Marginal Models for Clustered Time‐to‐Event Data with Competing Risks Using Pseudovalues

Summary Many time‐to‐event studies are complicated by the presence of competing risks and by nesting of individuals within a cluster, such as patients in the same center in a multicenter study. Several methods have been proposed for modeling the cumulative incidence function with independent observations. However, when subjects are clustered, one needs to account for the presence of a cluster effect either through frailty modeling of the hazard or subdistribution hazard, or by adjusting for the within‐cluster correlation in a marginal model. We propose a method for modeling the marginal cumulative incidence function directly. We compute leave‐one‐out pseudo‐observations from the cumulative incidence function at several time points. These are used in a generalized estimating equation to model the marginal cumulative incidence curve, and obtain consistent estimates of the model parameters. A sandwich variance estimator is derived to adjust for the within‐cluster correlation. The method is easy to implement using standard software once the pseudovalues are obtained, and is a generalization of several existing models. Simulation studies show that the method works well to adjust the SE for the within‐cluster correlation. We illustrate the method on a dataset looking at outcomes after bone marrow transplantation.     

Longitudinal Studies of Binary Response Data Following Case–Control and Stratified Case–Control Sampling: Design and Analysis

Summary We discuss design and analysis of longitudinal studies after case–control sampling, wherein interest is in the relationship between a longitudinal binary response that is related to the sampling (case–control) variable, and a set of covariates. We propose a semiparametric modeling framework based on a marginal longitudinal binary response model and an ancillary model for subjects' case–control status. In this approach, the analyst must posit the population prevalence of being a case, which is then used to compute an offset term in the ancillary model. Parameter estimates from this model are used to compute offsets for the longitudinal response model. Examining the impact of population prevalence and ancillary model misspecification, we show that time‐invariant covariate parameter estimates, other than the intercept, are reasonably robust, but intercept and time‐varying covariate parameter estimates can be sensitive to such misspecification. We study design and analysis issues impacting study efficiency, namely: choice of sampling variable and the strength of its relationship to the response, sample stratification, choice of working covariance weighting, and degree of flexibility of the ancillary model. The research is motivated by a longitudinal study following case–control sampling of the time course of attention deficit hyperactivity disorder (ADHD) symptoms.     

The Effect of Sample Design in the Discriminant Analysis for Two Groups

This paper shows the effect of sample design on the Discriminant Analysis for two groups by means of a simulation study involving stratified design. Four criteria of discrimination are used and compared. Also, the equivalency between the Multiple Linear Regression using the Generalized Estimating Equations and the Discriminant Analysis for two normal populations from a Complex Design is proved. The results are applied to an epidemiological problem.     

An Estimating Equations Approach for Modelling Kappa

Agreement between raters for binary outcome data is typically assessed using the kappa coefficient. There has been considerable recent work extending logistic regression to provide summary estimates of interrater agreement adjusted for covariates predictive of the marginal probability of classification by each rater. We propose an estimating equations approach which can also be used to identify covariates predictive of kappa. Models may include an arbitrary and variable number of raters per subject and yet do not require any stringent parametric assumptions. Examples used to illustrate this procedure include an investigation of factors affecting agreement between primary and proxy respondents from a case‐control study and a study of the effects of gender and zygosity on twin concordance for smoking history.     

Incorporating Correlation for Multivariate Failure Time Data When Cluster Size Is Large

Summary We propose a new estimation method for multivariate failure time data using the quadratic inference function (QIF) approach. The proposed method efficiently incorporates within‐cluster correlations. Therefore, it is more efficient than those that ignore within‐cluster correlation. Furthermore, the proposed method is easy to implement. Unlike the weighted estimating equations in Cai and Prentice (1995, Biometrika 82 , 151–164), it is not necessary to explicitly estimate the correlation parameters. This simplification is particularly useful in analyzing data with large cluster size where it is difficult to estimate intracluster correlation. Under certain regularity conditions, we show the consistency and asymptotic normality of the proposed QIF estimators. A chi‐squared test is also developed for hypothesis testing. We conduct extensive Monte Carlo simulation studies to assess the finite sample performance of the proposed methods. We also illustrate the proposed methods by analyzing primary biliary cirrhosis (PBC) data.     

