Identifiability assumptions for missing covariate data in failure time regression models

Methods in the literature for missing covariate data in survival models have relied on the missing at random (MAR) assumption to render regression parameters identifiable. MAR means that missingness can depend on the observed exit time, and whether or not that exit is a failure or a censoring event. By considering ways in which missingness of covariate X could depend on the true but possibly censored failure time T and the true censoring time C, we attempt to identify missingness mechanisms which would yield MAR data. We find that, under various reasonable assumptions about how missingness might depend on T and/or C, additional strong assumptions are needed to obtain MAR. We conclude that MAR is difficult to justify in practical applications. One exception arises when missingness is independent of T, and C is independent of the value of the missing X. As alternatives to MAR, we propose two new missingness assumptions. In one, the missingness depends on T but not on C; in the other, the situation is reversed. For each, we show that the failure time model is identifiable. When missingness is independent of T, we show that the naive complete record analysis will yield a consistent estimator of the failure time distribution. When missingness is independent of C, we develop a complete record likelihood function and a corresponding estimator for parametric failure time models. We propose analyses to evaluate the plausibility of either assumption in a particular data set, and illustrate the ideas using data from the literature on this problem.     

Adjusting for Nonignorable Missingness When Estimating Generalized Additive Models

Generalized additive models (GAMs) have been widely used for flexible modeling of various types of outcomes. When the outcome in a GAM is subject to missing, practical analyses often assume that missingness is missing at random (MAR). This assumption can be of suspicion when the missingness is not by design. Evaluating the potential effects of alternative nonignorable missing data mechanism on the MAR inference from a GAM can be important but often challenging due to the complicatedness of alternative nonignorable models. We apply the index approach to local sensitivity (Troxel, Ma, and Heitjan 2004 (2004). Statistica Sinica 14 , 1221–1237) to evaluate the potential changes of the GAM estimates in the neighborhood of the MAR model. The approach avoids fitting any complicated nonignorable GAM. Only MAR estimates are required to calculate the resulting sensitivity index and adjust the GAM estimates to account for nonignorable missingness. Thus the proposed approach is considerably simpler to conduct, as compared with the alternative methods. The simulation study shows that the index provides valid assessment of the local sensitivity of the GAM estimates to nonignorable missingness. We then illustrate the method using a rheumatoid arthritis clinical trial data set.     

Mixed-effect hybrid models for longitudinal data with nonignorable dropout

Summary .  Selection models and pattern-mixture models are often used to deal with nonignorable dropout in longitudinal studies. These two classes of models are based on different factorizations of the joint distribution of the outcome process and the dropout process. We consider a new class of models, called mixed-effect hybrid models (MEHMs), where the joint distribution of the outcome process and dropout process is factorized into the marginal distribution of random effects, the dropout process conditional on random effects, and the outcome process conditional on dropout patterns and random effects. MEHMs combine features of selection models and pattern-mixture models: they directly model the missingness process as in selection models, and enjoy the computational simplicity of pattern-mixture models. The MEHM provides a generalization of shared-parameter models (SPMs) by relaxing the conditional independence assumption between the measurement process and the dropout process given random effects. Because SPMs are nested within MEHMs, likelihood ratio tests can be constructed to evaluate the conditional independence assumption of SPMs. We use data from a pediatric AIDS clinical trial to illustrate the models.     

Marginalized transition shared random effects models for longitudinal binary data with nonignorable dropout

In longitudinal studies investigators frequently have to assess and address potential biases introduced by missing data. New methods are proposed for modeling longitudinal categorical data with nonignorable dropout using marginalized transition models and shared random effects models. Random effects are introduced for both serial dependence of outcomes and nonignorable missingness. Fisher‐scoring and Quasi–Newton algorithms are developed for parameter estimation. Methods are illustrated with a real dataset.     

Robust Estimation of Area Under ROC Curve Using Auxiliary Variables in the Presence of Missing Biomarker Values

Summary In medical research, the receiver operating characteristic (ROC) curves can be used to evaluate the performance of biomarkers for diagnosing diseases or predicting the risk of developing a disease in the future. The area under the ROC curve (ROC AUC), as a summary measure of ROC curves, is widely utilized, especially when comparing multiple ROC curves. In observational studies, the estimation of the AUC is often complicated by the presence of missing biomarker values, which means that the existing estimators of the AUC are potentially biased. In this article, we develop robust statistical methods for estimating the ROC AUC and the proposed methods use information from auxiliary variables that are potentially predictive of the missingness of the biomarkers or the missing biomarker values. We are particularly interested in auxiliary variables that are predictive of the missing biomarker values. In the case of missing at random (MAR), that is, missingness of biomarker values only depends on the observed data, our estimators have the attractive feature of being consistent if one correctly specifies, conditional on auxiliary variables and disease status, either the model for the probabilities of being missing or the model for the biomarker values. In the case of missing not at random (MNAR), that is, missingness may depend on the unobserved biomarker values, we propose a sensitivity analysis to assess the impact of MNAR on the estimation of the ROC AUC. The asymptotic properties of the proposed estimators are studied and their finite‐sample behaviors are evaluated in simulation studies. The methods are further illustrated using data from a study of maternal depression during pregnancy.     

