Censoring the editor in transient forebrain ischemia

A molecular explanation for why some neurons are more vulnerable than others to ischemic injury has long remained elusive. In this issue of Neuron, Peng et al. propose that CREB-dependent downregulation of the RNA editing enzyme ADAR2, resulting in defective Q/R editing of AMPA receptor GluR2 subunits and increased availability of calcium and zinc-permeable death-promoting AMPA receptors, underlies the vulnerability of some neuronal populations to ischemia.     

Insider Censoring: Distortion of Data with Nondetects

Environmental data often include low-level concentrations below reporting limits. These data may be reported as “< RL,” where RL is one of several types of reporting limits. Some values also may be reported as a single number, but flagged with a qualifier (J-values) to indicate a difference in precision as compared to values above the RL. A currently used method for reporting censored environmental data called “insider censoring” produces a strong upward bias, while also distorting the shape of the data distribution. This results in inaccurate estimates of summary statistics and regression coefficients, distorts evaluations of whether data follow a normal distribution, and introduces inaccuracies into risk assessments and models. Insider censoring occurs when data measured as below the detection limit (< DL) are reported as less than the higher quantitation limit (< QL), whereas values between the DL and QL are reported as individual numbers. Three unbiased alternatives to insider censoring are presented so that laboratories and their data users can recognize, and remedy, this problem.     

Censoring in an epidemic with an application to hemophilia-associated AIDS

In epidemiologic studies of infectious diseases, the times of infection may be known only up to an interval. A two-stage parametric regression model is proposed for the analysis of cohort studies during an epidemic in which the exact times of infection cannot be ascertained. The methods permit joint estimation of the effects of covariates both on the risk of infection and the risk of progression to clinical disease once infected. The methodology is applied to a cohort of hemophiliacs who were at risk of infection with the AIDS virus. It was found that hemophiliacs with severe Type A hemophilia were at highest risk of infection, and the risk of infection increased sharply in the early 1980s. Hemophiliacs who were over the age of 20 at infection were at higher risk of progression to AIDS than hemophiliacs who were under age 20. The estimate of the cumulative probability of developing AIDS within t years of infection (the incubation period distribution) for hemophiliacs over age 20 was 1 - exp(-.0021t2.516). Since follow-up in this cohort was restricted to about 10 years from infection, estimates of the incubation period distribution beyond 10 years depend on model extrapolation and should be interpreted cautiously.     

A Model for the Censoring Process in Incomplete Repeated Measurement Experiments

Premature terminations or dropouts occur often in repeated measurement experiments. A number of methods have been proposed to analyze such data but most of them assume that the censoring mechanism is, within each group, unaffected by the mechanism generating the response variables. In this paper, we propose a model for the censoring mechanism that generates dropouts. We then show how this model can be used to check whether the censoring mechanism is affected by the response variables and other covariates. Finally, the methods of the paper are applied to the “Halothane” data set.     

Inference in Randomized Studies with Informative Censoring and Discrete Time-to-Event Endpoints

In this article, we present a method for estimating and comparing the treatment-specific distributions of a discrete time-to-event variable from right-censored data. Our method allows for (1) adjustment for informative censoring due to measured prognostic factors for time to event and censoring and (2) quantification of the sensitivity of the inference to residual dependence between time to event and censoring due to unmeasured factors. We develop our approach in the context of a randomized trial for the treatment of chronic schizophrenia. We perform a simulation study to assess the practical performance of our methodology.     

Semiparametric Contrasts of Cumulative Pre-Treatment Mortality in the Presence of Dependent Censoring

In clinical settings, the necessity of treatment is often measured in terms of the patient’s prognosis in the absence of treatment. Along these lines, it is often of interest to compare subgroups of patients (e.g., based on underlying diagnosis) with respect to pre-treatment survival. Such comparisons may be complicated by at least two important issues. First, mortality contrasts by subgroup may differ over follow-up time, as opposed to being constant, and may follow a form that is difficult to model parametrically. Moreover, in settings where the proportional hazards assumption fails, investigators tend to be more interested in cumulative (as opposed to instantaneous) effects on mortality. Second, pre-treatment death is censored by the receipt of treatment and in settings where treatment assignment depends on time-dependent factors that also affect mortality, such censoring is likely to be informative. We propose semiparametric methods for contrasting subgroup-specific cumulative mortality in the presence of dependent censoring. The proposed estimators are based on the cumulative hazard function, with pre-treatment mortality assumed to follow a stratified Cox model. No functional form is assumed for the nature of the non-proportionality. Asymptotic properties of the proposed estimators are derived, and simulation studies show that the proposed methods are applicable to practical sample sizes. The methods are then applied to contrast pre-transplant mortality for acute versus chronic End-Stage Liver Disease patients.     

