. We illustrate the methodologies with a real example from a heart disease study.     

Unconditional Exact Tests for Equivalence or Noninferiority for Paired Binary Endpoints

Problems of establishing equivalence or noninferiority between two medical diagnostic procedures involve comparisons of the response rates between correlated proportions. When the sample size is small, the asymptotic tests may not be reliable. This article proposes an unconditional exact test procedure to assess equivalence or noninferiority. Two statistics, a sample-based test statistic and a restricted maximum likelihood estimation (RMLE)-based test statistic, to define the rejection region of the exact test are considered. We show the p-value of the proposed unconditional exact tests can be attained at the boundary point of the null hypothesis. Assessment of equivalence is often based on a comparison of the confidence limits with the equivalence limits. We also derive the unconditional exact confidence intervals on the difference of the two proportion means for the two test statistics. A typical data set of comparing two diagnostic procedures is analyzed using the proposed unconditional exact and asymptotic methods. The p-value from the unconditional exact tests is generally larger than the p-value from the asymptotic tests. In other words, an exact confidence interval is generally wider than the confidence interval obtained from an asymptotic test.     

Sample size determination for establishing equivalence/noninferiority via ratio of two proportions in matched-pair design

In this article, we propose approximate sample size formulas for establishing equivalence or noninferiority of two treatments in match-pairs design. Using the ratio of two proportions as the equivalence measure, we derive sample size formulas based on a score statistic for two types of analyses: hypothesis testing and confidence interval estimation. Depending on the purpose of a study, these formulas can be used to provide a sample size estimate that guarantees a prespecified power of a hypothesis test at a certain significance level or controls the width of a confidence interval with a certain confidence level. Our empirical results confirm that these score methods are reliable in terms of true size, coverage probability, and skewness. A liver scan detection study is used to illustrate the proposed methods.     

A non-iterative confidence interval estimating procedure for the intraclass kappa statistic with multinomial outcomes

We obtain the asymptotic sample variance of the intraclass kappa statistic for multinomial outcome data. A modified Wald type procedure based on this theory is then used for confidence interval construction. The results of a simulation study show that the proposed non-iterative approach performs very well in terms of confidence interval coverage and width for samples as small as 50. The procedure is illustrated with two examples from previously published medical studies.     

Confidence intervals for spectral mean and ratio statistics

We propose a new method, to construct confidence intervals forspectral mean and related ratio statistics of a stationary process,that avoids direct estimation of their asymptotic variances.By introducing a bandwidth, a self-normalization procedure isadopted and the distribution of the new statistic is asymptoticallynuisance-parameter free. The bandwidth is chosen using informationcriteria and a moving average sieve approximation. Through asimulation study, we demonstrate good finite sample performanceof our method when the sample size is moderate, while a comparisonwith an empirical likelihood-based method for ratio statisticsis made, confirming a wider applicability of our method.     

Sample size determination for matched-pair equivalence trials using rate ratio

In this article, we compare Wald-type, logarithmic transformation, and Fieller-type statistics for the classical 2-sided equivalence testing of the rate ratio under matched-pair designs with a binary end point. These statistics can be implemented through sample-based, constrained least squares estimation and constrained maximum likelihood (CML) estimation methods. Sample size formulae based on the CML estimation method are developed. We consider formulae that control a prespecified power or confidence width. Our simulation studies show that statistics based on the CML estimation method generally outperform other statistics and methods with respect to actual type I error rate and average width of confidence intervals. Also, the corresponding sample size formulae are valid asymptotically in the sense that the exact power and actual coverage probability for the estimated sample size are generally close to their prespecified values. The methods are illustrated with a real example from a clinical laboratory study.     

Statistical Inference For Risk Difference in an Incomplete Correlated 2 × 2 Table

In some infectious disease studies and 2‐step treatment studies, 2 × 2 table with structural zero could arise in situations where it is theoretically impossible for a particular cell to contain observations or structural void is introduced by design. In this article, we propose a score test of hypotheses pertaining to the marginal and conditional probabilities in a 2 × 2 table with structural zero via the risk/rate difference measure. Score test‐based confidence interval will also be outlined. We evaluate the performance of the score test and the existing likelihood ratio test. Our empirical results evince the similar and satisfactory performance of the two tests (with appropriate adjustments) in terms of coverage probability and expected interval width. Both tests consistently perform well from small‐ to moderate‐sample designs. The score test however has the advantage that it is only undefined in one scenario while the likelihood ratio test can be undefined in many scenarios. We illustrate our method by a real example from a two‐step tuberculosis skin test study.     

