Nonparametric rank-based methods for group sequential monitoring of paired censored survival data

This research gives methods for nonparametric sequential monitoring of paired censored survival data in the two-sample problem using paired weighted log-rank statistics with adjustments for dependence in survival and censoring outcomes. The joint asymptotic closed-form distribution of these sequentially monitored statistics has a dependent increments structure. Simulations validating operating characteristics of the proposed methods highlight power and size consequences of ignoring even mildly correlated data. A motivating example is presented via the Early Treatment Diabetic Retinopathy Study.     

A flexible cure rate model for spatially correlated survival data based on generalized extreme value distribution and Gaussian process priors

Our present work proposes a new survival model in a Bayesian context to analyze right‐censored survival data for populations with a surviving fraction, assuming that the log failure time follows a generalized extreme value distribution. Many applications require a more flexible modeling of covariate information than a simple linear or parametric form for all covariate effects. It is also necessary to include the spatial variation in the model, since it is sometimes unexplained by the covariates considered in the analysis. Therefore, the nonlinear covariate effects and the spatial effects are incorporated into the systematic component of our model. Gaussian processes (GPs) provide a natural framework for modeling potentially nonlinear relationship and have recently become extremely powerful in nonlinear regression. Our proposed model adopts a semiparametric Bayesian approach by imposing a GP prior on the nonlinear structure of continuous covariate. With the consideration of data availability and computational complexity, the conditionally autoregressive distribution is placed on the region‐specific frailties to handle spatial correlation. The flexibility and gains of our proposed model are illustrated through analyses of simulated data examples as well as a dataset involving a colon cancer clinical trial from the state of Iowa.     

Simultaneous group sequential analysis of rank-based and weighted Kaplan-Meier tests for paired censored survival data

This research sequentially monitors paired survival differences using a new class of nonparametric tests based on functionals of standardized paired weighted log-rank (PWLR) and standardized paired weighted Kaplan-Meier (PWKM) tests. During a trial, these tests may alternately assume the role of the more extreme statistic. By monitoring PEMAX, the maximum between the absolute values of the standardized PWLR and PWKM, one combines advantages of rank-based (RB) and non-RB paired testing paradigms. Simulations show that monitoring treatment differences using PEMAX maintains type I error and is nearly as powerful as using the more advantageous of the two tests in proportional hazards (PH) as well as non-PH situations. Hence, PEMAX preserves power more robustly than individually monitored PWLR and PWKM, while maintaining a reasonably simple approach to design and analysis of results. An example from the Early Treatment Diabetic Retinopathy Study (ETDRS) is given.     

Bayesian Inference for the Spatio-Temporal Invasion of Alien Species

In this paper we develop a Bayesian approach to parameter estimation in a stochastic spatio-temporal model of the spread of invasive species across a landscape. To date, statistical techniques, such as logistic and autologistic regression, have outstripped stochastic spatio-temporal models in their ability to handle large numbers of covariates. Here we seek to address this problem by making use of a range of covariates describing the bio-geographical features of the landscape. Relative to regression techniques, stochastic spatio-temporal models are more transparent in their representation of biological processes. They also explicitly model temporal change, and therefore do not require the assumption that the species' distribution (or other spatial pattern) has already reached equilibrium as is often the case with standard statistical approaches. In order to illustrate the use of such techniques we apply them to the analysis of data detailing the spread of an invasive plant, Heracleum mantegazzianum, across Britain in the 20th Century using geo-referenced covariate information describing local temperature, elevation and habitat type. The use of Markov chain Monte Carlo sampling within a Bayesian framework facilitates statistical assessments of differences in the suitability of different habitat classes for H. mantegazzianum, and enables predictions of future spread to account for parametric uncertainty and system variability. Our results show that ignoring such covariate information may lead to biased estimates of key processes and implausible predictions of future distributions.     

Resampling-based multiple testing methods with covariate adjustment: application to investigation of antiretroviral drug susceptibility

Summary .   Identifying genetic mutations that cause clinical resistance to antiretroviral drugs requires adjustment for potential confounders, such as the number of active drugs in a HIV-infected patient's regimen other than the one of interest. Motivated by this problem, we investigated resampling-based methods to test equal mean response across multiple groups defined by HIV genotype, after adjustment for covariates. We consider construction of test statistics and their null distributions under two types of model: parametric and semiparametric. The covariate function is explicitly specified in the parametric but not in the semiparametric approach. The parametric approach is more precise when models are correctly specified, but suffer from bias when they are not; the semiparametric approach is more robust to model misspecification, but may be less efficient. To help preserve type I error while also improving power in both approaches, we propose resampling approaches based on matching of observations with similar covariate values. Matching reduces the impact of model misspecification as well as imprecision in estimation. These methods are evaluated via simulation studies and applied to a data set that combines results from a variety of clinical studies of salvage regimens. Our focus is on relating HIV genotype to viral susceptibility to abacavir after adjustment for the number of active antiretroviral drugs (excluding abacavir) in the patient's regimen.     