Semiparametric Analysis for Recurrent Event Data with Time-Dependent Covariates and Informative Censoring

Summary .  Recurrent event data analyses are usually conducted under the assumption that the censoring time is independent of the recurrent event process. In many applications the censoring time can be informative about the underlying recurrent event process, especially in situations where a correlated failure event could potentially terminate the observation of recurrent events. In this article, we consider a semiparametric model of recurrent event data that allows correlations between censoring times and recurrent event process via frailty. This flexible framework incorporates both time-dependent and time-independent covariates in the formulation, while leaving the distributions of frailty and censoring times unspecified. We propose a novel semiparametric inference procedure that depends on neither the frailty nor the censoring time distribution. Large sample properties of the regression parameter estimates and the estimated baseline cumulative intensity functions are studied. Numerical studies demonstrate that the proposed methodology performs well for realistic sample sizes. An analysis of hospitalization data for patients in an AIDS cohort study is presented to illustrate the proposed method.     

A Likelihood Ratio Test of the Equality of Paired Survival Data with Censoring

A test is developed to determine whether the mean survival times are equal when dealing with paired survival data. We assume the data follow a bivariate exponential distribution for which the variables are conditionally independent. The unconditional distribution is derived in which the distribution of the nuissance variable is general. A method based on the likelihood ratio is derived to obtain the test. The data are allowed to have both left and right censoring.     

Weighted Estimation of the Accelerated Failure Time Model in the Presence of Dependent Censoring

Independent censoring is a crucial assumption in survival analysis. However, this is impractical in many medical studies, where the presence of dependent censoring leads to difficulty in analyzing covariate effects on disease outcomes. The semicompeting risks framework offers one approach to handling dependent censoring. There are two representative estimators based on an artificial censoring technique in this data structure. However, neither of these estimators is better than another with respect to efficiency (standard error). In this paper, we propose a new weighted estimator for the accelerated failure time (AFT) model under dependent censoring. One of the advantages in our approach is that these weights are optimal among all the linear combinations of the previously mentioned two estimators. To calculate these weights, a novel resampling-based scheme is employed. Attendant asymptotic statistical results for the estimator are established. In addition, simulation studies, as well as an application to real data, show the gains in efficiency for our estimator.     

An Asymptotically Optimal Adaptive Selection Procedure in the Proportional Hazards Model with Conditionally Independent Censoring

Assume k independent populations are given which are distributed according to R, …,R (ϑ_i ∈ Θ ⊆ R ). Taking samples of size n the population with the smallest ϑ-value is to be selected. Using the framework of Le Cam's decision theory (Le Cam , 1986; Strasser , 1985) under mild regularity assumptions, an asymptotically optimal selection procedure is derived for the sequence of localized models. In the proportional hazards model with conditionally independent censoring, an asymptotically optimal adaptive selection procedure is constructed by substituting the unknown nuisance parameter by a kernel estimator.     

Inference on Risk Rates Based on Mortality Data Under Censoring and Competing Risks Using Parametric Models

In this paper we consider the competing risks model where the risks may not be independent. We assume both fixed and random censoring. The random censoring mechanism could have either a parametric or a non-parametric form. The life distributions and the parametric censoring distribution considered are exponential or Weibull. The expressions for the asymptotic confidence intervals for various parameters of interest under different models, using the estimated Fisher information matrix and parametric bootstrap techniques have been derived. Monte Carlo simulation studies for some of these cases have been carried out.     

Double Inverse‐Weighted Estimation of Cumulative Treatment Effects Under Nonproportional Hazards and Dependent Censoring

Summary In medical studies of time‐to‐event data, nonproportional hazards and dependent censoring are very common issues when estimating the treatment effect. A traditional method for dealing with time‐dependent treatment effects is to model the time‐dependence parametrically. Limitations of this approach include the difficulty to verify the correctness of the specified functional form and the fact that, in the presence of a treatment effect that varies over time, investigators are usually interested in the cumulative as opposed to instantaneous treatment effect. In many applications, censoring time is not independent of event time. Therefore, we propose methods for estimating the cumulative treatment effect in the presence of nonproportional hazards and dependent censoring. Three measures are proposed, including the ratio of cumulative hazards, relative risk, and difference in restricted mean lifetime. For each measure, we propose a double inverse‐weighted estimator, constructed by first using inverse probability of treatment weighting (IPTW) to balance the treatment‐specific covariate distributions, then using inverse probability of censoring weighting (IPCW) to overcome the dependent censoring. The proposed estimators are shown to be consistent and asymptotically normal. We study their finite‐sample properties through simulation. The proposed methods are used to compare kidney wait‐list mortality by race.     