Homogeneity test of rate ratios in stratified matched-pair studies

This paper investigates homogeneity test of rate ratios in stratified matched-pair studies on the basis of asymptotic and bootstrap-resampling methods. Based on the efficient score approach, we develop a simple and computationally tractable score test statistic. Several other homogeneity test statistics are also proposed on the basis of the weighted least-squares estimate and logarithmic transformation. Sample size formulae are derived to guarantee a pre-specified power for the proposed tests at the pre-given significance level. Empirical results confirm that (i) the modified score statistic based on the bootstrap-resampling method performs better in the sense that its empirical type I error rate is much closer to the pre-specified nominal level than those of other tests and its power is greater than those of other tests, and is hence recommended, whilst the statistics based on the weighted least-squares estimate and logarithmic transformation are slightly conservative under some of the considered settings; (ii) the derived sample size formulae are rather accurate in the sense that their empirical powers obtained from the estimated sample sizes are very close to the pre-specified nominal powers. A real example is used to illustrate the proposed methodologies.     

Mapping quantitative trait loci using multiple phenotypes in general pedigrees

The use of correlated phenotypes may dramatically increase the power to detect the underlying quantitative trait loci (QTLs). Current approaches for multiple phenotypes include regression-based methods, the multivariate variance of components method, factor analysis and structural equations. Issues with these methods include: 1) They are computation intensive and are subject to problems of optimization algorithms; 2) Existing claims on the asymptotic distribution of the likelihood ratio statistic for the multivariate variance of components method are contradictory and erroneous; 3) The dimension reduction of the parameter space under the null hypothesis, a phenomenon that is unique to multivariate analyses, makes the asymptotic distribution of the likelihood ratio statistic more complicated than expected. In this article, three cases of varying complexity are considered. For each case, the efficient score statistic, which is asympotically equivalent to the likelihood ratio statistic, is derived, so is its asymptotic distribution [correction]. These methods are straightforward to calculate. Finite-sample properties of these score statistics are studied through extensive simulations. These score statistics are for use with general pedigrees.     

On the asymptotic behaviour of the pseudolikelihood ratio test statistic with boundary problems

This paper considers the asymptotic distribution of the likelihood ratio statistic T for testing a subset of parameter of interest θ, θ = (γ, η), H(0) : γ = γ(0), based on the pseudolikelihood L(θ, ??), where ?? is a consistent estimator of ?, the nuisance parameter. We show that the asymptotic distribution of T under H(0) is a weighted sum of independent chi-squared variables. Some sufficient conditions are provided for the limiting distribution to be a chi-squared variable. When the true value of the parameter of interest, θ(0), or the true value of the nuisance parameter, ?(0), lies on the boundary of parameter space, the problem is shown to be asymptotically equivalent to the problem of testing the restricted mean of a multivariate normal distribution based on one observation from a multivariate normal distribution with misspecified covariance matrix, or from a mixture of multivariate normal distributions. A variety of examples are provided for which the limiting distributions of T may be mixtures of chi-squared variables. We conducted simulation studies to examine the performance of the likelihood ratio test statistics in variance component models and teratological experiments.     

On the finite sample distribution of the likelihood ratio statistic for testing heterogeneity in meta-analysis

In meta-analysis, hypothesis testing is one of the commonly used approaches for assessing whether heterogeneity exists in effects between studies. The literature concluded that the Q-statistic is clearly the best choice and criticized the performance of the likelihood ratio test in terms of the type I error control and power. However, all the criticism for the likelihood ratio test is based on the use of a mixture of two chi-square distributions with 0 and 1 degrees of freedom, which is justified only asymptotically. In this study, we develop a novel method to derive the finite sample distribution of the likelihood ratio test and restricted likelihood ratio test statistics for testing the zero variance component in the random effects model for meta-analysis. We also extend this result to the heterogeneity test when metaregression is applied. A numerical study shows that the proposed statistics have superior performance to the Q-statistic, especially when the number of studies collected for meta-analysis is small to moderate.     

Simultaneous Non‐inferiority Test of Sensitivity and Specificity for Two Diagnostic Procedures in the Presence of a Gold Standard

Sensitivity and specificity have traditionally been used to assess the performance of a diagnostic procedure. Diagnostic procedures with both high sensitivity and high specificity are desirable, but these procedures are frequently too expensive, hazardous, and/or difficult to operate. A less sophisticated procedure may be preferred, if the loss of the sensitivity or specificity is determined to be clinically acceptable. This paper addresses the problem of simultaneous testing of sensitivity and specificity for an alternative test procedure with a reference test procedure when a gold standard is present. The hypothesis is formulated as a compound hypothesis of two non‐inferiority (one‐sided equivalence) tests. We present an asymptotic test statistic based on the restricted maximum likelihood estimate in the framework of comparing two correlated proportions under the prospective and retrospective sampling designs. The sample size and power of an asymptotic test statistic are derived. The actual type I error and power are calculated by enumerating the exact probabilities in the rejection region. For applications that require high sensitivity as well as high specificity, a large number of positive subjects and a large number of negative subjects are needed. We also propose a weighted sum statistic as an alternative test by comparing a combined measure of sensitivity and specificity of the two procedures. The sample size determination is independent of the sampling plan for the two tests.     