Parametric Procedures in the Analysis of Replicated Pairwise Interaction Point Patterns

A parametric approach fits particular classes of parametric models to the data, uses the model parameter estimates as summaries and tests for differences between groups by comparing fits with and without the assumption of common parameter values across groups. The paper discusses how a parametric approach can be implemented in the specific context of a single‐factor replicated spatial experiment and uses simulations to show when the parametric approach can be efficient or potentially misleading. An analysis of the spatial distribution of pyramidal neurons in human patients is also shown.     

Patterns of treatment effects in subsets of patients in clinical trials

We discuss the practice of examining patterns of treatment effects across overlapping patient subpopulations. In particular, we focus on the case in which patient subgroups are defined to contain patients having increasingly larger (or smaller) values of one particular covariate of interest, with the intent of exploring the possible interaction between treatment effect and that covariate. We formalize these subgroup approaches (STEPP: subpopulation treatment effect pattern plots) and implement them when treatment effect is defined as the difference in survival at a fixed time point between two treatment arms. The joint asymptotic distribution of the treatment effect estimates is derived, and used to construct simultaneous confidence bands around the estimates and to test the null hypothesis of no interaction. These methods are illustrated using data from a clinical trial conducted by the International Breast Cancer Study Group, which demonstrates the critical role of estrogen receptor content of the primary breast cancer for selecting appropriate adjuvant therapy. The considerations are also relevant for general subset analysis, since information from the same patients is typically used in the estimation of treatment effects within two or more subgroups of patients defined with respect to different covariates.     

Adjustment for Missingness Using Auxiliary Information in Semiparametric Regression

Summary .  In this article, we study the estimation of mean response and regression coefficient in semiparametric regression problems when response variable is subject to nonrandom missingness. When the missingness is independent of the response conditional on high-dimensional auxiliary information, the parametric approach may misspecify the relationship between covariates and response while the nonparametric approach is infeasible because of the curse of dimensionality. To overcome this, we study a model-based approach to condense the auxiliary information and estimate the parameters of interest nonparametrically on the condensed covariate space. Our estimators possess the double robustness property, i.e., they are consistent whenever the model for the response given auxiliary covariates or the model for the missingness given auxiliary covariate is correct. We conduct a number of simulations to compare the numerical performance between our estimators and other existing estimators in the current missing data literature, including the propensity score approach and the inverse probability weighted estimating equation. A set of real data is used to illustrate our approach.     

Marginal analysis of longitudinal ordinal data with misclassification in both response and covariates

Marginal methods have been widely used for the analysis of longitudinal ordinal and categorical data. These models do not require full parametric assumptions on the joint distribution of repeated response measurements but only specify the marginal or even association structures. However, inference results obtained from these methods often incur serious bias when variables are subject to error. In this paper, we tackle the problem that misclassification exists in both response and categorical covariate variables. We develop a marginal method for misclassification adjustment, which utilizes second‐order estimating functions and a functional modeling approach, and can yield consistent estimates and valid inference for mean and association parameters. We propose a two‐stage estimation approach for cases in which validation data are available. Our simulation studies show good performance of the proposed method under a variety of settings. Although the proposed method is phrased to data with a longitudinal design, it also applies to correlated data arising from clustered and family studies, in which association parameters may be of scientific interest. The proposed method is applied to analyze a dataset from the Framingham Heart Study as an illustration.     

Using expert knowledge to incorporate uncertainty in cause‐of‐death assignments for modeling of cause‐specific mortality

Implicit and explicit use of expert knowledge to inform ecological analyses is becoming increasingly common because it often represents the sole source of information in many circumstances. Thus, there is a need to develop statistical methods that explicitly incorporate expert knowledge, and can successfully leverage this information while properly accounting for associated uncertainty during analysis. Studies of cause‐specific mortality provide an example of implicit use of expert knowledge when causes‐of‐death are uncertain and assigned based on the observer's knowledge of the most likely cause. To explicitly incorporate this use of expert knowledge and the associated uncertainty, we developed a statistical model for estimating cause‐specific mortality using a data augmentation approach within a Bayesian hierarchical framework. Specifically, for each mortality event, we elicited the observer's belief of cause‐of‐death by having them specify the probability that the death was due to each potential cause. These probabilities were then used as prior predictive values within our framework. This hierarchical framework permitted a simple and rigorous estimation method that was easily modified to include covariate effects and regularizing terms. Although applied to survival analysis, this method can be extended to any event‐time analysis with multiple event types, for which there is uncertainty regarding the true outcome. We conducted simulations to determine how our framework compared to traditional approaches that use expert knowledge implicitly and assume that cause‐of‐death is specified accurately. Simulation results supported the inclusion of observer uncertainty in cause‐of‐death assignment in modeling of cause‐specific mortality to improve model performance and inference. Finally, we applied the statistical model we developed and a traditional method to cause‐specific survival data for white‐tailed deer, and compared results. We demonstrate that model selection results changed between the two approaches, and incorporating observer knowledge in cause‐of‐death increased the variability associated with parameter estimates when compared to the traditional approach. These differences between the two approaches can impact reported results, and therefore, it is critical to explicitly incorporate expert knowledge in statistical methods to ensure rigorous inference.     