A semi-parametric shared parameter model to handle nonmonotone nonignorable missingness

Summary .  Longitudinal studies often generate incomplete response patterns according to a missing not at random mechanism. Shared parameter models provide an appealing framework for the joint modelling of the measurement and missingness processes, especially in the nonmonotone missingness case, and assume a set of random effects to induce the interdependence. Parametric assumptions are typically made for the random effects distribution, violation of which leads to model misspecification with a potential effect on the parameter estimates and standard errors. In this article we avoid any parametric assumption for the random effects distribution and leave it completely unspecified. The estimation of the model is then made using a semi-parametric maximum likelihood method. Our proposal is illustrated on a randomized longitudinal study on patients with rheumatoid arthritis exhibiting nonmonotone missingness.     

A characterization of missingness at random in a generalized shared‐parameter joint modeling framework for longitudinal and time‐to‐event data,and sensitivity analysis

We consider a conceptual correspondence between the missing data setting, and joint modeling of longitudinal and time‐to‐event outcomes. Based on this, we formulate an extended shared random effects joint model. Based on this, we provide a characterization of missing at random, which is in line with that in the missing data setting. The ideas are illustrated using data from a study on liver cirrhosis, contrasting the new framework with conventional joint models.     

Nonignorable Models for Intermittently Missing Categorical Longitudinal Responses

Summary A class of nonignorable models is presented for handling nonmonotone missingness in categorical longitudinal responses. This class of models includes the traditional selection models and shared parameter models. This allows us to perform a broader than usual sensitivity analysis. In particular, instead of considering variations to a chosen nonignorable model, we study sensitivity between different missing data frameworks. An appealing feature of the developed class is that parameters with a marginal interpretation are obtained, while algebraically simple models are considered. Specifically, marginalized mixed‐effects models ( Heagerty, 1999 , Biometrics 55, 688–698) are used for the longitudinal process that model separately the marginal mean and the correlation structure. For the correlation structure, random effects are introduced and their distribution is modeled either parametrically or non‐parametrically to avoid potential misspecifications.     

Cox regression with survival-time-dependent missing covariate values

Analysis with time-to-event data in clinical and epidemiological studies often encounters missing covariate values, and the missing at random assumption is commonly adopted, which assumes that missingness depends on the observed data, including the observed outcome which is the minimum of survival and censoring time. However, it is conceivable that in certain settings, missingness of covariate values is related to the survival time but not to the censoring time. This is especially so when covariate missingness is related to an unmeasured variable affected by the patient's illness and prognosis factors at baseline. If this is the case, then the covariate missingness is not at random as the survival time is censored, and it creates a challenge in data analysis. In this article, we propose an approach to deal with such survival-time-dependent covariate missingness based on the well known Cox proportional hazard model. Our method is based on inverse propensity weighting with the propensity estimated by nonparametric kernel regression. Our estimators are consistent and asymptotically normal, and their finite-sample performance is examined through simulation. An application to a real-data example is included for illustration.     

Joint model selection of marginal mean regression and correlation structure for longitudinal data with missing outcome and covariates

This work develops a joint model selection criterion for simultaneously selecting the marginal mean regression and the correlation/covariance structure in longitudinal data analysis where both the outcome and the covariate variables may be subject to general intermittent patterns of missingness under the missing at random mechanism. The new proposal, termed “joint longitudinal information criterion” (JLIC), is based on the expected quadratic error for assessing model adequacy, and the second‐order weighted generalized estimating equation (WGEE) estimation for mean and covariance models. Simulation results reveal that JLIC outperforms existing methods performing model selection for the mean regression and the correlation structure in a two stage and hence separate manner. We apply the proposal to a longitudinal study to identify factors associated with life satisfaction in the elderly of Taiwan.     

