Parametric survival models for interval-censored data with time-dependent covariates

We present a parametric family of regression models for interval-censored event-time (survival) data that accomodates both fixed (e.g. baseline) and time-dependent covariates. The model employs a three-parameter family of survival distributions that includes the Weibull, negative binomial, and log-logistic distributions as special cases, and can be applied to data with left, right, interval, or non-censored event times. Standard methods, such as Newton-Raphson, can be employed to estimate the model and the resulting estimates have an asymptotically normal distribution about the true values with a covariance matrix that is consistently estimated by the information function. The deviance function is described to assess model fit and a robust sandwich estimate of the covariance may also be employed to provide asymptotically robust inferences when the model assumptions do not apply. Spline functions may also be employed to allow for non-linear covariates. The model is applied to data from a long-term study of type 1 diabetes to describe the effects of longitudinal measures of glycemia (HbA1c) over time (the time-dependent covariate) on the risk of progression of diabetic retinopathy (eye disease), an interval-censored event-time outcome.     

Relative index of inequality: definition, estimation, and inference

The relative index of inequality (RII) is a commonly used measure of the extent to which the occurrence of an outcome such as chronic illness or early death varies with socioeconomic status or some other background variable. The standard RII estimator applies only to linear variation in incidence rates. In this paper a general definition of the RII is introduced, alternative approaches to point estimation are considered, and a parametric bootstrap method is suggested for the construction of approximate confidence intervals. Estimation based on cubic splines fitted by maximum penalized likelihood is developed in some detail, and the proposed approach handles naturally the commonly needed adjustment for a 'standardizing' covariate such as age. Death rates in a large longitudinal study in England and Wales from 1996-2000 are analyzed in order to illustrate the various methods. A small simulation study explores the relative merits of different estimators. The approach based on cubic splines is found to reduce bias substantially, at the expense of some increase in variance, when variation in incidence rates is nonlinear.     

A modification of Peto's nonparametric estimation of survival curves for interval-censored data

Peto (1973, Applied Statistics, 22, 86-91) gave a nonparametric generalized maximum-likelihood estimate of the survival function for interval-censored data. His method has a tendency to concentrate probability masses at the endpoints of the intervals, even for the ordinary grouped data, instead of spreading them through the intervals, as one might expect them to be in the underlying distribution. We describe a modification that overcomes this. The new estimate reduces to the standard binomial estimate when applied to grouped data. It also reduces to the Kaplan-Meier estimate when applied to survival data that consist of only exact or right-censored observations. Both estimates are maximum-likelihood estimates but are based on different interpretations of the endpoints of the intervals.     

Combining longitudinal studies of PSA

Prostate-specific antigen (PSA) is a biomarker commonly used to screen for prostate cancer. Several studies have examined PSA growth rates prior to prostate cancer diagnosis. However, the resulting estimates are highly variable. In this article we propose a non-linear Bayesian hierarchical model to combine longitudinal data on PSA growth from three different studies. Our model enables novel investigations into patterns of PSA growth that were previously impossible due to sample size limitations. The goals of our analysis are twofold: first, to characterize growth rates of PSA accounting for differences when combining data from different studies; second, to investigate the impact of clinical covariates such as advanced disease and unfavorable histology on PSA growth rates.     

Bayesian modeling of multiple lesion onset and growth from interval-censored data

In studying rates of occurrence and progression of lesions (or tumors), it is typically not possible to obtain exact onset times for each lesion. Instead, data consist of the number of lesions that reach a detectable size between screening examinations, along with measures of the size/severity of individual lesions at each exam time. This interval-censored data structure makes it difficult to properly adjust for the onset time distribution in assessing covariate effects on rates of lesion progression. This article proposes a joint model for the multiple lesion onset and progression process, motivated by cross-sectional data from a study of uterine leiomyoma tumors. By using a joint model, one can potentially obtain more precise inferences on rates of onset, while also performing onset time-adjusted inferences on lesion severity. Following a Bayesian approach, we propose a data augmentation Markov chain Monte Carlo algorithm for posterior computation.