The use of mixed logit models to reflect heterogeneity in capture-recapture studies

We examine issues in estimating population size N with capture-recapture models when there is variable catchability among subjects. We focus on a logistic-normal mixed model, for which the logit of the probability of capture is an additive function of a random subject and a fixed sampling occasion parameter. When the probability of capture is small or the degree of heterogeneity is large, the log-likelihood surface is relatively flat and it is difficult to obtain much information about N. We also discuss a latent class model and a log-linear model that account for heterogeneity and show that the log-linear model has greater scope. Models assuming homogeneity provide much narrower intervals for N but are usually highly overly optimistic, the actual coverage probability being much lower than the nominal level.     

Interval estimation of the mean difference in the analysis of over‐dispersed count data

This paper focuses on the development and study of the confidence interval procedures for mean difference between two treatments in the analysis of over‐dispersed count data in order to measure the efficacy of the experimental treatment over the standard treatment in clinical trials. In this study, two simple methods are proposed. One is based on a sandwich estimator of the variance of the regression estimator using the generalized estimating equations (GEEs) approach of Zeger and Liang (1986) and the other is based on an estimator of the variance of a ratio estimator (1977). We also develop three other procedures following the procedures studied by Newcombe (1998) and the procedure studied by Beal (1987). As assessed by Monte Carlo simulations, all the procedures have reasonably well coverage properties. Moreover, the interval procedure based on GEEs outperforms other interval procedures in the sense that it maintains the coverage very close to the nominal coverage level and that it has the shortest interval length, a satisfactory location property, and a very simple form, which can be easily implemented in the applied fields. Illustrative applications in the biological studies for these confidence interval procedures are also presented.     

Sample size determination in clinical trials with multiple co‐primary endpoints including mixed continuous and binary variables

In the field of pharmaceutical drug development, there have been extensive discussions on the establishment of statistically significant results that demonstrate the efficacy of a new treatment with multiple co‐primary endpoints. When designing a clinical trial with such multiple co‐primary endpoints, it is critical to determine the appropriate sample size for indicating the statistical significance of all the co‐primary endpoints with preserving the desired overall power because the type II error rate increases with the number of co‐primary endpoints. We consider overall power functions and sample size determinations with multiple co‐primary endpoints that consist of mixed continuous and binary variables, and provide numerical examples to illustrate the behavior of the overall power functions and sample sizes. In formulating the problem, we assume that response variables follow a multivariate normal distribution, where binary variables are observed in a dichotomized normal distribution with a certain point of dichotomy. Numerical examples show that the sample size decreases as the correlation increases when the individual powers of each endpoint are approximately and mutually equal.     

Modeling clustered long‐term survivors using marginal mixture cure model

There is a great deal of recent interests in modeling right‐censored clustered survival time data with a possible fraction of cured subjects who are nonsusceptible to the event of interest using marginal mixture cure models. In this paper, we consider a semiparametric marginal mixture cure model for such data and propose to extend an existing generalized estimating equation approach by a new unbiased estimating equation for the regression parameters in the latency part of the model. The large sample properties of the regression effect estimators in both incidence and the latency parts are established. The finite sample properties of the estimators are studied in simulation studies. The proposed method is illustrated with a bone marrow transplantation data and a tonsil cancer data.     

Analysis of Zero‐Inflated Poisson Data Incorporating Extent of Exposure

When analyzing Poisson count data sometimes a high frequency of extra zeros is observed. The Zero‐Inflated Poisson (ZIP) model is a popular approach to handle zero‐inflation. In this paper we generalize the ZIP model and its regression counterpart to accommodate the extent of individual exposure. Empirical evidence drawn from an occupational injury data set confirms that the incorporation of exposure information can exert a substantial impact on the model fit. Tests for zero‐inflation are also considered. Their finite sample properties are examined in a Monte Carlo study.     

