A Stochastic Regression Model for General Trend Analysis of Longitudinal Continuous Data

A predictive continuous time model is developed for continuous panel data to assess the effect of time‐varying covariates on the general direction of the movement of a continuous response that fluctuates over time. This is accomplished by reparameterizing the infinitesimal mean of an Ornstein–Uhlenbeck processes in terms of its equilibrium mean and a drift parameter, which assesses the rate that the process reverts to its equilibrium mean. The equilibrium mean is modeled as a linear predictor of covariates. This model can be viewed as a continuous time first‐order autoregressive regression model with time‐varying lag effects of covariates and the response, which is more appropriate for unequally spaced panel data than its discrete time analog. Both maximum likelihood and quasi‐likelihood approaches are considered for estimating the model parameters and their performances are compared through simulation studies. The simpler quasi‐likelihood approach is suggested because it yields an estimator that is of high efficiency relative to the maximum likelihood estimator and it yields a variance estimator that is robust to the diffusion assumption of the model. To illustrate the proposed model, an application to diastolic blood pressure data from a follow‐up study on cardiovascular diseases is presented. Missing observations are handled naturally with this model.     

Analysis of Longitudinal Data of Epileptic Seizure Counts – A Two‐State Hidden Markov Regression Approach

This paper discusses a two‐state hidden Markov Poisson regression (MPR) model for analyzing longitudinal data of epileptic seizure counts, which allows for the rate of the Poisson process to depend on covariates through an exponential link function and to change according to the states of a two‐state Markov chain with its transition probabilities associated with covariates through a logit link function. This paper also considers a two‐state hidden Markov negative binomial regression (MNBR) model, as an alternative, by using the negative binomial instead of Poisson distribution in the proposed MPR model when there exists extra‐Poisson variation conditional on the states of the Markov chain. The two proposed models in this paper relax the stationary requirement of the Markov chain, allow for overdispersion relative to the usual Poisson regression model and for correlation between repeated observations. The proposed methodology provides a plausible analysis for the longitudinal data of epileptic seizure counts, and the MNBR model fits the data much better than the MPR model. Maximum likelihood estimation using the EM and quasi‐Newton algorithms is discussed. A Monte Carlo study for the proposed MPR model investigates the reliability of the estimation method, the choice of probabilities for the initial states of the Markov chain, and some finite sample behaviors of the maximum likelihood estimates, suggesting that (1) the estimation method is accurate and reliable as long as the total number of observations is reasonably large, and (2) the choice of probabilities for the initial states of the Markov process has little impact on the parameter estimates.     

Structured additive regression for categorical space-time data: a mixed model approach

Motivated by a space-time study on forest health with damage state of trees as the response, we propose a general class of structured additive regression models for categorical responses, allowing for a flexible semiparametric predictor. Nonlinear effects of continuous covariates, time trends, and interactions between continuous covariates are modeled by penalized splines. Spatial effects can be estimated based on Markov random fields, Gaussian random fields, or two-dimensional penalized splines. We present our approach from a Bayesian perspective, with inference based on a categorical linear mixed model representation. The resulting empirical Bayes method is closely related to penalized likelihood estimation in a frequentist setting. Variance components, corresponding to inverse smoothing parameters, are estimated using (approximate) restricted maximum likelihood. In simulation studies we investigate the performance of different choices for the spatial effect, compare the empirical Bayes approach to competing methodology, and study the bias of mixed model estimates. As an application we analyze data from the forest health survey.     

Analysis of longitudinal count data with serial correlation

We propose a state space model for analyzing equally or unequally spaced longitudinal count data with serial correlation. With a log link function, the mean of the Poisson response variable is a nonlinear function of the fixed and random effects. The random effects are assumed to be generated from a Gaussian first order autoregression (AR(1)). In this case, the mean of the observations has a log normal distribution. We use a combination of linear and nonlinear methods to take advantage of the Gaussian process embedded in a nonlinear function. The state space model uses a modified Kalman filter recursion to estimate the mean and variance of the AR(1) random error given the previous observations. The marginal likelihood is approximated by numerically integrating out the AR(1) random error. Simulation studies with different sets of parameters show that the state space model performs well. The model is applied to Epileptic Seizure data and Primary Care Visits Data. Missing and unequally spaced observations are handled naturally with this model.     

