Analysis of Rates Using a Generalized Poisson Regression Model

In this paper a generalization of the Poisson regression model indexed by a shape parameter is proposed for the analysis of life table and follow-up data with concomitant variables. The model is suitable for analysis of extra-Poisson variation data. The model is used to fit the survival data given in Holford (1980). The model parameters, the hazard and survival functions are estimated by the method of maximum likelihood. The results obtained from this study seem to be comparable to those obtained by Chen (1988). Approximate tests of the dispersion and goodness-of-fit of the data to the model are also discussed.     

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.     

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.     

A Semiparametric Joint Model for Longitudinal and Survival Data with Application to Hemodialysis Study

Summary .  In many longitudinal clinical studies, the level and progression rate of repeatedly measured biomarkers on each subject quantify the severity of the disease and that subject's susceptibility to progression of the disease. It is of scientific and clinical interest to relate such quantities to a later time-to-event clinical endpoint such as patient survival. This is usually done with a shared parameter model. In such models, the longitudinal biomarker data and the survival outcome of each subject are assumed to be conditionally independent given subject-level severity or susceptibility (also called frailty in statistical terms). In this article, we study the case where the conditional distribution of longitudinal data is modeled by a linear mixed-effect model, and the conditional distribution of the survival data is given by a Cox proportional hazard model. We allow unknown regression coefficients and time-dependent covariates in both models. The proposed estimators are maximizers of an exact correction to the joint log likelihood with the frailties eliminated as nuisance parameters, an idea that originated from correction of covariate measurement error in measurement error models. The corrected joint log likelihood is shown to be asymptotically concave and leads to consistent and asymptotically normal estimators. Unlike most published methods for joint modeling, the proposed estimation procedure does not rely on distributional assumptions of the frailties. The proposed method was studied in simulations and applied to a data set from the Hemodialysis Study.     

A comparison of test statistics for assessing the effects of concomitant variables in survival analysis

In data analysis involving the proportional-hazards regression model due to Cox (1972, Journal of the Royal Statistical Society, Series B 34, 187-220), the test criteria commonly used for assessing the partial contribution to survival of subsets of concomitant variables are the classical likelihood ratio (LR) and Wald statistics. This paper presents an investigation of three other test criteria with potentially major computational advantages over the classical tests, especially for stepwise variable selection in moderate to large data sets. The alternative criteria considered are Rao's efficient score statistic and two other score statistics. Under the Cox model, the performance of these tests is examined empirically and compared with the performance of the LR and Wald statistics. Rao's test performs comparably to the LR test in all the cases considered. The performance of the other criteria is competitive in many cases. The use of these statistics is illustrated in a study of coronary artery disease.     

Linear parameter haplotype models with stratification

OBJECTIVES: The question of interest is estimating the relationship between haplotypes and an outcome measure, based upon unphased genotypes. The outcome of interest might be predicting the presence of disease in a logistic model, predicting a numeric drug response in a linear model, or predicting survival time in a parametric survival model with censoring. Explanatory variables may include phased haplotype design variables, environmental variables, or interactions between them. METHODS: We extend existing generalized linear haplotype models to parametric survival outcomes. To improve the stability of model variance estimates, a profile likelihood solution is proposed. An adjustment for population stratification is also considered. Here we investigate data sampled from known 'strata' (e.g., gender or ethnicity) that influence haplotype prior probabilities and thus the regression model weights. Differing linear model variance estimates, and the effect of stratification and departures from Hardy-Weinberg Equilibrium (HWE) on parameter estimates, are compared and contrasted via simulation. RESULTS: From simulations, we observed an improvement in statistical power when using a solution to profile likelihood equations. We also saw that stratification had little impact on estimates. Haplotypes that are not in HWE had a negative impact on power to test hypotheses. Finally, profile likelihood solutions for haplotypes deviating from HWE had improved power and confidence interval coverage of regression model coefficients.     

Estimation of doubly labeled water energy expenditure with confidence intervals

Bivariate regression is used to estimate energy expenditure from doubly labeled water data. Two straight lines are fitted to the logarithms of the enrichments of oxygen-18 and deuterium simultaneously as a bivariate regression, so that the correlations between the oxygen and deuterium regression coefficients can be estimated. Maximum likelihood methods are used to extend bivariate regression to unbalanced situations caused by missing observations and to include replicate laboratory determination from the same urine samples, even if one of the replicates is missing. Use of maximum likelihood allows the determination of a confidence interval for the energy expenditure based on the log likelihood surface rather than use of the propagation of variance methods for nonlinear transformations. The model is extended to include the subject's deviations from the two lines as a bivariate continuous-time first-order autoregression to allow for serial correlation in the observations. The analysis of data from two subjects, one without apparent serial correlation and one with serial correlation, is presented.     

