Investigating network structures in recurrent event data with discrete observation times.

Recurrent event data analyses are usually conducted under the assumption that the censoring time is independent of the recurrent event process. In many applications the censoring time can be informative about the underlying recurrent event process, especially in situations where a correlated failure event could potentially terminate the observation of recurrent events. In this article, we consider a semiparametric model of recurrent event data that allows correlations between censoring times and recurrent event process via frailty. This flexible framework incorporates both time-dependent and time-independent covariates in the formulation, while leaving the distributions of frailty and censoring times unspecified. We propose a novel semiparametric inference procedure that depends on neither the frailty nor the censoring time distribution. Large sample properties of the regression parameter estimates and the estimated baseline cumulative intensity functions are studied. Numerical studies demonstrate that the proposed methodology performs well for realistic sample sizes. An analysis of hospitalization data for patients in an AIDS cohort study is presented to illustrate the proposed method.

Introduction: Recurrent event data are common in many longitudinal studies. Often, a terminating event such as death can be correlated with the recurrent event process. A shared frailty model applied to account for the association between recurrent and terminal events. In some situations, a fraction of subjects experience neither recurrent events nor death; these subjects are cured.
 Methods: In this paper, we discussed the Bayesian approach of a joint frailty model for recurrent and terminal events in the presence of cure fraction. We compared estimates of parameters in the Frequentist and Bayesian approaches via simulation studies in various sample sizes; we applied the joint frailty model in the presence of cure fraction with Frequentist and Bayesian approaches for breast cancer.
 Results: In small sample size Bayesian approach compared to Frequentist approach had a smaller standard error and mean square error, and the coverage probabilities close to nominal level of 95%. Also, in Bayesian approach, the sampling means of the estimated standard errors were close to the empirical standard error.
 Conclusion: The simulation results suggested that when sample size was small, the use of Bayesian joint frailty model in the presence of cure fraction led to more efficiency in parameter estimation and statistical inference.

Chapter 3 - Recurrent Event Theory

Panel count data arise when the number of recurrent events experienced by each subject is observed intermittently at discrete examination times. The examination time process can be informative about the underlying recurrent event process even after conditioning on covariates. We consider a semiparametric accelerated mean model for the recurrent event process and allow the two processes to be correlated through a shared frailty. The regression parameters have a simple marginal interpretation of modifying the time scale of the cumulative mean function of the event process. A novel estimation procedure for the regression parameters and the baseline rate function is proposed based on a conditioning technique. In contrast to existing methods, the proposed method is robust in the sense that it requires neither the strong Poisson-type assumption for the underlying recurrent event process nor a parametric assumption on the distribution of the unobserved frailty. Moreover, the distribution of the examination time process is left unspecified, allowing for arbitrary dependence between the two processes. Asymptotic consistency of the estimator is established, and the variance of the estimator is estimated by a model-based smoothed bootstrap procedure. Numerical studies demonstrated that the proposed point estimator and variance estimator perform well with practical sample sizes. The methods are applied to data from a skin cancer chemoprevention trial.

Modeling recurrent event data with multiple event types has drawn interest in recent biomedical studies due to its flexibility for understanding different risk factors for multiple recurrent event processes. However, in such data type, missing event type appears frequently because of various reasons such as recording ignorance or resource limitation. In this study, we aim to propose an inverse probability weighted estimation that is commonly used in the missing data literature to correct possibly biased estimation by a complete-case analysis. This approach is not limited to a specific form of the recurrent event model. We derive the large sample theory in a general form. We demonstrate that our approach can be applied to either multiplicative or additive rates model with practical sample size via comprehensive simulations. Nonmucoid and mucoid Pseudomonas aeruginosa infections of 14888 patients in 2016 Cystic Fibrosis Foundation Patient Registry data are analyzed to show that, without including 12% events with missing event type in the analysis, several factors may be misidentified as risk factors for the nonmucoid type of infections.