Bayesian regularization for flexible baseline hazard functions in Cox survival models

Fully Bayesian methods for Cox models specify a model for the baseline hazard function. Parametric approaches generally provide monotone estimations. Semi‐parametric choices allow for more flexible patterns but they can suffer from overfitting and instability. Regularization methods through prior distributions with correlated structures usually give reasonable answers to these types of situations. We discuss Bayesian regularization for Cox survival models defined via flexible baseline hazards specified by a mixture of piecewise constant functions and by a cubic B‐spline function. For those “semi‐parametric” proposals, different prior scenarios ranging from prior independence to particular correlated structures are discussed in a real study with microvirulence data and in an extensive simulation scenario that includes different data sample and time axis partition sizes in order to capture risk variations. The posterior distribution of the parameters was approximated using Markov chain Monte Carlo methods. Model selection was performed in accordance with the deviance information criteria and the log pseudo‐marginal likelihood. The results obtained reveal that, in general, Cox models present great robustness in covariate effects and survival estimates independent of the baseline hazard specification. In relation to the “semi‐parametric” baseline hazard specification, the B‐splines hazard function is less dependent on the regularization process than the piecewise specification because it demands a smaller time axis partition to estimate a similar behavior of the risk.     

Analysis of failure time data with multilevel clustering, with application to the child vitamin a intervention trial in Nepal

We consider the problem of estimating covariate effects in the marginal Cox proportional hazard model and multilevel associations for child mortality data collected from a vitamin A supplementation trial in Nepal, where the data are clustered within households and villages. For this purpose, a class of multivariate survival models that can be represented by a functional of marginal survival functions and accounts for hierarchical structure of clustering is exploited. Based on this class of models, an estimation strategy involving a within-cluster resampling procedure is proposed, and a model assessment approach is presented. The asymptotic theory for the proposed estimators and lack-of-fit test is established. The simulation study shows that the estimates are approximately unbiased, and the proposed test statistic is conservative under extremely heavy censoring but approaches the size otherwise. The analysis of the Nepal study data shows that the association of mortality is much greater within households than within villages.     

Weight calibration to improve the efficiency of pure risk estimates from case-control samples nested in a cohort

Cohort studies provide information on relative hazards and pure risks of disease. For rare outcomes, large cohorts are needed to have sufficient numbers of events, making it costly to obtain covariate information on all cohort members. We focus on nested case-control designs that are used to estimate relative hazard in the Cox regression model. In 1997, Langholz and Borgan showed that pure risk can also be estimated from nested case-control data. However, these approaches do not take advantage of some covariates that may be available on all cohort members. Researchers have used weight calibration to increase the efficiency of relative hazard estimates from case-cohort studies and nested cased-control studies. Our objective is to extend weight calibration approaches to nested case-control designs to improve precision of estimates of relative hazards and pure risks. We show that calibrating sample weights additionally against follow-up times multiplied by relative hazards during the risk projection period improves estimates of pure risk. Efficiency improvements for relative hazards for variables that are available on the entire cohort also contribute to improved efficiency for pure risks. We develop explicit variance formulas for the weight-calibrated estimates. Simulations show how much precision is improved by calibration and confirm the validity of inference based on asymptotic normality. Examples are provided using data from the American Association of Retired Persons Diet and Health Cohort Study.     

A survival analysis approach to modeling human fecundity

Understanding conception probabilities is important not only for helping couples to achieve pregnancy but also in identifying acute or chronic reproductive toxicants that affect the highly timed and interrelated processes underlying hormonal profiles, ovulation, libido, and conception during menstrual cycles. Currently, 2 statistical approaches are available for estimating conception probabilities depending upon the research question and extent of data collection during the menstrual cycle: a survival approach when interested in modeling time-to-pregnancy (TTP) in relation to women or couples' purported exposure(s), or a hierarchical Bayesian approach when one is interested in modeling day-specific conception probabilities during the estimated fertile window. We propose a biologically valid discrete survival model that unifies the above 2 approaches while relaxing some assumptions that may not be consistent with human reproduction or behavior. This approach combines both the survival and the hierarchical models allowing investigators to obtain the distribution of TTP and day-specific probabilities during the fertile window in a single model. Our model allows for the consideration of covariate effects at both the cycle and the daily level while accounting for daily variation in conception. We conduct extensive simulations and utilize the New York State Angler Prospective Pregnancy Cohort Study to illustrate our approach. We also provide the code to implement the model in R software in the supplemental section of the supplementary material available at Biostatistics online.     

