The weighted generalized estimating equations approach for the evaluation of medical diagnostic test at subunit level

Sensitivity and specificity are common measures used to evaluate the performance of a diagnostic test. A diagnostic test is often administrated at a subunit level, e.g. at the level of vessel, ear or eye of a patient so that the treatment can be targeted at the specific subunit. Therefore, it is essential to evaluate the diagnostic test at the subunit level. Often patients with more negative subunit test results are less likely to receive the gold standard tests than patients with more positive subunit test results. To account for this type of missing data and correlation between subunit test results, we proposed a weighted generalized estimating equations (WGEE) approach to evaluate subunit sensitivities and specificities. A simulation study was conducted to evaluate the performance of the WGEE estimators and the weighted least squares (WLS) estimators (Barnhart and Kosinski, 2003) under a missing at random assumption. The results suggested that WGEE estimator is consistent under various scenarios of percentage of missing data and sample size, while the WLS approach could yield biased estimators due to a misspecified missing data mechanism. We illustrate the methodology with a cardiology example.     

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.     

Smoothed empirical likelihood inference for ROC curve in the presence of missing biomarker values

This paper considers statistical inference for the receiver operating characteristic (ROC) curve in the presence of missing biomarker values by utilizing estimating equations (EEs) together with smoothed empirical likelihood (SEL). Three approaches are developed to estimate ROC curve and construct its SEL-based confidence intervals based on the kernel-assisted EE imputation, multiple imputation, and hybrid imputation combining the inverse probability weighted imputation and multiple imputation. Under some regularity conditions, we show asymptotic properties of the proposed maximum SEL estimators for ROC curve. Simulation studies are conducted to investigate the performance of the proposed SEL approaches. An example is illustrated by the proposed methodologies. Empirical results show that the hybrid imputation method behaves better than the kernel-assisted and multiple imputation methods, and the proposed three SEL methods outperform existing nonparametric method.     

Multiple Imputation Approaches for the Analysis of Dichotomized Responses in Longitudinal Studies with Missing Data

Summary Often a binary variable is generated by dichotomizing an underlying continuous variable measured at a specific time point according to a prespecified threshold value. In the event that the underlying continuous measurements are from a longitudinal study, one can use the repeated‐measures model to impute missing data on responder status as a result of subject dropout and apply the logistic regression model on the observed or otherwise imputed responder status. Standard Bayesian multiple imputation techniques ( Rubin, 1987 , in Multiple Imputation for Nonresponse in Surveys) that draw the parameters for the imputation model from the posterior distribution and construct the variance of parameter estimates for the analysis model as a combination of within‐ and between‐imputation variances are found to be conservative. The frequentist multiple imputation approach that fixes the parameters for the imputation model at the maximum likelihood estimates and construct the variance of parameter estimates for the analysis model using the results of Robins and Wang (2000, Biometrika 87, 113–124) is shown to be more efficient. We propose to apply ( Kenward and Roger, 1997 , Biometrics 53, 983–997) degrees of freedom to account for the uncertainty associated with variance–covariance parameter estimates for the repeated measures model.     

Empirical‐likelihood‐based criteria for model selection on marginal analysis of longitudinal data with dropout missingness

Longitudinal data are common in clinical trials and observational studies, where missing outcomes due to dropouts are always encountered. Under such context with the assumption of missing at random, the weighted generalized estimating equation (WGEE) approach is widely adopted for marginal analysis. Model selection on marginal mean regression is a crucial aspect of data analysis, and identifying an appropriate correlation structure for model fitting may also be of interest and importance. However, the existing information criteria for model selection in WGEE have limitations, such as separate criteria for the selection of marginal mean and correlation structures, unsatisfactory selection performance in small‐sample setups, and so forth. In particular, there are few studies to develop joint information criteria for selection of both marginal mean and correlation structures. In this work, by embedding empirical likelihood into the WGEE framework, we propose two innovative information criteria named a joint empirical Akaike information criterion and a joint empirical Bayesian information criterion, which can simultaneously select the variables for marginal mean regression and also correlation structure. Through extensive simulation studies, these empirical‐likelihood‐based criteria exhibit robustness, flexibility, and outperformance compared to the other criteria including the weighted quasi‐likelihood under the independence model criterion, the missing longitudinal information criterion, and the joint longitudinal information criterion. In addition, we provide a theoretical justification of our proposed criteria, and present two real data examples in practice for further illustration.     

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.     

Effectiveness of Trichogramma ostriniae and T. nubilale for controlling the European corn borer Ostrinia nubilalis in sweet corn

Seven field releases of Trichogramma ostriniae and T. nubilale (Hymenoptera: Trichogrammatidae) were made separately and in combination in a sweet corn field to compare the level of parasitism in sentinel eggs of the European corn borer, Ostrinia nubilalis (Lepidoptera: Pyralidae). The results indicate that the levels of egg parasitism among different release dates differed mainly because of changes in weather and plant architecture within the season. The level of egg parasitism by releasing T. ostriniae alone was found to be 15% higher than that by releasing T. nubilale alone, and 20% higher than by releasing the combination of the two species. Further analyses using the logistic regression model for independent and correlated data indicated T. ostriniae to be more efficient at discovering host egg masses and to have higher levels of egg parasitism than T. nubilale. Mutual interference between T. ostriniae and T. nubilale was the main factor for the lower level of egg parasitism when T. ostriniae and T. nubilale were released together. The results suggest that T. ostriniae is the better candidate for augmentative releases for control of the European corn borer, and the two species should not be released into a corn field at the same time.     

A Bayesian Two‐Part Latent Class Model for Longitudinal Medical Expenditure Data: Assessing the Impact of Mental Health and Substance Abuse Parity

Summary In 2001, the U.S. Office of Personnel Management required all health plans participating in the Federal Employees Health Benefits Program to offer mental health and substance abuse benefits on par with general medical benefits. The initial evaluation found that, on average, parity did not result in either large spending increases or increased service use over the four‐year observational period. However, some groups of enrollees may have benefited from parity more than others. To address this question, we propose a Bayesian two‐part latent class model to characterize the effect of parity on mental health use and expenditures. Within each class, we fit a two‐part random effects model to separately model the probability of mental health or substance abuse use and mean spending trajectories among those having used services. The regression coefficients and random effect covariances vary across classes, thus permitting class‐varying correlation structures between the two components of the model. Our analysis identified three classes of subjects: a group of low spenders that tended to be male, had relatively rare use of services, and decreased their spending pattern over time; a group of moderate spenders, primarily female, that had an increase in both use and mean spending after the introduction of parity; and a group of high spenders that tended to have chronic service use and constant spending patterns. By examining the joint 95% highest probability density regions of expected changes in use and spending for each class, we confirmed that parity had an impact only on the moderate spender class.