Bivariate or multivariate recurrent event processes are often encountered in longitudinal studies in which more than one type of event is of interest. There has been much research on regression analysis for such data, but little has been done to measure the dependence between recurrent event processes. We propose a time-dependent measure, termed the rate ratio, to assess the local dependence between two types of recurrent event processes. We model the rate ratio as a parametric function of time, and leave unspecified all other aspects of the distribution. We develop a composite likelihood procedure for model fitting and parameter estimation. We show that the proposed estimator is consistent and asymptotically normal. Its finite sample performance is evaluated by simulation and illustrated by an application to a soft tissue sarcoma study.

Panel count data typically refer to data arising from studies with recurrent events, in which subjects are observed only at discrete time points rather than under continuous observations. We investigate a general situation where a recurrent event process is eventually truncated by an informative terminal event and we are particularly interested in behaviors of the recurrent event process near the terminal event. We propose a reversed mean model for estimating the mean function of the recurrent event process. We develop a two-stage sieve likelihood-based method to estimate the mean function, which overcomes the computational difficulties arising from a nuisance functional parameter involved in the likelihood. The consistency and the convergence rate of the two-stage estimator are established. Allowing for the convergence rate slower than the standard rate, we develop the general weak convergence theory of M-estimators with a nuisance functional parameter, and then apply it to the proposed estimator for deriving the asymptotic normality. Furthermore, a class of two-sample tests is developed. The proposed methods are evaluated with extensive simulation studies and illustrated with panel count data from the Chinese Longitudinal Healthy Longevity Study.

Many service industries require high level of system availability to be competitive. An appropriate system unavailability metric is important for business decisions and to minimize the operation risks. In practice, a system can be unavailable for service because of multiple types of events, and the durations of these events can also vary. In addition, the data that record the system operating history often have a complicated structure. In this paper, we develop a framework for estimating system unavailability metric based on historical data of a fleet of heavy‐duty industry equipment, which we call System A. During the useful life of System A, repairs and maintenance actions are performed. However, not all repairs or maintenance actions were recorded. Specifically, the information on event times, types, and durations is available only for certain time intervals (i.e., observation windows), instead of the entire useful life span of the system. Thus, the data structure is window‐observed recurrent event with multiple event types. We use a nonhomogeneous Poisson process model with a bathtub intensity function to describe the recurrent events, and a truncated lognormal distribution to describe the event durations. We then define a conservative metric for system unavailability, obtain an estimate of this metric, and quantify the statistical uncertainty. Copyright © 2013 John Wiley & Sons, Ltd.

Panel count data and interval-censored data are two types of incomplete data that often occur in event history studies. Almost all existing statistical methods are developed for their separate analysis. In this paper, we investigate a more general situation where a recurrent event process and an interval-censored failure event occur together. To intuitively and clearly explain the relationship between the recurrent current process and failure event, we propose a failure time-dependent mean model through a completely unspecified link function. To overcome the challenges arising from the blending of nonparametric components and parametric regression coefficients, we develop a two-stage conditional expected likelihood-based estimation procedure. We establish the consistency, the convergence rate and the asymptotic normality of the proposed two-stage estimator. Furthermore, we construct a class of two-sample tests for comparison of mean functions from different groups. The proposed methods are evaluated by extensive simulation studies and are illustrated with the skin cancer data that motivated this study.

We propose a Bayesian semiparametric joint regression model for a recurrent event process and survival time. Assuming independent latent subject frailties, we define marginal models for the recurrent event process intensity and survival distribution as functions of the subject's frailty and baseline covariates. A robust Bayesian model, called Joint-DP, is obtained by assuming a Dirichlet process for the frailty distribution. We present a simulation study that compares posterior estimates under the Joint-DP model to a Bayesian joint model with lognormal frailties, a frequentist joint model, and marginal models for either the recurrent event process or survival time. The simulations show that the Joint-DP model does a good job of correcting for treatment assignment bias, and has favorable estimation reliability and accuracy compared with the alternative models. The Joint-DP model is applied to analyze an observational dataset from esophageal cancer patients treated with chemo-radiation, including the times of recurrent effusions of fluid to the heart or lungs, survival time, prognostic covariates, and radiation therapy modality.