Mixed effects logistic regression models for multiple longitudinal binary functional limitation responses with informative drop-out and confounding by baseline outcomes

In the context of analyzing multiple functional limitation responses collected longitudinally from the Longitudinal Study of Aging (LSOA), we investigate the heterogeneity of these outcomes with respect to their associations with previous functional status and other risk factors in the presence of informative drop-out and confounding by baseline outcomes. We accommodate the longitudinal nature of the multiple outcomes with a unique extension of the nested random effects logistic model with an autoregressive structure to include drop-out and baseline outcome components with shared random effects. Estimation of fixed effects and variance components is by maximum likelihood with numerical integration. This shared parameter selection model assumes that drop-out is conditionally independent of the multiple functional limitation outcomes given the underlying random effect representing an individual's trajectory of functional status across time. Whereas it is not possible to fully assess the adequacy of this assumption, we assess the robustness of this approach by varying the assumptions underlying the proposed model such as the random effects structure, the drop-out component, and omission of baseline functional outcomes as dependent variables in the model. Heterogeneity among the associations between each functional limitation outcome and a set of risk factors for functional limitation, such as previous functional limitation and physical activity, exists for the LSOA data of interest. Less heterogeneity is observed among the estimates of time-level random effects variance components that are allowed to vary across functional outcomes and time. We also note that. under an autoregressive structure, bias results from omitting the baseline outcome component linked to the follow-up outcome component by subject-level random effects.     

Analyzing incomplete longitudinal clinical trial data

Using standard missing data taxonomy, due to Rubin and co-workers, and simple algebraic derivations, it is argued that some simple but commonly used methods to handle incomplete longitudinal clinical trial data, such as complete case analyses and methods based on last observation carried forward, require restrictive assumptions and stand on a weaker theoretical foundation than likelihood-based methods developed under the missing at random (MAR) framework. Given the availability of flexible software for analyzing longitudinal sequences of unequal length, implementation of likelihood-based MAR analyses is not limited by computational considerations. While such analyses are valid under the comparatively weak assumption of MAR, the possibility of data missing not at random (MNAR) is difficult to rule out. It is argued, however, that MNAR analyses are, themselves, surrounded with problems and therefore, rather than ignoring MNAR analyses altogether or blindly shifting to them, their optimal place is within sensitivity analysis. The concepts developed here are illustrated using data from three clinical trials, where it is shown that the analysis method may have an impact on the conclusions of the study.     

Score test for missing at random or not under logistic missingness models

Missing data are frequently encountered in various disciplines and can be divided into three categories: missing completely at random (MCAR), missing at random (MAR), and missing not at random (MNAR). Valid statistical approaches to missing data depend crucially on correct identification of the underlying missingness mechanism. Although the problem of testing whether this mechanism is MCAR or MAR has been extensively studied, there has been very little research on testing MAR versus MNAR. A critical challenge that is faced when dealing with this problem is the issue of model identification under MNAR. In this paper, under a logistic model for the missing probability, we develop two score tests for the problem of whether the missingness mechanism is MAR or MNAR under a parametric model and a semiparametric location model on the regression function. The implementation of the score tests circumvents the identification issue as it requires only parameter estimation under the null MAR assumption. Our simulations and analysis of human immunodeficiency virus data show that the score tests have well-controlled type I errors and desirable powers.     

Biased Estimation of Adjusted Odds Ratios from Incomplete Covariate Data Due to Violation of the Missing at Random Assumption

We investigate the possible bias due to an erroneous missing at random assumption if adjusted odds ratios are estimated from incomplete covariate data using the maximum likelihood principle. A relation between complete case estimates and maximum likelihood estimates allows us to identify situations where the bias vanishes. Numerical computations demonstrate that the bias is most serious if the degree of the violation of the missing at random assumption depends on the value of the outcome variable or of the observed covariate. Implications for the analysis of prospective and retrospective studies are given.     

Bayesian informative dropout model for longitudinal binary data with random effects using conditional and joint modeling approaches

Dropouts are common in longitudinal study. If the dropout probability depends on the missing observations at or after dropout, this type of dropout is called informative (or nonignorable) dropout (ID). Failure to accommodate such dropout mechanism into the model will bias the parameter estimates. We propose a conditional autoregressive model for longitudinal binary data with an ID model such that the probabilities of positive outcomes as well as the drop‐out indicator in each occasion are logit linear in some covariates and outcomes. This model adopting a marginal model for outcomes and a conditional model for dropouts is called a selection model. To allow for the heterogeneity and clustering effects, the outcome model is extended to incorporate mixture and random effects. Lastly, the model is further extended to a novel model that models the outcome and dropout jointly such that their dependency is formulated through an odds ratio function. Parameters are estimated by a Bayesian approach implemented using the user‐friendly Bayesian software WinBUGS. A methadone clinic dataset is analyzed to illustrate the proposed models. Result shows that the treatment time effect is still significant but weaker after allowing for an ID process in the data. Finally the effect of drop‐out on parameter estimates is evaluated through simulation studies.     

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.     

