Empirical likelihood inference for the area under the ROC curve

For a continuous-scale diagnostic test, the most commonly used summary index of the receiver operating characteristic curve (ROC) is the area under the curve (AUC) that measures the accuracy of the diagnostic test. In this article, we propose an empirical likelihood (EL) approach for the inference on the AUC. First we define an EL ratio for the AUC and show that its limiting distribution is a scaled chi-square distribution. We then obtain an EL-based confidence interval for the AUC using the scaled chi-square distribution. This EL inference for the AUC can be extended to stratified samples, and the resulting limiting distribution is a weighted sum of independent chi-square distributions. Additionally we conduct simulation studies to compare the relative performance of the proposed EL-based interval with the existing normal approximation-based intervals and bootstrap intervals for the AUC.     

Improving estimation efficiency for regression with MNAR covariates

For regression with covariates missing not at random where the missingness depends on the missing covariate values, complete-case (CC) analysis leads to consistent estimation when the missingness is independent of the response given all covariates, but it may not have the desired level of efficiency. We propose a general empirical likelihood framework to improve estimation efficiency over the CC analysis. We expand on methods in Bartlett et al. (2014, Biostatistics 15 , 719–730) and Xie and Zhang (2017, Int J Biostat 13 , 1–20) that improve efficiency by modeling the missingness probability conditional on the response and fully observed covariates by allowing the possibility of modeling other data distribution-related quantities. We also give guidelines on what quantities to model and demonstrate that our proposal has the potential to yield smaller biases than existing methods when the missingness probability model is incorrect. Simulation studies are presented, as well as an application to data collected from the US National Health and Nutrition Examination Survey.     

Semiparametric estimation of the covariate-specific ROC curve in presence of ignorable verification bias

Covariate-specific receiver operating characteristic (ROC) curves are often used to evaluate the classification accuracy of a medical diagnostic test or a biomarker, when the accuracy of the test is associated with certain covariates. In many large-scale screening tests, the gold standard is subject to missingness due to high cost or harmfulness to the patient. In this article, we propose a semiparametric estimation of the covariate-specific ROC curves with a partial missing gold standard. A location-scale model is constructed for the test result to model the covariates' effect, but the residual distributions are left unspecified. Thus the baseline and link functions of the ROC curve both have flexible shapes. With the gold standard missing at random (MAR) assumption, we consider weighted estimating equations for the location-scale parameters, and weighted kernel estimating equations for the residual distributions. Three ROC curve estimators are proposed and compared, namely, imputation-based, inverse probability weighted, and doubly robust estimators. We derive the asymptotic normality of the estimated ROC curve, as well as the analytical form of the standard error estimator. The proposed method is motivated and applied to the data in an Alzheimer's disease research.     

Semiparametric model-based inference in the presence of missing responses

We consider a semiparametric model that parameterizes the conditionaldensity of the response, given covariates, but allows the marginaldistribution of the covariates to be completely arbitrary. Responsesmay be missing. A likelihood-based imputation estimator anda semi-empirical-likelihood-based estimator for the parametervector describing the conditional density are defined and provedto be asymptotically normal. Semi-empirical loglikelihood functionsfor the parameter vector and the response mean are derived.It is shown that the two semi-empirical loglikelihood functionsare distributed asymptotically as weighted ² and scaled ², respectively.     

Quantile regression for nonignorable missing data with its application of analyzing electronic medical records

Over the past decade, there has been growing enthusiasm for using electronic medical records (EMRs) for biomedical research. Quantile regression estimates distributional associations, providing unique insights into the intricacies and heterogeneity of the EMR data. However, the widespread nonignorable missing observations in EMR often obscure the true associations and challenge its potential for robust biomedical discoveries. We propose a novel method to estimate the covariate effects in the presence of nonignorable missing responses under quantile regression. This method imposes no parametric specifications on response distributions, which subtly uses implicit distributions induced by the corresponding quantile regression models. We show that the proposed estimator is consistent and asymptotically normal. We also provide an efficient algorithm to obtain the proposed estimate and a randomly weighted bootstrap approach for statistical inferences. Numerical studies, including an empirical analysis of real-world EMR data, are used to assess the proposed method's finite-sample performance compared to existing literature.     

