Joint frailty modeling of time-to-event data to elicit the evolution pathway of events: a generalized linear mixed model approach

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Ng, Shu Kay
Tawiah, Richard
Mclachlan, Geoffrey J
Gopalan, Vinod
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2021
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Abstract

Multimorbidity constitutes a serious challenge on the healthcare systems in the world, due to its association with poorer health-related outcomes, more complex clinical management, increases in health service utilization and costs, but a decrease in productivity. However, to date, most evidence on multimorbidity is derived from cross-sectional studies that have limited capacity to understand the pathway of multimorbid conditions. In this article, we present an innovative perspective on analyzing longitudinal data within a statistical framework of survival analysis of time-to-event recurrent data. The proposed methodology is based on a joint frailty modeling approach with multivariate random effects to account for the heterogeneous risk of failure and the presence of informative censoring due to a terminal event. We develop a generalized linear mixed model method for the efficient estimation of parameters. We demonstrate the capacity of our approach using a real cancer registry data set on the multimorbidity of melanoma patients and document the relative performance of the proposed joint frailty model to the natural competitor of a standard frailty model via extensive simulation studies. Our new approach is timely to advance evidence-based knowledge to address increasingly complex needs related to multimorbidity and develop interventions that are most effective and viable to better help a large number of individuals with multiple conditions.

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Biostatistics

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© The Author 2021. Published by Oxford University Press. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

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This publication has been entered as an advanced online version in Griffith Research Online.

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Biostatistics

Genetics

Statistics

Cancer registry data

Generalized linear mixed models

Informative censoring

Mean residual life

Multimorbidity

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Ng, SK; Tawiah, R; Mclachlan, GJ; Gopalan, V, Joint frailty modeling of time-to-event data to elicit the evolution pathway of events: a generalized linear mixed model approach., Biostatistics, 2021

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