Bayesian latent multi‐state modeling for nonequidistant longitudinal electronic health records

Large amounts of longitudinal health records are now available for dynamic monitoring of the underlying processes governing the observations. However, the health status progression across time is not typically observed directly: records are observed only when a subject interacts with the system, yielding irregular and often sparse observations. This suggests that the observed trajectories should be modeled via a latent continuous‐time process potentially as a function of time‐varying covariates. We develop a continuous‐time hidden Markov model to analyze longitudinal data accounting for irregular visits and different types of observations. By employing a specific missing data likelihood formulation, we can construct an efficient computational algorithm. We focus on Bayesian inference for the model: this is facilitated by an expectation‐maximization algorithm and Markov chain Monte Carlo methods. Simulation studies demonstrate that these approaches can be implemented efficiently for large data sets in a fully Bayesian setting. We apply this model to a real cohort where patients suffer from chronic obstructive pulmonary disease with the outcome being the number of drugs taken, using health care utilization indicators and patient characteristics as covariates.     

A statistical model for under- or overdispersed clustered and longitudinal count data

We propose a likelihood-based model for correlated count data that display under- or overdispersion within units (e.g. subjects). The model is capable of handling correlation due to clustering and/or serial correlation, in the presence of unbalanced, missing or unequally spaced data. A family of distributions based on birth-event processes is used to model within-subject underdispersion. A computational approach is given to overcome a parameterization difficulty with this family, and this allows use of common Markov Chain Monte Carlo software (e.g. WinBUGS) for estimation. Application of the model to daily counts of asthma inhaler use by children shows substantial within-subject underdispersion, between-subject heterogeneity and correlation due to both clustering of measurements within subjects and serial correlation of longitudinal measurements. The model provides a major improvement over Poisson longitudinal models, and diagnostics show that the model fits well.     

A mixed model for two-state Markov processes under panel observation

Many chronic medical conditions can be meaningfully characterized in terms of a two-state stochastic process. Here we consider the problem in which subjects make transitions among two such states in continuous time but are only observed at discrete, irregularly spaced time points that are possibly unique to each subject. Data arising from such an observation scheme are called panel data, and methods for related analyses are typically based on Markov assumptions. The purpose of this article is to present a conditionally Markov model that accommodates subject-to-subject variation in the model parameters by the introduction of random effects. We focus on a particular random effects formulation that generates a closed-form expression for the marginal likelihood. The methodology is illustrated by application to a data set from a parasitic field infection survey.     

Markov models for covariate dependence of binary sequences

Suppose that a heterogeneous group of individuals is followed over time and that each individual can be in state 0 or state 1 at each time point. The sequence of states is assumed to follow a binary Markov chain. In this paper we model the transition probabilities for the 0 to 0 and 1 to 0 transitions by two logistic regressions, thus showing how the covariates relate to changes in state. With p covariates, there are 2(p + 1) parameters including intercepts, which we estimate by maximum likelihood. We show how to use transition probability estimates to test hypotheses about the probability of occupying state 0 at time i (i = 2, ..., T) and the equilibrium probability of state 0. These probabilities depend on the covariates. A recursive algorithm is suggested to estimate regression coefficients when some responses are missing. Extensions of the basic model which allow time-dependent covariates and nonstationary or second-order Markov chains are presented. An example shows the model applied to a study of the psychological impact of breast cancer in which women did or did not manifest distress at four time points in the year following surgery.     

Maximum likelihood analysis of a general latent variable model with hierarchically mixed data

A general two-level latent variable model is developed to provide a comprehensive framework for model comparison of various submodels. Nonlinear relationships among the latent variables in the structural equations at both levels, as well as the effects of fixed covariates in the measurement and structural equations at both levels, can be analyzed within the framework. Moreover, the methodology can be applied to hierarchically mixed continuous, dichotomous, and polytomous data. A Monte Carlo EM algorithm is implemented to produce the maximum likelihood estimate. The E-step is completed by approximating the conditional expectations through observations that are simulated by Markov chain Monte Carlo methods, while the M-step is completed by conditional maximization. A procedure is proposed for computing the complicated observed-data log likelihood and the BIC for model comparison. The methods are illustrated by using a real data set.     

