Semiparametric additive time-varying coefficients model for longitudinal data with censored time origin

Statistical analysis of longitudinal data often involves modeling treatment effects on clinically relevant longitudinal biomarkers since an initial event (the time origin). In some studies including preventive HIV vaccine efficacy trials, some participants have biomarkers measured starting at the time origin, whereas others have biomarkers measured starting later with the time origin unknown. The semiparametric additive time-varying coefficient model is investigated where the effects of some covariates vary nonparametrically with time while the effects of others remain constant. Weighted profile least squares estimators coupled with kernel smoothing are developed. The method uses the expectation maximization approach to deal with the censored time origin. The Kaplan–Meier estimator and other failure time regression models such as the Cox model can be utilized to estimate the distribution and the conditional distribution of left censored event time related to the censored time origin. Asymptotic properties of the parametric and nonparametric estimators and consistent asymptotic variance estimators are derived. A two-stage estimation procedure for choosing weight is proposed to improve estimation efficiency. Numerical simulations are conducted to examine finite sample properties of the proposed estimators. The simulation results show that the theory and methods work well. The efficiency gain of the two-stage estimation procedure depends on the distribution of the longitudinal error processes. The method is applied to analyze data from the Merck 023/HVTN 502 Step HIV vaccine study.     

Multikink quantile regression for longitudinal data with application to progesterone data analysis

Motivated by investigating the relationship between progesterone and the days in a menstrual cycle in a longitudinal study, we propose a multikink quantile regression model for longitudinal data analysis. It relaxes the linearity condition and assumes different regression forms in different regions of the domain of the threshold covariate. In this paper, we first propose a multikink quantile regression for longitudinal data. Two estimation procedures are proposed to estimate the regression coefficients and the kink points locations: one is a computationally efficient profile estimator under the working independence framework while the other one considers the within-subject correlations by using the unbiased generalized estimation equation approach. The selection consistency of the number of kink points and the asymptotic normality of two proposed estimators are established. Second, we construct a rank score test based on partial subgradients for the existence of the kink effect in longitudinal studies. Both the null distribution and the local alternative distribution of the test statistic have been derived. Simulation studies show that the proposed methods have excellent finite sample performance. In the application to the longitudinal progesterone data, we identify two kink points in the progesterone curves over different quantiles and observe that the progesterone level remains stable before the day of ovulation, then increases quickly in 5 to 6 days after ovulation and then changes to stable again or drops slightly.     

Estimation in Semiparametric Transition Measurement Error Models for Longitudinal Data

Summary .  We consider semiparametric transition measurement error models for longitudinal data, where one of the covariates is measured with error in transition models, and no distributional assumption is made for the underlying unobserved covariate. An estimating equation approach based on the pseudo conditional score method is proposed. We show the resulting estimators of the regression coefficients are consistent and asymptotically normal. We also discuss the issue of efficiency loss. Simulation studies are conducted to examine the finite-sample performance of our estimators. The longitudinal AIDS Costs and Services Utilization Survey data are analyzed for illustration.     

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.     

Median regression with censored cost data

Because of the skewness of the distribution of medical costs, we consider modeling the median as well as other quantiles when establishing regression relationships to covariates. In many applications, the medical cost data are also right censored. In this article, we propose semiparametric procedures for estimating the parameters in median regression models based on weighted estimating equations when censoring is present. Numerical studies are conducted to show that our estimators perform well with small samples and the resulting inference is reliable in circumstances of practical importance. The methods are applied to a dataset for medical costs of patients with colorectal cancer.     

Covariate-adjusted varying coefficient models

Covariate-adjusted regression was recently proposed for situations where both predictors and response in a regression model are not directly observed, but are observed after being contaminated by unknown functions of a common observable covariate. The method has been appealing because of its flexibility in targeting the regression coefficients under different forms of distortion. We extend this methodology proposed for regression into the framework of varying coefficient models, where the goal is to target the covariate-adjusted relationship between longitudinal variables. The proposed method of covariate-adjusted varying coefficient model (CAVCM) is illustrated with an analysis of a longitudinal data set containing calcium absorbtion and intake measurements on 188 subjects. We estimate the age-dependent relationship between these two variables adjusted for the covariate body surface area. Simulation studies demonstrate the flexibility of CAVCM in handling different forms of distortion in the longitudinal setting.     