A Likelihood-Based Approach with Shared Latent Random Parameters for the Longitudinal Binary and Informative Censoring Processes

Longitudinal studies with binary outcomes characterized by informative right censoring are commonly encountered in clinical, basic, behavioral, and health sciences. Approaches developed to analyze data with binary outcomes were mainly tailored to clustered or longitudinal data with missing completely at random or at random. Studies that focused on informative right censoring with binary outcomes are characterized by their imbedded computational complexity and difficulty of implementation. Here we present a new maximum likelihood-based approach with repeated binary measures modeled in a generalized linear mixed model as a function of time and other covariates. The longitudinal binary outcome and the censoring process determined by the number of times a subject is observed share latent random variables (random intercept and slope) where these subject-specific random effects are common to both models. A simulation study and sensitivity analysis were conducted to test the model under different assumptions and censoring settings. Our results showed accuracy of the estimates generated under this model when censoring was fully informative or partially informative with dependence on the slopes. A successful implementation was undertaken on a cohort of renal transplant patients with blood urea nitrogen as a binary outcome measured over time to indicate normal and abnormal kidney function until the emanation of graft rejection that eventuated in informative right censoring. In addition to its novelty and accuracy, an additional key feature and advantage of the proposed model is its viability of implementation on available analytical tools and widespread application on any other longitudinal dataset with informative censoring.

     

Inverse Probability of Censoring Weighted Estimates of Kendall's τ for Gap Time Analyses

Summary In life history studies, interest often lies in the analysis of the interevent, or gap times and the association between event times. Gap time analyses are challenging however, even when the length of follow‐up is determined independently of the event process, because associations between gap times induce dependent censoring for second and subsequent gap times. This article discusses nonparametric estimation of the association between consecutive gap times based on Kendall's τ in the presence of this type of dependent censoring. A nonparametric estimator that uses inverse probability of censoring weights is provided. Estimates of conditional gap time distributions can be obtained following specification of a particular copula function. Simulation studies show the estimator performs well and compares favorably with an alternative estimator. Generalizations to a piecewise constant Clayton copula are given. Several simulation studies and illustrations with real data sets are also provided.     

Addressing an Idiosyncrasy in Estimating Survival Curves Using Double Sampling in the Presence of Self-Selected Right Censoring

We investigate the use of follow-up samples of individuals to estimate survival curves from studies that are subject to right censoring from two sources: (i) early termination of the study, namely, administrative censoring, or (ii) censoring due to lost data prior to administrative censoring, so-called dropout. We assume that, for the full cohort of individuals, administrative censoring times are independent of the subjects' inherent characteristics, including survival time. To address the loss to censoring due to dropout, which we allow to be possibly selective, we consider an intensive second phase of the study where a representative sample of the originally lost subjects is subsequently followed and their data recorded. As with double-sampling designs in survey methodology, the objective is to provide data on a representative subset of the dropouts. Despite assumed full response from the follow-up sample, we show that, in general in our setting, administrative censoring times are not independent of survival times within the two subgroups, nondropouts and sampled dropouts. As a result, the stratified Kaplan-Meier estimator is not appropriate for the cohort survival curve. Moreover, using the concept of potential outcomes, as opposed to observed outcomes, and thereby explicitly formulating the problem as a missing data problem, reveals and addresses these complications. We present an estimation method based on the likelihood of an easily observed subset of the data and study its properties analytically for large samples. We evaluate our method in a realistic situation by simulating data that match published margins on survival and dropout from an actual hip-replacement study. Limitations and extensions of our design and analytic method are discussed.     

A Simple Two‐Sample Rank Test for Multivariate Survival Outcomes with Left Truncation and Right Censoring

A distribution‐free two‐sample rank test is proposed for testing for differences between survival distributions in the analysis of biomedical studies in which two groups of subjects are followed over time for a particular outcome, which may recur. This method is motivated by an observational HIV (human immunodeficiency virus) study in which a group of HIV‐seropositive women and a comparable group of HIV‐seronegative women were examined every 6 months for the presence of cervical intraepithelial neoplasia (CIN), the cervical cancer precursor. Women entered the study serially and were subject to random loss to follow‐up. Only women free of CIN at study entry were followed resulting in left‐truncated survival times. If a woman is found to be CIN infected at a later examination, she is treated and then followed until CIN recurs. The two groups of women were compared at both occurrences of CIN on the basis of rank statistics. For the first occurrence of CIN, survival times since the beginning of the study (based on calendar time) are compared. For a recurrence of CIN, survival times since the first development of CIN are compared. The proposed test statistic for an overall difference between the two groups follows a chi‐square distribution with two degrees of freedom. Simulation results demonstrate the usefulness of the proposed test proposed test statistic, which reduces to the Gehan statistic if each person is followed only to the first failure and there is no serial enrollment.     

A Bayesian Decision Procedure for Selecting Prognostic Variables Associated with Survival for Data in which Censoring is Prevalent

A Bayesian procedure is developed for the selection of concomitant variables in survival models. The variables are selected in a step-up procedure according to the criterion of maximum expected likelihood, where the expectation is over the prior parameter space. Prior knowledge of the influence of these covariates on patient prognosis is incorporated into the analysis. The step-up procedure is stopped when the Bayes factor in favor of omitting the variable selected in a particular step exceeds a specified value. The resulting model with the selected variables is fitted using Bayes estimates of the coefficients. This technique is applied to Hodgkin's disease data from a large Cooperative Clinical Trial Group and the results are compared to the results from the classical likelihood selection procedure.