Empirical‐likelihood‐based criteria for model selection on marginal analysis of longitudinal data with dropout missingness

Longitudinal data are common in clinical trials and observational studies, where missing outcomes due to dropouts are always encountered. Under such context with the assumption of missing at random, the weighted generalized estimating equation (WGEE) approach is widely adopted for marginal analysis. Model selection on marginal mean regression is a crucial aspect of data analysis, and identifying an appropriate correlation structure for model fitting may also be of interest and importance. However, the existing information criteria for model selection in WGEE have limitations, such as separate criteria for the selection of marginal mean and correlation structures, unsatisfactory selection performance in small‐sample setups, and so forth. In particular, there are few studies to develop joint information criteria for selection of both marginal mean and correlation structures. In this work, by embedding empirical likelihood into the WGEE framework, we propose two innovative information criteria named a joint empirical Akaike information criterion and a joint empirical Bayesian information criterion, which can simultaneously select the variables for marginal mean regression and also correlation structure. Through extensive simulation studies, these empirical‐likelihood‐based criteria exhibit robustness, flexibility, and outperformance compared to the other criteria including the weighted quasi‐likelihood under the independence model criterion, the missing longitudinal information criterion, and the joint longitudinal information criterion. In addition, we provide a theoretical justification of our proposed criteria, and present two real data examples in practice for further illustration.     

ROC curve inference for best linear combination of two biomarkers subject to limits of detection

The receiver operating characteristic (ROC) curve is a tool commonly used to evaluate biomarker utility in clinical diagnosis of disease. Often, multiple biomarkers are developed to evaluate the discrimination for the same outcome. Levels of multiple biomarkers can be combined via best linear combination (BLC) such that their overall discriminatory ability is greater than any of them individually. Biomarker measurements frequently have undetectable levels below a detection limit sometimes denoted as limit of detection (LOD). Ignoring observations below the LOD or substituting some replacement value as a method of correction has been shown to lead to negatively biased estimates of the area under the ROC curve for some distributions of single biomarkers. In this paper, we develop asymptotically unbiased estimators, via the maximum likelihood technique, of the area under the ROC curve of BLC of two bivariate normally distributed biomarkers affected by LODs. We also propose confidence intervals for this area under curve. Point and confidence interval estimates are scrutinized by simulation study, recording bias and root mean square error and coverage probability, respectively. An example using polychlorinated biphenyl (PCB) levels to classify women with and without endometriosis illustrates the potential benefits of our methods.     

On the Impact of Parametric Assumptions and Robust Alternatives for Longitudinal Data Analysis

Models for longitudinal data are employed in a wide range of behavioral, biomedical, psychosocial, and health‐care‐related research. One popular model for continuous response is the linear mixed‐effects model (LMM). Although simulations by recent studies show that LMM provides reliable estimates under departures from the normality assumption for complete data, the invariable occurrence of missing data in practical studies renders such robustness results less useful when applied to real study data. In this paper, we show by simulated studies that in the presence of missing data estimates of the fixed effect of LMM are biased under departures from normality. We discuss two robust alternatives, the weighted generalized estimating equations (WGEE) and the augmented WGEE (AWGEE), and compare their performances with LMM using real as well as simulated data. Our simulation results show that both WGEE and AWGEE provide valid inference for skewed non‐normal data when missing data follows the missing at random, the most popular missing data mechanism for real study data.     

Inverse probability weighting estimation of the volume under the ROC surface in the presence of verification bias

In diagnostic medicine, the volume under the receiver operating characteristic (ROC) surface (VUS) is a commonly used index to quantify the ability of a continuous diagnostic test to discriminate between three disease states. In practice, verification of the true disease status may be performed only for a subset of subjects under study since the verification procedure is invasive, risky, or expensive. The selection for disease examination might depend on the results of the diagnostic test and other clinical characteristics of the patients, which in turn can cause bias in estimates of the VUS. This bias is referred to as verification bias. Existing verification bias correction in three‐way ROC analysis focuses on ordinal tests. We propose verification bias‐correction methods to construct ROC surface and estimate the VUS for a continuous diagnostic test, based on inverse probability weighting. By applying U‐statistics theory, we develop asymptotic properties for the estimator. A Jackknife estimator of variance is also derived. Extensive simulation studies are performed to evaluate the performance of the new estimators in terms of bias correction and variance. The proposed methods are used to assess the ability of a biomarker to accurately identify stages of Alzheimer's disease.     

A Model for Adjusting for Nonignorable Verification Bias in Estimation of the ROC Curve and Its Area with Likelihood‐Based Approach

Summary In estimation of the ROC curve, when the true disease status is subject to nonignorable missingness, the observed likelihood involves the missing mechanism given by a selection model. In this article, we proposed a likelihood‐based approach to estimate the ROC curve and the area under the ROC curve when the verification bias is nonignorable. We specified a parametric disease model in order to make the nonignorable selection model identifiable. With the estimated verification and disease probabilities, we constructed four types of empirical estimates of the ROC curve and its area based on imputation and reweighting methods. In practice, a reasonably large sample size is required to estimate the nonignorable selection model in our settings. Simulation studies showed that all four estimators of ROC area performed well, and imputation estimators were generally more efficient than the other estimators proposed. We applied the proposed method to a data set from research in Alzheimer's disease.