Modeling multivariate survival data by a semiparametric random effects proportional odds model

In this article, the focus is on the analysis of multivariate survival time data with various types of dependence structures. Examples of multivariate survival data include clustered data and repeated measurements from the same subject, such as the interrecurrence times of cancer tumors. A random effect semiparametric proportional odds model is proposed as an alternative to the proportional hazards model. The distribution of the random effects is assumed to be multivariate normal and the random effect is assumed to act additively to the baseline log-odds function. This class of models, which includes the usual shared random effects model, the additive variance components model, and the dynamic random effects model as special cases, is highly flexible and is capable of modeling a wide range of multivariate survival data. A unified estimation procedure is proposed to estimate the regression and dependence parameters simultaneously by means of a marginal-likelihood approach. Unlike the fully parametric case, the regression parameter estimate is not sensitive to the choice of correlation structure of the random effects. The marginal likelihood is approximated by the Monte Carlo method. Simulation studies are carried out to investigate the performance of the proposed method. The proposed method is applied to two well-known data sets, including clustered data and recurrent event times data.     

Modeling microarray data using a threshold mixture model

An important goal of microarray studies is the detection of genes that show significant changes in expression when two classes of biological samples are being compared. We present an ANOVA-style mixed model with parameters for array normalization, overall level of gene expression, and change of expression between the classes. For the latter we assume a mixing distribution with a probability mass concentrated at zero, representing genes with no changes, and a normal distribution representing the level of change for the other genes. We estimate the parameters by optimizing the marginal likelihood. To make this practical, Laplace approximations and a backfitting algorithm are used. The performance of the model is studied by simulation and by application to publicly available data sets.     

Bayesian semiparametric dynamic frailty models for multiple event time data

Many biomedical studies collect data on times of occurrence for a health event that can occur repeatedly, such as infection, hospitalization, recurrence of disease, or tumor onset. To analyze such data, it is necessary to account for within-subject dependency in the multiple event times. Motivated by data from studies of palpable tumors, this article proposes a dynamic frailty model and Bayesian semiparametric approach to inference. The widely used shared frailty proportional hazards model is generalized to allow subject-specific frailties to change dynamically with age while also accommodating nonproportional hazards. Parametric assumptions on the frailty distribution are avoided by using Dirichlet process priors for a shared frailty and for multiplicative innovations on this frailty. By centering the semiparametric model on a conditionally conjugate dynamic gamma model, we facilitate posterior computation and lack-of-fit assessments of the parametric model. Our proposed method is demonstrated using data from a cancer chemoprevention study.     

Joint modeling of longitudinal and survival data via a common frailty

We develop a joint model for the analysis of longitudinal and survival data in the presence of data clustering. We use a mixed effects model for the repeated measures that incorporates both subject- and cluster-level random effects, with subjects nested within clusters. A Cox frailty model is used for the survival model in order to accommodate the clustering. We then link the two responses via the common cluster-level random effects, or frailties. This model allows us to simultaneously evaluate the effect of covariates on the two types of responses, while accounting for both the relationship between the responses and data clustering. The model was motivated by a study of end-stage renal disease patients undergoing hemodialysis, where we wished to evaluate the effect of iron treatment on both the patients' hemoglobin levels and survival times, with the patients clustered by enrollment site.     

Proper multivariate conditional autoregressive models for spatial data analysis

In the past decade conditional autoregressive modelling specifications have found considerable application for the analysis of spatial data. Nearly all of this work is done in the univariate case and employs an improper specification. Our contribution here is to move to multivariate conditional autoregressive models and to provide rich, flexible classes which yield proper distributions. Our approach is to introduce spatial autoregression parameters. We first clarify what classes can be developed from the family of Mardia (1988) and contrast with recent work of Kim et al. (2000). We then present a novel parametric linear transformation which provides an extension with attractive interpretation. We propose to employ these models as specifications for second-stage spatial effects in hierarchical models. Two applications are discussed; one for the two-dimensional case modelling spatial patterns of child growth, the other for a four-dimensional situation modelling spatial variation in HLA-B allele frequencies. In each case, full Bayesian inference is carried out using Markov chain Monte Carlo simulation.     

Hierarchical proportional hazards regression models for highly stratified data

In clinical trials conducted over several data collection centers, the most common statistically defensible analytic method, a stratified Cox model analysis, suffers from two important defects. First, identification of units that are outlying with respect to the baseline hazard is awkward since this hazard is implicit (rather than explicit) in the Cox partial likelihood. Second (and more seriously), identification of modest treatment effects is often difficult since the model fails to acknowledge any similarity across the strata. We consider a number of hierarchical modeling approaches that preserve the integrity of the stratified design while offering a middle ground between traditional stratified and unstratified analyses. We investigate both fully parametric (Weibull) and semiparametric models, the latter based not on the Cox model but on an extension of an idea by Gelfand and Mallick (1995, Biometrics 51, 843-852), which models the integrated baseline hazard as a mixture of monotone functions. We illustrate the methods using data from a recent multicenter AIDS clinical trial, comparing their ease of use, interpretation, and degree of robustness with respect to estimates of both the unit-specific baseline hazards and the treatment effect.     