On the estimation of average treatment effects with right-censored time to event outcome and competing risks

We are interested in the estimation of average treatment effects based on right-censored data of an observational study. We focus on causal inference of differences between t-year absolute event risks in a situation with competing risks. We derive doubly robust estimation equations and implement estimators for the nuisance parameters based on working regression models for the outcome, censoring, and treatment distribution conditional on auxiliary baseline covariates. We use the functional delta method to show that these estimators are regular asymptotically linear estimators and estimate their variances based on estimates of their influence functions. In empirical studies, we assess the robustness of the estimators and the coverage of confidence intervals. The methods are further illustrated using data from a Danish registry study.     

Heteroscedastic Nonlinear Regression Models with Random Effects and Their Application to Enzyme Kinetic Data

We present a new modification of nonlinear regression models for repeated measures data with heteroscedastic error structures by combining the transform-both-sides and weighting model from Caroll and Ruppert (1988) with the nonlinear random effects model from Lindstrom and Bates (1990). The proposed parameter estimators are a combination of pseudo maximum likelihood estimators for the transform-both-sides and weighting model and maximum likelihood (ML) or restricted maximum likelihood (REML) estimators for linear mixed effects models. The new method is investigated by analyzing simulated enzyme kinetic data published by Jones (1993).     

Modeling longitudinal data with nonignorable dropouts using a latent dropout class model

In longitudinal studies with dropout, pattern-mixture models form an attractive modeling framework to account for nonignorable missing data. However, pattern-mixture models assume that the components of the mixture distribution are entirely determined by the dropout times. That is, two subjects with the same dropout time have the same distribution for their response with probability one. As that is unlikely to be the case, this assumption made lead to classification error. In addition, if there are certain dropout patterns with very few subjects, which often occurs when the number of observation times is relatively large, pattern-specific parameters may be weakly identified or require identifying restrictions. We propose an alternative approach, which is a latent-class model. The dropout time is assumed to be related to the unobserved (latent) class membership, where the number of classes is less than the number of observed patterns; a regression model for the response is specified conditional on the latent variable. This is a type of shared-parameter model, where the shared "parameter" is discrete. Parameter estimates are obtained using the method of maximum likelihood. Averaging the estimates of the conditional parameters over the distribution of the latent variable yields estimates of the marginal regression parameters. The methodology is illustrated using longitudinal data on depression from a study of HIV in women.     

A simple imputation method for longitudinal studies with non-ignorable non-responses

Missing data are a common problem in longitudinal studies in the health sciences. Motivated by data from the Muscatine Coronary Risk Factor (MCRF) study, a longitudinal study of obesity, we propose a simple imputation method for handling non-ignorable non-responses (i.e., when non-response is related to the specific values that should have been obtained) in longitudinal studies with either discrete or continuous outcomes. In the proposed approach, two regression models are specified; one for the marginal mean of the response, the other for the conditional mean of the response given non-response patterns. Statistical inference for the model parameters is based on the generalized estimating equations (GEE) approach. An appealing feature of the proposed method is that it can be readily implemented using existing, widely-available statistical software. The method is illustrated using longitudinal data on obesity from the MCRF study.     

Modified Gaussian estimation for correlated binary data

In this paper, we develop a Gaussian estimation (GE) procedure to estimate the parameters of a regression model for correlated (longitudinal) binary response data using a working correlation matrix. A two‐step iterative procedure is proposed for estimating the regression parameters by the GE method and the correlation parameters by the method of moments. Consistency properties of the estimators are discussed. A simulation study was conducted to compare 11 estimators of the regression parameters, namely, four versions of the GE, five versions of the generalized estimating equations (GEEs), and two versions of the weighted GEE. Simulations show that (i) the Gaussian estimates have the smallest mean square error and best coverage probability if the working correlation structure is correctly specified and (ii) when the working correlation structure is correctly specified, the GE and the GEE with exchangeable correlation structure perform best as opposed to when the correlation structure is misspecified.     