Bayesian Modeling of Age-Specific Survival in Nesting Studies Under Dirichlet Priors

There has been much work done in nest survival analysis using the maximum likelihood (ML) method. The ML method suffers from the instability of numerical calculations when models having a large number of unknown parameters are used. A Bayesian approach of model fitting is developed to estimate age-specific survival rates for nesting studies using a large class of prior distributions. The computation is done by Gibbs sampling. Some latent variables are introduced to simplify the full conditional distributions. The method is illustrated using both a real and a simulated data set. Results indicate that Bayesian analysis provides stable and accurate estimates of nest survival rates.     

Joint models for multivariate longitudinal and multivariate survival data

Joint modeling of longitudinal and survival data is becoming increasingly essential in most cancer and AIDS clinical trials. We propose a likelihood approach to extend both longitudinal and survival components to be multidimensional. A multivariate mixed effects model is presented to explicitly capture two different sources of dependence among longitudinal measures over time as well as dependence between different variables. For the survival component of the joint model, we introduce a shared frailty, which is assumed to have a positive stable distribution, to induce correlation between failure times. The proposed marginal univariate survival model, which accommodates both zero and nonzero cure fractions for the time to event, is then applied to each marginal survival function. The proposed multivariate survival model has a proportional hazards structure for the population hazard, conditionally as well as marginally, when the baseline covariates are specified through a specific mechanism. In addition, the model is capable of dealing with survival functions with different cure rate structures. The methodology is specifically applied to the International Breast Cancer Study Group (IBCSG) trial to investigate the relationship between quality of life, disease-free survival, and overall survival.     

Estimation in the cox proportional hazards model with left-truncated and interval-censored data

We show that the nonparametric maximum likelihood estimate (NPMLE) of the regression coefficient from the joint likelihood (of the regression coefficient and the baseline survival) works well for the Cox proportional hazards model with left-truncated and interval-censored data, but the NPMLE may underestimate the baseline survival. Two alternatives are also considered: first, the marginal likelihood approach by extending Satten (1996, Biometrika 83, 355-370) to truncated data, where the baseline distribution is eliminated as a nuisance parameter; and second, the monotone maximum likelihood estimate that maximizes the joint likelihood by assuming that the baseline distribution has a nondecreasing hazard function, which was originally proposed to overcome the underestimation of the survival from the NPMLE for left-truncated data without covariates (Tsai, 1988, Biometrika 75, 319-324). The bootstrap is proposed to draw inference. Simulations were conducted to assess their performance. The methods are applied to the Massachusetts Health Care Panel Study data set to compare the probabilities of losing functional independence for male and female seniors.     

Semiparametric approaches for joint modeling of longitudinal and survival data with time-varying coefficients

Summary .   We study joint modeling of survival and longitudinal data. There are two regression models of interest. The primary model is for survival outcomes, which are assumed to follow a time-varying coefficient proportional hazards model. The second model is for longitudinal data, which are assumed to follow a random effects model. Based on the trajectory of a subject's longitudinal data, some covariates in the survival model are functions of the unobserved random effects. Estimated random effects are generally different from the unobserved random effects and hence this leads to covariate measurement error. To deal with covariate measurement error, we propose a local corrected score estimator and a local conditional score estimator. Both approaches are semiparametric methods in the sense that there is no distributional assumption needed for the underlying true covariates. The estimators are shown to be consistent and asymptotically normal. However, simulation studies indicate that the conditional score estimator outperforms the corrected score estimator for finite samples, especially in the case of relatively large measurement error. The approaches are demonstrated by an application to data from an HIV clinical trial.     

Bayesian inference for prevalence in longitudinal two-phase studies

We consider Bayesian inference and model selection for prevalence estimation using a longitudinal two-phase design in which subjects initially receive a low-cost screening test followed by an expensive diagnostic test conducted on several occasions. The change in the subject's diagnostic probability over time is described using four mixed-effects probit models in which the subject-specific effects are captured by latent variables. The computations are performed using Markov chain Monte Carlo methods. These models are then compared using the deviance information criterion. The methodology is illustrated with an analysis of alcohol and drug use in adolescents using data from the Great Smoky Mountains Study.     