Turning the analysis of obesity–mortality associations upside down: Modeling years of life lost through conditional distributions

Objective:

We demonstrate the utility of parametric survival analysis. The analysis of longevity as a function of risk factors such as body mass index (BMI; kg/m²), activity levels, and dietary factors is a mainstay of obesity research. Modeling survival through hazard functions, relative risks, or odds of dying with methods such as Cox proportional hazards or logistic regression are the most common approaches and have many advantages. However, they also have disadvantages in terms of the ease of interpretability, especially for non‐statisticians; the need for additional data to convert parameter estimates to estimates of years of life lost (YLL); debates about the appropriate time scale in the model; and an inability to estimate median survival time when the censoring rate is too high.

Design and Methods:

We will conduct parametric survival analyses with multiple distributions, including distributions that are known to be poor fits (Gaussian), as well as a newly discovered “Compressed Gaussian”'' distribution.

Results:

Parametric survival analysis models were able to accurately estimate median survival times in a population‐based data set of 15,703 individuals, even for distributions that were not good fits and the censoring rate was high, due to the central limit theorem.

Conclusions:

Parametric survival models are able to provide more direct answers, and in our analysis of an obesity‐related data set, gave consistent YLL estimates regardless of the distribution used. We recommend increased consideration of parametric survival models in chronic disease and risk factor epidemiology.     

Statistical optimization of parametric accelerated failure time model for mapping survival trait loci

Most existing statistical methods for mapping quantitative trait loci (QTL) are not suitable for analyzing survival traits with a skewed distribution and censoring mechanism. As a result, researchers incorporate parametric and semi-parametric models of survival analysis into the framework of the interval mapping for QTL controlling survival traits. In survival analysis, accelerated failure time (AFT) model is considered as a de facto standard and fundamental model for data analysis. Based on AFT model, we propose a parametric approach for mapping survival traits using the EM algorithm to obtain the maximum likelihood estimates of the parameters. Also, with Bayesian information criterion (BIC) as a model selection criterion, an optimal mapping model is constructed by choosing specific error distributions with maximum likelihood and parsimonious parameters. Two real datasets were analyzed by our proposed method for illustration. The results show that among the five commonly used survival distributions, Weibull distribution is the optimal survival function for mapping of heading time in rice, while Log-logistic distribution is the optimal one for hyperoxic acute lung injury.     

Semiparametric models for missing covariate and response data in regression models

We consider a class of semiparametric models for the covariate distribution and missing data mechanism for missing covariate and/or response data for general classes of regression models including generalized linear models and generalized linear mixed models. Ignorable and nonignorable missing covariate and/or response data are considered. The proposed semiparametric model can be viewed as a sensitivity analysis for model misspecification of the missing covariate distribution and/or missing data mechanism. The semiparametric model consists of a generalized additive model (GAM) for the covariate distribution and/or missing data mechanism. Penalized regression splines are used to express the GAMs as a generalized linear mixed effects model, in which the variance of the corresponding random effects provides an intuitive index for choosing between the semiparametric and parametric model. Maximum likelihood estimates are then obtained via the EM algorithm. Simulations are given to demonstrate the methodology, and a real data set from a melanoma cancer clinical trial is analyzed using the proposed methods.     

Estimation with correlated censored survival data with missing covariates

Incomplete covariate data are a common occurrence in studies in which the outcome is survival time. Further, studies in the health sciences often give rise to correlated, possibly censored, survival data. With no missing covariate data, if the marginal distributions of the correlated survival times follow a given parametric model, then the estimates using the maximum likelihood estimating equations, naively treating the correlated survival times as independent, give consistent estimates of the relative risk parameters Lipsitz et al. 1994 50, 842-846. Now, suppose that some observations within a cluster have some missing covariates. We show in this paper that if one naively treats observations within a cluster as independent, that one can still use the maximum likelihood estimating equations to obtain consistent estimates of the relative risk parameters. This method requires the estimation of the parameters of the distribution of the covariates. We present results from a clinical trial Lipsitz and Ibrahim (1996b) 2, 5-14 with five covariates, four of which have some missing values. In the trial, the clusters are the hospitals in which the patients were treated.