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.     

Semiparametric transformation models for interval‐censored data in the presence of a cure fraction

Mixed case interval‐censored data arise when the event of interest is known only to occur within an interval induced by a sequence of random examination times. Such data are commonly encountered in disease research with longitudinal follow‐up. Furthermore, the medical treatment has progressed over the last decade with an increasing proportion of patients being cured for many types of diseases. Thus, interest has grown in cure models for survival data which hypothesize a certain proportion of subjects in the population are not expected to experience the events of interest. In this article, we consider a two‐component mixture cure model for regression analysis of mixed case interval‐censored data. The first component is a logistic regression model that describes the cure rate, and the second component is a semiparametric transformation model that describes the distribution of event time for the uncured subjects. We propose semiparametric maximum likelihood estimation for the considered model. We develop an EM type algorithm for obtaining the semiparametric maximum likelihood estimators (SPMLE) of regression parameters and establish their consistency, efficiency, and asymptotic normality. Extensive simulation studies indicate that the SPMLE performs satisfactorily in a wide variety of settings. The proposed method is illustrated by the analysis of the hypobaric decompression sickness data from National Aeronautics and Space Administration.     

Marginally specified generalized linear mixed models: a robust approach

Longitudinal data modeling is complicated by the necessity to deal appropriately with the correlation between observations made on the same individual. Building on an earlier nonrobust version proposed by Heagerty (1999, Biometrics 55, 688-698), our robust marginally specified generalized linear mixed model (ROBMS-GLMM) provides an effective method for dealing with such data. This model is one of the first to allow both population-averaged and individual-specific inference. As well, it adopts the flexibility and interpretability of generalized linear mixed models for introducing dependence but builds a regression structure for the marginal mean, allowing valid application with time-dependent (exogenous) and time-independent covariates. These new estimators are obtained as solutions of a robustified likelihood equation involving Huber's least favorable distribution and a collection of weights. Huber's least favorable distribution produces estimates that are resistant to certain deviations from the random effects distributional assumptions. Innovative weighting strategies enable the ROBMS-GLMM to perform well when faced with outlying observations both in the response and covariates. We illustrate the methodology with an analysis of a prospective longitudinal study of laryngoscopic endotracheal intubation, a skill that numerous health-care professionals are expected to acquire. The principal goal of our research is to achieve robust inference in longitudinal analyses.     

Two‐stage orthogonality based estimation for semiparametric varying‐coefficient models and its applications in analyzing AIDS data

Semiparametric smoothing methods are usually used to model longitudinal data, and the interest is to improve efficiency for regression coefficients. This paper is concerned with the estimation in semiparametric varying‐coefficient models (SVCMs) for longitudinal data. By the orthogonal projection method, local linear technique, quasi‐score estimation, and quasi‐maximum likelihood estimation, we propose a two‐stage orthogonality‐based method to estimate parameter vector, coefficient function vector, and covariance function. The developed procedures can be implemented separately and the resulting estimators do not affect each other. Under some mild conditions, asymptotic properties of the resulting estimators are established explicitly. In particular, the asymptotic behavior of the estimator of coefficient function vector at the boundaries is examined. Further, the finite sample performance of the proposed procedures is assessed by Monte Carlo simulation experiments. Finally, the proposed methodology is illustrated with an analysis of an acquired immune deficiency syndrome (AIDS) dataset.     

Empirical Likelihood Semiparametric Regression Analysis for Longitudinal Data

A semiparametric regression model for longitudinal data is considered.The empirical likelihood method is used to estimate the regressioncoefficients and the baseline function, and to construct confidenceregions and intervals. It is proved that the maximum empiricallikelihood estimator of the regression coefficients achievesasymptotic efficiency and the estimator of the baseline functionattains asymptotic normality when a bias correction is made.Two calibrated empirical likelihood approaches to inferencefor the baseline function are developed. We propose a groupwiseempirical likelihood procedure to handle the inter-series dependencefor the longitudinal semiparametric regression model, and employbias correction to construct the empirical likelihood ratiofunctions for the parameters of interest. This leads us to provea nonparametric version of Wilks' theorem. Compared with methodsbased on normal approximations, the empirical likelihood doesnot require consistent estimators for the asymptotic varianceand bias. A simulation compares the empirical likelihood andnormal-based methods in terms of coverage accuracies and averageareas/lengths of confidence regions/intervals.     

