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Non-parametric frailty Cox models for hierarchical time-to-event data.

Accepted version
Peer-reviewed

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Authors

Gasperoni, Francesca  ORCID logo  https://orcid.org/0000-0002-1713-9477
Ieva, Francesca 
Paganoni, Anna Maria 
Jackson, Christopher H 
Sharples, Linda 

Abstract

We propose a novel model for hierarchical time-to-event data, for example, healthcare data in which patients are grouped by their healthcare provider. The most common model for this kind of data is the Cox proportional hazard model, with frailties that are common to patients in the same group and given a parametric distribution. We relax the parametric frailty assumption in this class of models by using a non-parametric discrete distribution. This improves the flexibility of the model by allowing very general frailty distributions and enables the data to be clustered into groups of healthcare providers with a similar frailty. A tailored Expectation-Maximization algorithm is proposed for estimating the model parameters, methods of model selection are compared, and the code is assessed in simulation studies. This model is particularly useful for administrative data in which there are a limited number of covariates available to explain the heterogeneity associated with the risk of the event. We apply the model to a clinical administrative database recording times to hospital readmission, and related covariates, for patients previously admitted once to hospital for heart failure, and we explore latent clustering structures among healthcare providers.

Description

Keywords

Discrete frailty, Expectation–Maximization algorithm, Finite mixture model, Multilevel survival data, Time-to-event data, Algorithms, Cluster Analysis, Computer Simulation, Health Personnel, Humans, Patient Admission, Proportional Hazards Models, Statistical Distributions, Statistics, Nonparametric, Time Factors, Time-to-Treatment

Journal Title

Biostatistics

Conference Name

Journal ISSN

1465-4644
1468-4357

Volume Title

21

Publisher

Oxford University Press (OUP)
Sponsorship
MRC (unknown)
MRC