Flexible nonhomogeneous markov models for panel observed data

Methods for fitting nonhomogeneous Markov models to panel-observed data using direct numerical solution to the Kolmogorov Forward equations are developed. Nonhomogeneous Markov models occur most commonly when baseline transition intensities depend on calendar time, but may also occur with deterministic time-dependent covariates such as age. We propose transition intensities based on B-splines as a smooth alternative to piecewise constant intensities and also as a generalization of time transformation models. An expansion of the system of differential equations allows first derivatives of the likelihood to be obtained, which can be used in a Fisher scoring algorithm for maximum likelihood estimation. The method is evaluated through a small simulation study and demonstrated on data relating to the development of cardiac allograft vasculopathy in posttransplantation patients.     

Unequally spaced longitudinal data with AR(1) serial correlation

This paper discusses longitudinal data analysis when each subject is observed at different unequally spaced time points. Observations within subjects are assumed to be either uncorrelated or to have a continuous-time first-order autoregressive structure, possibly with observation error. The random coefficients are assumed to have an arbitrary between-subject covariance matrix. Covariates can be included in the fixed effects part of the model. Exact maximum likelihood estimates of the unknown parameters are computed using the Kalman filter to evaluate the likelihood, which is then maximized with a nonlinear optimization program. An example is presented where a large number of subjects are each observed at a small number of observation times. Hypothesis tests for selecting the best model are carried out using Wald's test on contrasts or likelihood ratio tests based on fitting full and restricted models.     

A mixed mover-stayer model for spatiotemporal two-state processes

Studies of recurring infection or chronic disease often collect longitudinal data on the disease status of subjects. Two-state transitional models are useful for analysis in such studies where, at any point in time, an individual may be said to occupy either a diseased or disease-free state and interest centers on the transition process between states. Here, two additional features are present. The data are spatially arranged and it is important to account for spatial correlation in the transitional processes corresponding to different subjects. In addition there are subgroups of individuals with different mechanisms of transitions. These subgroups are not known a priori and hence group membership must be estimated. Covariates modulating transitions are included in a logistic additive framework. Inference for the resulting mixture spatial Markov regression model is not straightforward. We develop here a Monte Carlo expectation maximization algorithm for maximum likelihood estimation and a Markov chain Monte Carlo sampling scheme for summarizing the posterior distribution in a Bayesian analysis. The methodology is applied to a study of recurrent weevil infestation in British Columbia forests.     

A Dynamic Logistic Regression Model for Multiple Spell Failure Time Data

The paper deals with discrete-time regression models to analyze multistate-multiepisode failure time data. The covariate process may include fixed and external as well as internal time dependent covariates. The effects of the covariates may differ among different kinds of failures and among successive episodes. A dynamic form of the logistic regression model is investigated and maximum likelihood estimation of the regression coefficients is discussed. In the last section we give an application of the model to the analysis of survival time after breast cancer operation.     

Flexible modeling via a hybrid estimation scheme in generalized mixed models for longitudinal data

To circumvent the computational complexity of likelihood inference in generalized mixed models that assume linear or more general additive regression models of covariate effects, Laplace's approximations to multiple integrals in the likelihood have been commonly used without addressing the issue of adequacy of the approximations for individuals with sparse observations. In this article, we propose a hybrid estimation scheme to address this issue. The likelihoods for subjects with sparse observations use Monte Carlo approximations involving importance sampling, while Laplace's approximation is used for the likelihoods of other subjects that satisfy a certain diagnostic check on the adequacy of Laplace's approximation. Because of its computational tractability, the proposed approach allows flexible modeling of covariate effects by using regression splines and model selection procedures for knot and variable selection. Its computational and statistical advantages are illustrated by simulation and by application to longitudinal data from a fecundity study of fruit flies, for which overdispersion is modeled via a double exponential family.     