Sample-size formula for the proportional-hazards regression model

A formula is derived for determining the number of observations necessary to test the equality of two survival distributions when concomitant information is incorporated. This formula should be useful in designing clinical trials with a heterogeneous patient population. Schoenfeld (1981, Biometrika 68, 316-319) derived the asymptotic power of a class of statistics used to test the equality of two survival distributions. That result is extended to the case where concomitant information is available for each individual and where the proportional-hazards model holds. The loss of efficiency caused by ignoring concomitant variables is also computed.     

Mixed Poisson likelihood regression models for longitudinal interval count data

In many longitudinal studies it is desired to estimate and test the rate over time of a particular recurrent event. Often only the event counts corresponding to the elapsed time intervals between each subject's successive observation times, and baseline covariate data, are available. The intervals may vary substantially in length and number between subjects, so that the corresponding vectors of counts are not directly comparable. A family of Poisson likelihood regression models incorporating a mixed random multiplicative component in the rate function of each subject is proposed for this longitudinal data structure. A related empirical Bayes estimate of random-effect parameters is also described. These methods are illustrated by an analysis of dyspepsia data from the National Cooperative Gallstone Study.     

A variable risk clinical prognostic compartmental model

A model for predicting the occurrence of disease endpoints from a knowledge of baseline variables and intermediate events is described and illustrated with numerical examples. Maximum likelihood equations are developed and maximum likelihood estimates of coefficients in risk functions of variables included in a stepwise upward procedure are applied to a small set of data for illustrative purposes.     

The Analysis of Life Table and Follow-up Data with Covariates Using Poisson Regression Model

The Poisson regression model for the analysis of life table and follow-up data with covariates is presented. An example is presented to show how this technique can be used to construct a parsimonious model which describes a set of survival data. All parameters in the model, the hazard and survival functions are estimated by maximum likelihood.     

Testing hypotheses in case-control studies--equivalence of Mantel-Haenszel statistics and logit score tests.

The two approaches in common use for the analysis of case-control studies are cross-classification by confounding variables, and modeling the logarithm of the odds ratio as a function of exposure and confounding variables. We show here that score statistics derived from the likelihood function in the latter approach are identical to the Mantel-Haenszel test statistics appropriate for the former approach. This identity holds in the most general situation considered, testing for marginal homogeneity in mK tables. This equivalence is demonstrated by a permutational argument which leads to a general likelihood expression in which the exposure variable may be a vector of discrete and/or continuous variables and in which more than two comparison groups may be considered. This likelihood can be used in analyzing studies in which there are multiple controls for each case or in which several disease categories are being compared. The possibility of including continuous variables makes this likelihood useful in situations that cannot be treated using the Mantel-Haenszel cross-classification approach.     

Distribution-free regression analysis of grouped survival data

Methods based on regression models for logarithmic hazard functions, Cox models, are given for analysis of grouped and censored survival data. By making an approximation it is possible to obtain explicitly a maximum likelihood function involving only the regression parameters. This likelihood function is a convenient analog to Cox's partial likelihood for ungrouped data. The method is applied to data from a toxicological experiment.     

The effect of conditional dependence on the evaluation of diagnostic tests

The accuracy of a new diagnostic test is often determined by comparison with a reference test which also has unknown error rates. Maximum likelihood estimation of the error rates of both tests is possible if they are simultaneously applied to two populations with different disease prevalences. The estimation procedure assumes that the two tests are independent, conditional on a subject's true diagnostic status. If the tests are conditionally dependent, error rates for both tests can be substantially underestimated. Estimators for the prevalence rates in the two populations can be positively or negatively biased, depending on the relative magnitude of the two conditional covariances and the value of the prevalence parameter.     

Bayes Estimator of Survival Probability from Randomly Censored Observations with Weibull Distribution of Time to Death

This paper deals with Bayes estimation of survival probability when the data are randomly censored. Such a situation arises in case of a clinical trial which extends for a limited period T. A fixed number of patients (n) are observed whose times to death have identical Weibull distribution with parameters β and θ. The maximum times of observation for different patients are also independent uniform variables as the patients arrive randomly throughout the trial. For the joint prior distribution of (β, θ) as suggested by Sinha and Kale (1980, page 137) Bayes estimator of survival probability at time t (0<t<T) has been obtained. Considering squared error loss function it is the mean of the survival probability with respect to the posterior distribution of (β, θ). This estimator is then compared with the maximum likelihood estimator, by simulation, for various values of β, θ and censoring percentage. The proposed estimator is found to be better under certain conditions.