Response-adaptive regression for longitudinal data

We propose a response-adaptive model for functional linear regression, which is adapted to sparsely sampled longitudinal responses. Our method aims at predicting response trajectories and models the regression relationship by directly conditioning the sparse and irregular observations of the response on the predictor, which can be of scalar, vector, or functional type. This obliterates the need to model the response trajectories, a task that is challenging for sparse longitudinal data and was previously required for functional regression implementations for longitudinal data. The proposed approach turns out to be superior compared to previous functional regression approaches in terms of prediction error. It encompasses a variety of regression settings that are relevant for the functional modeling of longitudinal data in the life sciences. The improved prediction of response trajectories with the proposed response-adaptive approach is illustrated for a longitudinal study of Kiwi weight growth and by an analysis of the dynamic relationship between viral load and CD4 cell counts observed in AIDS clinical trials.     

Regression modeling of semicompeting risks data

Semicompeting risks data are often encountered in clinical trials with intermediate endpoints subject to dependent censoring from informative dropout. Unlike with competing risks data, dropout may not be dependently censored by the intermediate event. There has recently been increased attention to these data, in particular inferences about the marginal distribution of the intermediate event without covariates. In this article, we incorporate covariates and formulate their effects on the survival function of the intermediate event via a functional regression model. To accommodate informative censoring, a time-dependent copula model is proposed in the observable region of the data which is more flexible than standard parametric copula models for the dependence between the events. The model permits estimation of the marginal distribution under weaker assumptions than in previous work on competing risks data. New nonparametric estimators for the marginal and dependence models are derived from nonlinear estimating equations and are shown to be uniformly consistent and to converge weakly to Gaussian processes. Graphical model checking techniques are presented for the assumed models. Nonparametric tests are developed accordingly, as are inferences for parametric submodels for the time-varying covariate effects and copula parameters. A novel time-varying sensitivity analysis is developed using the estimation procedures. Simulations and an AIDS data analysis demonstrate the practical utility of the methodology.     

An estimation method for the semiparametric mixed effects model

A semiparametric mixed effects regression model is proposed for the analysis of clustered or longitudinal data with continuous, ordinal, or binary outcome. The common assumption of Gaussian random effects is relaxed by using a predictive recursion method (Newton and Zhang, 1999) to provide a nonparametric smooth density estimate. A new strategy is introduced to accelerate the algorithm. Parameter estimates are obtained by maximizing the marginal profile likelihood by Powell's conjugate direction search method. Monte Carlo results are presented to show that the method can improve the mean squared error of the fixed effects estimators when the random effects distribution is not Gaussian. The usefulness of visualizing the random effects density itself is illustrated in the analysis of data from the Wisconsin Sleep Survey. The proposed estimation procedure is computationally feasible for quite large data sets.     

Conditional estimation for generalized linear models when covariates are subject-specific parameters in a mixed model for longitudinal measurements

The relationship between a primary endpoint and features of longitudinal profiles of a continuous response is often of interest, and a relevant framework is that of a generalized linear model with covariates that are subject-specific random effects in a linear mixed model for the longitudinal measurements. Naive implementation by imputing subject-specific effects from individual regression fits yields biased inference, and several methods for reducing this bias have been proposed. These require a parametric (normality) assumption on the random effects, which may be unrealistic. Adapting a strategy of Stefanski and Carroll (1987, Biometrika74, 703-716), we propose estimators for the generalized linear model parameters that require no assumptions on the random effects and yield consistent inference regardless of the true distribution. The methods are illustrated via simulation and by application to a study of bone mineral density in women transitioning to menopause.