Maximum likelihood methods for nonignorable missing responses and covariates in random effects models

This article analyzes quality of life (QOL) data from an Eastern Cooperative Oncology Group (ECOG) melanoma trial that compared treatment with ganglioside vaccination to treatment with high-dose interferon. The analysis of this data set is challenging due to several difficulties, namely, nonignorable missing longitudinal responses and baseline covariates. Hence, we propose a selection model for estimating parameters in the normal random effects model with nonignorable missing responses and covariates. Parameters are estimated via maximum likelihood using the Gibbs sampler and a Monte Carlo expectation maximization (EM) algorithm. Standard errors are calculated using the bootstrap. The method allows for nonmonotone patterns of missing data in both the response variable and the covariates. We model the missing data mechanism and the missing covariate distribution via a sequence of one-dimensional conditional distributions, allowing the missing covariates to be either categorical or continuous, as well as time-varying. We apply the proposed approach to the ECOG quality-of-life data and conduct a small simulation study evaluating the performance of the maximum likelihood estimates. Our results indicate that a patient treated with the vaccine has a higher QOL score on average at a given time point than a patient treated with high-dose interferon.     

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.     

A time-heterogeneous D-vine copula model for unbalanced and unequally spaced longitudinal data

In many longitudinal studies, the number and timing of measurements differ across study subjects. Statistical analysis of such data requires accounting for both the unbalanced study design and the unequal spacing of repeated measurements. This paper proposes a time-heterogeneous D-vine copula model that allows for time adjustment in the dependence structure of unequally spaced and potentially unbalanced longitudinal data. The proposed approach not only offers flexibility over its time-homogeneous counterparts but also allows for parsimonious model specifications at the tree or vine level for a given D-vine structure. It further provides a robust strategy to specify the joint distribution of non-Gaussian longitudinal data. The performance of the time-heterogeneous D-vine copula models are evaluated through simulation studies and by a real data application. Our findings suggest improved predictive performance of the proposed approach over the linear mixed-effects model and time-homogeneous D-vine copula model.     

Zero‐Inflated Negative Binomial Mixed Regression Modeling of Over‐Dispersed Count Data with Extra Zeros

In many biometrical applications, the count data encountered often contain extra zeros relative to the Poisson distribution. Zero‐inflated Poisson regression models are useful for analyzing such data, but parameter estimates may be seriously biased if the nonzero observations are over‐dispersed and simultaneously correlated due to the sampling design or the data collection procedure. In this paper, a zero‐inflated negative binomial mixed regression model is presented to analyze a set of pancreas disorder length of stay (LOS) data that comprised mainly same‐day separations. Random effects are introduced to account for inter‐hospital variations and the dependency of clustered LOS observations. Parameter estimation is achieved by maximizing an appropriate log‐likelihood function using an EM algorithm. Alternative modeling strategies, namely the finite mixture of Poisson distributions and the non‐parametric maximum likelihood approach, are also considered. The determination of pertinent covariates would assist hospital administrators and clinicians to manage LOS and expenditures efficiently.     

A mixed-effects regression model for longitudinal multivariate ordinal data

A mixed-effects item response theory model that allows for three-level multivariate ordinal outcomes and accommodates multiple random subject effects is proposed for analysis of multivariate ordinal outcomes in longitudinal studies. This model allows for the estimation of different item factor loadings (item discrimination parameters) for the multiple outcomes. The covariates in the model do not have to follow the proportional odds assumption and can be at any level. Assuming either a probit or logistic response function, maximum marginal likelihood estimation is proposed utilizing multidimensional Gauss-Hermite quadrature for integration of the random effects. An iterative Fisher scoring solution, which provides standard errors for all model parameters, is used. An analysis of a longitudinal substance use data set, where four items of substance use behavior (cigarette use, alcohol use, marijuana use, and getting drunk or high) are repeatedly measured over time, is used to illustrate application of the proposed model.     

Stochastic Approximation Boosting for Incomplete Data Problems

Summary Boosting is a powerful approach to fitting regression models. This article describes a boosting algorithm for likelihood‐based estimation with incomplete data. The algorithm combines boosting with a variant of stochastic approximation that uses Markov chain Monte Carlo to deal with the missing data. Applications to fitting generalized linear and additive models with missing covariates are given. The method is applied to the Pima Indians Diabetes Data where over half of the cases contain missing values.