A spatial scan statistic for survival data

Spatial scan statistics with Bernoulli and Poisson models are commonly used for geographical disease surveillance and cluster detection. These models, suitable for count data, were not designed for data with continuous outcomes. We propose a spatial scan statistic based on an exponential model to handle either uncensored or censored continuous survival data. The power and sensitivity of the developed model are investigated through intensive simulations. The method performs well for different survival distribution functions including the exponential, gamma, and log-normal distributions. We also present a method to adjust the analysis for covariates. The cluster detection method is illustrated using survival data for men diagnosed with prostate cancer in Connecticut from 1984 to 1995.     

Modeling longitudinal data with nonparametric multiplicative random effects jointly with survival data

Summary .   In clinical studies, longitudinal biomarkers are often used to monitor disease progression and failure time. Joint modeling of longitudinal and survival data has certain advantages and has emerged as an effective way to mutually enhance information. Typically, a parametric longitudinal model is assumed to facilitate the likelihood approach. However, the choice of a proper parametric model turns out to be more elusive than models for standard longitudinal studies in which no survival endpoint occurs. In this article, we propose a nonparametric multiplicative random effects model for the longitudinal process, which has many applications and leads to a flexible yet parsimonious nonparametric random effects model. A proportional hazards model is then used to link the biomarkers and event time. We use B-splines to represent the nonparametric longitudinal process, and select the number of knots and degrees based on a version of the Akaike information criterion (AIC). Unknown model parameters are estimated through maximizing the observed joint likelihood, which is iteratively maximized by the Monte Carlo Expectation Maximization (MCEM) algorithm. Due to the simplicity of the model structure, the proposed approach has good numerical stability and compares well with the competing parametric longitudinal approaches. The new approach is illustrated with primary biliary cirrhosis (PBC) data, aiming to capture nonlinear patterns of serum bilirubin time courses and their relationship with survival time of PBC patients.     

Bayesian variable selection and estimation in semiparametric joint models of multivariate longitudinal and survival data

This paper presents a novel semiparametric joint model for multivariate longitudinal and survival data (SJMLS) by relaxing the normality assumption of the longitudinal outcomes, leaving the baseline hazard functions unspecified and allowing the history of the longitudinal response having an effect on the risk of dropout. Using Bayesian penalized splines to approximate the unspecified baseline hazard function and combining the Gibbs sampler and the Metropolis–Hastings algorithm, we propose a Bayesian Lasso (BLasso) method to simultaneously estimate unknown parameters and select important covariates in SJMLS. Simulation studies are conducted to investigate the finite sample performance of the proposed techniques. An example from the International Breast Cancer Study Group (IBCSG) is used to illustrate the proposed methodologies.     

Aberrant crypt foci and semiparametric modeling of correlated binary data

Summary .   Motivated by the spatial modeling of aberrant crypt foci (ACF) in colon carcinogenesis, we consider binary data with probabilities modeled as the sum of a nonparametric mean plus a latent Gaussian spatial process that accounts for short-range dependencies. The mean is modeled in a general way using regression splines. The mean function can be viewed as a fixed effect and is estimated with a penalty for regularization. With the latent process viewed as another random effect, the model becomes a generalized linear mixed model. In our motivating data set and other applications, the sample size is too large to easily accommodate maximum likelihood or restricted maximum likelihood estimation (REML), so pairwise likelihood, a special case of composite likelihood, is used instead. We develop an asymptotic theory for models that are sufficiently general to be used in a wide variety of applications, including, but not limited to, the problem that motivated this work. The splines have penalty parameters that must converge to zero asymptotically: we derive theory for this along with a data-driven method for selecting the penalty parameter, a method that is shown in simulations to improve greatly upon standard devices, such as likelihood crossvalidation. Finally, we apply the methods to the data from our experiment ACF. We discover an unexpected location for peak formation of ACF.     

Survival of bowhead whales,Balaena mysticetus,estimated from 1981-1998 photoidentification data