Sample Size Considerations for GEE Analyses of Three‐Level Cluster Randomized Trials

Summary Cluster randomized trials in health care may involve three instead of two levels, for instance, in trials where different interventions to improve quality of care are compared. In such trials, the intervention is implemented in health care units (“clusters”) and aims at changing the behavior of health care professionals working in this unit (“subjects”), while the effects are measured at the patient level (“evaluations”). Within the generalized estimating equations approach, we derive a sample size formula that accounts for two levels of clustering: that of subjects within clusters and that of evaluations within subjects. The formula reveals that sample size is inflated, relative to a design with completely independent evaluations, by a multiplicative term that can be expressed as a product of two variance inflation factors, one that quantifies the impact of within‐subject correlation of evaluations on the variance of subject‐level means and the other that quantifies the impact of the correlation between subject‐level means on the variance of the cluster means. Power levels as predicted by the sample size formula agreed well with the simulated power for more than 10 clusters in total, when data were analyzed using bias‐corrected estimating equations for the correlation parameters in combination with the model‐based covariance estimator or the sandwich estimator with a finite sample correction.     

One‐Sided Test to Assess Correlation in Linear Logistic Models using Estimating Equations

A score‐type test is proposed for testing the hypothesis of independent binary random variables against positive correlation in linear logistic models with sparse data and cluster specific covariates. The test is developed for univariate and multivariate one‐sided alternatives. The main advantage of using score test is that it requires estimation of the model only under the null hypothesis, that in this case corresponds to the binomial maximum likelihood fit. The score‐type test is developed from a class of estimating equations with block‐diagonal structure in which the coefficients of the linear logistic model are estimated simultaneously with the correlation. The simplicity of the score test is illustrated in two particular examples.     

Multiscale Adaptive Marginal Analysis of Longitudinal Neuroimaging Data with Time‐Varying Covariates

Summary Neuroimaging data collected at repeated occasions are gaining increasing attention in the neuroimaging community due to their potential in answering questions regarding brain development, aging, and neurodegeneration. These datasets are large and complicated, characterized by the intricate spatial dependence structure of each response image, multiple response images per subject, and covariates that may vary with time. We propose a multiscale adaptive generalized method of moments (MA‐GMM) approach to estimate marginal regression models for imaging datasets that contain time‐varying, spatially related responses and some time‐varying covariates. Our method categorizes covariates into types to determine the valid moment conditions to combine during estimation. Further, instead of assuming independence of voxels (the components that make up each subject’s response image at each time point) as many current neuroimaging analysis techniques do, this method “adaptively smoothes” neuroimaging response data, computing parameter estimates by iteratively building spheres around each voxel and combining observations within the spheres with weights. MA‐GMM’s development adds to the few available modeling approaches intended for longitudinal imaging data analysis. Simulation studies and an analysis of a real longitudinal imaging dataset from the Alzheimer’s Disease Neuroimaging Initiative are used to assess the performance of MA‐GMM. Martha Skup, Hongtu Zhu, and Heping Zhang for the Alzheimer’s Disease Neuroimaging Initiative.     

Complementary Log–Log Regression for the Estimation of Covariate‐Adjusted Prevalence Ratios in the Analysis of Data from Cross‐Sectional Studies

We assessed complementary log–log (CLL) regression as an alternative statistical model for estimating multivariable‐adjusted prevalence ratios (PR) and their confidence intervals. Using the delta method, we derived an expression for approximating the variance of the PR estimated using CLL regression. Then, using simulated data, we examined the performance of CLL regression in terms of the accuracy of the PR estimates, the width of the confidence intervals, and the empirical coverage probability, and compared it with results obtained from log–binomial regression and stratified Mantel–Haenszel analysis. Within the range of values of our simulated data, CLL regression performed well, with only slight bias of point estimates of the PR and good confidence interval coverage. In addition, and importantly, the computational algorithm did not have the convergence problems occasionally exhibited by log–binomial regression. The technique is easy to implement in SAS (SAS Institute, Cary, NC), and it does not have the theoretical and practical issues associated with competing approaches. CLL regression is an alternative method of binomial regression that warrants further assessment.