Nonignorable missingness in matched case-control data analyses

Matched case-control data analysis is often challenged by a missing covariate problem, the mishandling of which could cause bias or inefficiency. Satten and Carroll (2000, Biometrics56, 384-388) and other authors have proposed methods to handle missing covariates when the probability of missingness depends on the observed data, i.e., when data are missing at random. In this article, we propose a conditional likelihood method to handle the case when the probability of missingness depends on the unobserved covariate, i.e., when data are nonignorably missing. When the missing covariate is binary, the proposed method can be implemented using standard software. Using the Northern Manhattan Stroke Study data, we illustrate the method and discuss how sensitivity analysis can be conducted.     

A note on MAR, identifying restrictions, model comparison, and sensitivity analysis in pattern mixture models with and without covariates for incomplete data

Summary Pattern mixture modeling is a popular approach for handling incomplete longitudinal data. Such models are not identifiable by construction. Identifying restrictions is one approach to mixture model identification ( Little, 1995 , Journal of the American Statistical Association 90 , 1112–1121; Little and Wang, 1996 , Biometrics 52 , 98–111; Thijs et al., 2002 , Biostatistics 3 , 245–265; Kenward, Molenberghs, and Thijs, 2003 , Biometrika 90 , 53–71; Daniels and Hogan, 2008 , in Missing Data in Longitudinal Studies: Strategies for Bayesian Modeling and Sensitivity Analysis) and is a natural starting point for missing not at random sensitivity analysis ( Thijs et al., 2002 , Biostatistics 3 , 245–265; Daniels and Hogan, 2008 , in Missing Data in Longitudinal Studies: Strategies for Bayesian Modeling and Sensitivity Analysis). However, when the pattern specific models are multivariate normal, identifying restrictions corresponding to missing at random (MAR) may not exist. Furthermore, identification strategies can be problematic in models with covariates (e.g., baseline covariates with time‐invariant coefficients). In this article, we explore conditions necessary for identifying restrictions that result in MAR to exist under a multivariate normality assumption and strategies for identifying sensitivity parameters for sensitivity analysis or for a fully Bayesian analysis with informative priors. In addition, we propose alternative modeling and sensitivity analysis strategies under a less restrictive assumption for the distribution of the observed response data. We adopt the deviance information criterion for model comparison and perform a simulation study to evaluate the performances of the different modeling approaches. We also apply the methods to a longitudinal clinical trial. Problems caused by baseline covariates with time‐invariant coefficients are investigated and an alternative identifying restriction based on residuals is proposed as a solution.     

Improved Doubly Robust Estimation When Data Are Monotonely Coarsened,with Application to Longitudinal Studies with Dropout

Summary A routine challenge is that of making inference on parameters in a statistical model of interest from longitudinal data subject to dropout, which are a special case of the more general setting of monotonely coarsened data. Considerable recent attention has focused on doubly robust (DR) estimators, which in this context involve positing models for both the missingness (more generally, coarsening) mechanism and aspects of the distribution of the full data, that have the appealing property of yielding consistent inferences if only one of these models is correctly specified. DR estimators have been criticized for potentially disastrous performance when both of these models are even only mildly misspecified. We propose a DR estimator applicable in general monotone coarsening problems that achieves comparable or improved performance relative to existing DR methods, which we demonstrate via simulation studies and by application to data from an AIDS clinical trial.     

A sensitivity analysis for nonrandomly missing categorical data arising from a national health disability survey

Using data from 145,007 adults in the Disability Supplement to the National Health Interview Survey, we investigated the effect of balance difficulties on frequent depression after controlling for age, gender, race, and other baseline health status information. There were two major complications: (i) 80% of subjects were missing data on depression and the missing-data mechanism was likely related to depression, and (ii) the data arose from a complex sample survey. To adjust for (i) we investigated three classes of models: missingness in depression, missingness in depression and balance, and missingness in depression with an auxiliary variable. To adjust for (ii) we developed the first linearization variance formula for nonignorable missing-data models. Our sensitivity analysis was based on fitting a range of ignorable missing-data models along with nonignorable missing-data models that added one or two parameters. All nonignorable missing-data models that we considered fit the data substantially better than their ignorable missing-data counterparts. Under an ignorable missing-data mechanism, the odds ratio for the association between balance and depression was 2.0 with a 95% CI of (1.8, 2.2). Under 29 of the 30 selected nonignorable missing-data models, the odds ratios ranged from 2.7 with 95% CI of (2.3, 3.1) to 4.2 with 95% CI of (3.9, 4.6). Under one nonignorable missing-data model, the odds ratio was 7.4 with 95% CI of (6.3, 8.6). This is the first analysis to find a strong association between balance difficulties and frequent depression.