Annual survival probability of bowhead whales, Balaena mysticetus, was estimated using both Bayesian and maximum likelihood implementations of Cormack and Jolly-Seber (JS) models for capture-recapture estimation in open populations and reduced-parameter generalizations of these models. Aerial photographs of naturally marked bowheads collected between 1981 and 1998 provided the data. The marked whales first photographed in a particular year provided the initial 'capture' and 'release' of those marked whales and photographs in subsequent years the 'recaptures'. The Cormack model, often called the Cormack-Jolly-Seber (CJS) model, and the program MARK were used to identify the model with a single survival and time-varying capture probabilities as the most appropriate for these data. When survival was constrained to be one or less, the maximum likelihood estimate computed by MARK was one, invalidating confidence interval computations based on the asymptotic standard error or profile likelihood. A Bayesian Markov chain Monte Carlo (MCMC) implementation of the model was used to produce a posterior distribution for annual survival. The corresponding reduced-parameter JS model was also fit via MCMC because it is the more appropriate of the two models for these photoidentification data. Because the CJS model ignores much of the information on capture probabilities provided by the data, its results are less precise and more sensitive to the prior distributions used than results from the JS model. With priors for annual survival and capture probabilities uniform from 0 to 1, the posterior mean for bowhead survival rate from the JS model is 0.984, and 95% of the posterior probability lies between 0.948 and 1. This high estimated survival rate is consistent with other bowhead life history data.     

Design of long-term HIV dynamic studies using semiparametric mixed-effects models

Studies of HIV dynamics in AIDS research are very important in understanding the pathogenesis of HIV-1 infection and also in assessing the effectiveness of antiviral therapies. There are many AIDS clinical trials on HIV dynamics currently in development worldwide, giving rise to many design issues yet to be addressed. For example, most studies are focused on short-term viral dynamics and the existing models may not be applicable to describe long-term virologic response. In this paper, we use a simulation-based approach to study the designs of long-term viral dynamics under semiparametric nonlinear mixed-effects models. These models not only can preserve the meaningful interpretation of the short-term HIV dynamics, but also characterize the long-term virologic responses to antiretroviral (ARV) treatment. We investigate a number of feasible clinical protocol designs similar to those currently used in AIDS clinical trials. In particular, we evaluate whether earlier samplings can result in more useful information about the viral response trajectory; we also evaluate the effectiveness of two strategies: more frequent samplings per subject with fewer subjects versus fewer samplings per subject with more subjects while keeping the total number of samplings constant. The results of our investigation provide quantitative guidance for designing and selecting ARV therapy.     

Generalized hierarchical multivariate CAR models for areal data

In the fields of medicine and public health, a common application of areal data models is the study of geographical patterns of disease. When we have several measurements recorded at each spatial location (for example, information on p>/= 2 diseases from the same population groups or regions), we need to consider multivariate areal data models in order to handle the dependence among the multivariate components as well as the spatial dependence between sites. In this article, we propose a flexible new class of generalized multivariate conditionally autoregressive (GMCAR) models for areal data, and show how it enriches the MCAR class. Our approach differs from earlier ones in that it directly specifies the joint distribution for a multivariate Markov random field (MRF) through the specification of simpler conditional and marginal models. This in turn leads to a significant reduction in the computational burden in hierarchical spatial random effect modeling, where posterior summaries are computed using Markov chain Monte Carlo (MCMC). We compare our approach with existing MCAR models in the literature via simulation, using average mean square error (AMSE) and a convenient hierarchical model selection criterion, the deviance information criterion (DIC; Spiegelhalter et al., 2002, Journal of the Royal Statistical Society, Series B64, 583-639). Finally, we offer a real-data application of our proposed GMCAR approach that models lung and esophagus cancer death rates during 1991-1998 in Minnesota counties.     

Generalized spatial structural equation models

It is common in public health research to have high-dimensional, multivariate, spatially referenced data representing summaries of geographic regions. Often, it is desirable to examine relationships among these variables both within and across regions. An existing modeling technique called spatial factor analysis has been used and assumes that a common spatial factor underlies all the variables and causes them to be related to one another. An extension of this technique considers that there may be more than one underlying factor, and that relationships among the underlying latent variables are of primary interest. However, due to the complicated nature of the covariance structure of this type of data, existing methods are not satisfactory. We thus propose a generalized spatial structural equation model. In the first level of the model, we assume that the observed variables are related to particular underlying factors. In the second level of the model, we use the structural equation method to model the relationship among the underlying factors and use parametric spatial distributions on the covariance structure of the underlying factors. We apply the model to county-level cancer mortality and census summary data for Minnesota, including socioeconomic status and access to public utilities.     

Dynamic conditionally linear mixed models for longitudinal data

We develop a new class of models, dynamic conditionally linear mixed models, for longitudinal data by decomposing the within-subject covariance matrix using a special Cholesky decomposition. Here 'dynamic' means using past responses as covariates and 'conditional linearity' means that parameters entering the model linearly may be random, but nonlinear parameters are nonrandom. This setup offers several advantages and is surprisingly similar to models obtained from the first-order linearization method applied to nonlinear mixed models. First, it allows for flexible and computationally tractable models that include a wide array of covariance structures; these structures may depend on covariates and hence may differ across subjects. This class of models includes, e.g., all standard linear mixed models, antedependence models, and Vonesh-Carter models. Second, it guarantees the fitted marginal covariance matrix of the data is positive definite. We develop methods for Bayesian inference and motivate the usefulness of these models using a series of longitudinal depression studies for which the features of these new models are well suited.