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Mixed-effects models for health care longitudinal data with an informative visiting process: A Monte Carlo simulation study.

Published version
Peer-reviewed

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Authors

Gasparini, Alessandro  ORCID logo  https://orcid.org/0000-0002-8319-7624
Abrams, Keith R 
Barrett, Jessica K 
Major, Rupert W 
Sweeting, Michael J 

Abstract

Electronic health records are being increasingly used in medical research to answer more relevant and detailed clinical questions; however, they pose new and significant methodological challenges. For instance, observation times are likely correlated with the underlying disease severity: Patients with worse conditions utilise health care more and may have worse biomarker values recorded. Traditional methods for analysing longitudinal data assume independence between observation times and disease severity; yet, with health care data, such assumptions unlikely hold. Through Monte Carlo simulation, we compare different analytical approaches proposed to account for an informative visiting process to assess whether they lead to unbiased results. Furthermore, we formalise a joint model for the observation process and the longitudinal outcome within an extended joint modelling framework. We illustrate our results using data from a pragmatic trial on enhanced care for individuals with chronic kidney disease, and we introduce user-friendly software that can be used to fit the joint model for the observation process and a longitudinal outcome.

Description

Keywords

Monte Carlo simulation, electronic health records, informative visiting process, inverse intensity of visiting weighting, longitudinal data, mixed‐effects models, recurrent‐events models, selection bias

Journal Title

Stat Neerl

Conference Name

Journal ISSN

0039-0402
1467-9574

Volume Title

74

Publisher

Wiley
Sponsorship
MRC (unknown)
British Heart Foundation (CH/12/2/29428)
British Heart Foundation (RG/18/13/33946)
The PSP‐CKD study was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands. Ongoing support for the study is funded by NIHR CLAHRC East Midlands and Kidney Research UK (Grant TF2/2015). JKB is supported by the MRC Unit Programme number MC_UU_00002/5. MJC is partially funded by the MRC‐NIHR Methodology Research Panel (MR/P015433/1).