Recurrence data arise from multi-disciplinary domains spanning reliability, cyber security, healthcare, online retailing, etc. This paper investigates an additive-tree-based approach, known as Boost-R (Boosting for Recurrence Data), for recurrent event data with both static and dynamic features. Boost-R constructs an ensemble of gradient boosted additive trees to estimate the cumulative intensity function of the recurrent event process, where a new tree is added to the ensemble by minimizing the regularized L 2 distance between the observed and predicted cumulative intensity. Unlike conventional regression trees, a time-dependent function is constructed by Boost-R on each tree leaf. The sum of these functions, from multiple trees, yields the ensemble estimator of the cumulative intensity. The divide-and-conquer nature of tree-based methods is appealing when hidden sub-populations exist within a heterogeneous population. The non-parametric nature of regression trees helps to avoid parametric assumptions on the complex interactions between event processes and features. Critical insights and advantages of Boost-R are investigated through comprehensive numerical examples. Datasets and computer code of Boost-R are made available on GitHub. To our best knowledge, Boost-R is the first gradient boosted additive-tree-based approach for modeling large-scale recurrent event data with both static and dynamic feature information.

The recurrent-event setting, where the subjects experience multiple occurrences of the event of interest, are encountered in many biomedical applications. In analyzing recurrent event data, non informative censoring is often assumed for the implementation of statistical methods. However, when a terminating event such as death serves as part of the censoring mechanism, validity of the censoring assumption may be violated because recurrence can be a powerful risk factor for death. We consider joint modeling of recurrent event process and terminating event under a Bayesian framework in which a shared frailty is used to model the association between the intensity of the recurrent event process and the hazard of the terminating event. Our proposed model is implemented on data from a well-known cancer study.

Recurrent events are frequently encountered in biomedical studies. Evaluating the covariates effects on the marginal recurrent event rate is of practical interest. There are mainly two types of rate models for the recurrent event data: the multiplicative rates model and the additive rates model. We consider a more flexible additive-multiplicative rates model for analysis of recurrent event data, wherein some covariate effects are additive while others are multiplicative. We formulate estimating equations for estimating the regression parameters. The estimators for these regression parameters are shown to be consistent and asymptotically normally distributed under appropriate regularity conditions. Moreover, the estimator of the baseline mean function is proposed and its large sample properties are investigated. We also conduct simulation studies to evaluate the finite sample behavior of the proposed estimators. A medical study of patients with cystic fibrosis suffered from recurrent pulmonary exacerbations is provided for illustration of the proposed method.

Recurrent events, including cardiovascular events, are commonly observed in biomedical studies. Understanding the effects of various treatments on recurrent events and investigating the underlying mediation mechanisms by which treatments may reduce the frequency of recurrent events are crucial tasks for researchers. Although causal inference methods for recurrent event data have been proposed, they cannot be used to assess mediation. This study proposed a novel methodology of causal mediation analysis that accommodates recurrent outcomes of interest in a given individual. A formal definition of causal estimands (direct and indirect effects) within a counterfactual framework is given, and empirical expressions for these effects are identified. To estimate these effects, a semiparametric estimator with triple robustness against model misspecification was developed. The proposed methodology was demonstrated in a real-world application. The method was applied to measure the effects of two diabetes drugs on the recurrence of cardiovascular disease and to examine the mediating role of kidney function in this process.

Few methods are currently available for group sequential analysis of recurrent events data subject to a terminal event in the clinical trial setting. This research helps fill this gap by developing a completely nonparametric group sequential monitoring procedure for use with the two-sample Tayob and Murray statistic. Advantages of the Tayob and Murray statistic include high power to detect treatment differences when there is correlation between recurrent event times or between recurrent and terminal events in an individual. This statistic does not suffer bias from dependent censoring, regardless of the correlation between event times in an individual. This manuscript briefly reviews the Tayob and Murray statistic, develops and describes how to use methods for its group sequential analysis, and through simulation, compares its operating characteristics with those of Cook and Lawless, which is currently in use as the only available nonparametric method for group sequential analysis of recurrent event data. The merits of our proposed approach are most clearly demonstrated when gap times between recurrent events are correlated; when gap times between events are independent, the Cook and Lawless method is difficult to beat. Simulations demonstrate that as correlation between recurrent event times grows, the reduction in power using the Cook and Lawless approach is substantial when compared to our method. Finally, we use our method to analyze recurrent acute exacerbation outcomes from the azithromycin in chronic obstructive pulmonary disease trial.