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Computationally efficient methods for fitting mixed models to electronic health records data

Published version
Peer-reviewed

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Authors

Rhodes, KM 
Turner, R 
Payne, R 
White, I 

Abstract

Motivated by two case studies using primary care records from the Clinical Practice Research Datalink, we describe statistical methods that facilitate the analysis of tall data, with very large numbers of observations. Our focus is on investigating the association between patient characteristics and an outcome of interest, while allowing for variation among general practices. We explore ways to fit mixed effects models to tall data, including predictors of interest and confounding factors as covariates, and including random intercepts to allow for heterogeneity in outcome among practices. We introduce: (1) weighted regression and (2) meta-analysis of estimated regression coefficients from each practice. Both methods reduce the size of the dataset, thus decreasing the time required for statistical analysis. We compare the methods to an existing subsampling approach. All methods give similar point estimates, and weighted regression and meta-analysis give similar standard errors for point estimates to analysis of the entire dataset, but the subsampling method gives larger standard errors. Where all data are discrete, weighted regression is equivalent to fitting the mixed model to the entire dataset. In the presence of a continuous covariate, meta-analysis is useful. Both methods are easy to implement in standard statistical software

Description

Keywords

health records, meta-analysis, mixed-effects regression model, subsampling, tall data, Data Interpretation, Statistical, Datasets as Topic, Electronic Health Records, General Practice, Humans, Meta-Analysis as Topic, Models, Statistical, Regression Analysis

Journal Title

Statistics in Medicine

Conference Name

Journal ISSN

1097-0258
1097-0258

Volume Title

37

Publisher

Wiley-Blackwell
Sponsorship
MRC (unknown)
MRC (unknown)
MRC (1182928)
The authors are grateful to the CPRD team at the University of Cambridge. In particular, we thank Carol Wilson and Anna Cassel for providing access to the case study datasets that they spent much time preparing for analysis. Kirsty Rhodes was funded by Medical Research Council Unit Programmes U105260558 and MC_UU_00002/5. Rebecca Turner and Ian White were funded by Medical Research Council Unit Programmes U105260558 and MC_UU_12023/21