Constructing Confidence Intervals for Qtl Location

We describe a method for constructing the confidence interval of the QTL location parameter. This method is developed in the local asymptotic framework, leading to a linear model at each position of the putative QTL. The idea is to construct a likelihood ratio test, using statistics whose asymptotic distribution does not depend on the nuisance parameters and in particular on the effect of the QTL. We show theoretical properties of the confidence interval built with this test, and compare it with the classical confidence interval using simulations. We show in particular, that our confidence interval has the correct probability of containing the true map location of the QTL, for almost all QTLs, whereas the classical confidence interval can be very biased for QTLs having small effect.     

Adaptive design: estimation and inference with censored data in a semiparametric model

In this article, we provide a method of estimation for the treatment effect in the adaptive design for censored survival data with or without adjusting for risk factors other than the treatment indicator. Within the semiparametric Cox proportional hazards model, we propose a bias-adjusted parameter estimator for the treatment coefficient and its asymptotic confidence interval at the end of the trial. The method for obtaining an asymptotic confidence interval and point estimator is based on a general distribution property of the final test statistic from the weighted linear rank statistics at the interims with or without considering the nuisance covariates. The computation of the estimates is straightforward. Extensive simulation studies show that the asymptotic confidence intervals have reasonable nominal probability of coverage, and the proposed point estimators are nearly unbiased with practical sample sizes.     

Change-plane analysis for subgroup detection with a continuous treatment

Detecting and characterizing subgroups with differential effects of a binary treatment has been widely studied and led to improvements in patient outcomes and population risk management. Under the setting of a continuous treatment, however, such investigations remain scarce. We propose a semiparametric change-plane model and consequently a doubly robust test statistic for assessing the existence of two subgroups with differential treatment effects under a continuous treatment. The proposed testing procedure is valid when either the baseline function for the covariate effects or the generalized propensity score function for the continuous treatment is correctly specified. The asymptotic distributions of the test statistic under the null and local alternative hypotheses are established. When the null hypothesis of no subgroup is rejected, the change-plane parameters that define the subgroups can be estimated. This paper provides a unified framework of the change-plane method to handle various types of outcomes, including the exponential family of distributions and time-to-event outcomes. Additional extensions with nonparametric estimation approaches are also provided. We evaluate the performance of our proposed methods through extensive simulation studies under various scenarios. An application to the Health Effects of Arsenic Longitudinal Study with a continuous environmental exposure of arsenic is presented.     

A model free approach to combining biomarkers

For most diseases, single biomarkers do not have adequate sensitivity or specificity for practical purposes. We present an approach to combine several biomarkers into a composite marker score without assuming a model for the distribution of the predictors. Using sufficient dimension reduction techniques, we replace the original markers with a lower-dimensional version, obtained through linear transformations of markers that contain sufficient information for regression of the predictors on the outcome. We combine the linear transformations using their asymptotic properties into a scalar diagnostic score via the likelihood ratio statistic. The performance of this score is assessed by the area under the receiver-operator characteristics curve (ROC), a popular summary measure of the discriminatory ability of a single continuous diagnostic marker for binary disease outcomes. An asymptotic chi-squared test for assessing individual biomarker contribution to the diagnostic score is also derived.     

A powerful and robust new linkage statistic for discordant sibling pairs

Previously, Szatkiewicz and colleagues evaluated the performance of a wide variety of statistics for quantitative-trait-locus linkage, using discordant sibling pairs. They found that the most powerful statistics, in general, were a score statistic and a "composite statistic." However, whereas these two statistics have equal power under ideal conditions, each has limitations that reduce its power in certain circumstances. The score statistic depends on estimates of trait parameters and can lose a lot of power if those estimates are incorrect. The composite statistic is not sensitive to trait-parameter estimates but does depend on arbitrary weights that must be chosen on the basis of the ascertainment scheme. In this report, we elucidate the algebraic relationship between the score and composite statistics and then use that relationship to suggest a new statistic that combines the best properties of both. We call our new statistic the "robust discordant pair" (RDP) statistic. We report simulation studies to show that the RDP statistic does, indeed, have all of the strengths and none of the weaknesses of the score and composite statistics.