Search

Dynamic event prediction, using joint modeling of survival time and longitudinal variables, is extremely useful in personalized medicine. However, the estimation of joint models including many longitudinal markers is still a computational challenge because of the high number of random effects and parameters to be estimated. In this paper, we propose a model averaging strategy to combine predictions from several joint models for the event, including one longitudinal marker only or pairwise longitudinal markers. The prediction is computed as the weighted mean of the predictions from the one-marker or two-marker models, with the time-dependent weights estimated by minimizing the time-dependent Brier score. This method enables us to combine a large number of predictions issued from joint models to achieve a reliable and accurate individual prediction. Advantages and limits of the proposed methods are highlighted in a simulation study by comparison with the predictions from well-specified and misspecified all-marker joint models as well as the one-marker and two-marker joint models. Using the PBC2 data set, the method is used to predict the risk of death in patients with primary biliary cirrhosis. The method is also used to analyze a French cohort study called the 3C data. In our study, seventeen longitudinal markers are considered to predict the risk of death.

Collecting multiple longitudinal measurements and time-to-event outcomes is a common practice in clinical and epidemiological studies, often focusing on exploring associations between them. Joint modeling is the standard analytical tool for such data, with several R packages available. However, as the number of longitudinal markers increases, the computational burden and convergence challenges make joint modeling increasingly impractical. This paper introduces a novel two-stage Bayesian approach to estimate joint models for multiple longitudinal measurements and time-to-event outcomes. The method builds on the standard two-stage framework but improves the initial stage by estimating a separate one-marker joint model for the event and each longitudinal marker, rather than relying on mixed models. These estimates are used to derive predictions of individual marker trajectories, avoiding biases from informative dropouts. In the second stage, a proportional hazards model is fitted, incorporating the predicted current values and slopes of the markers as time-dependent covariates. To address uncertainty in the first-stage predictions, a multiple imputation technique is employed when estimating the Cox model in the second stage. This two-stage method allows for the analysis of numerous longitudinal markers, which is often infeasible with traditional multi-marker joint modeling. The paper evaluates the approach through simulation studies and applies it to the PBC2 dataset and a real-world dementia dataset containing 17 longitudinal markers. An R package, TSJM, implementing the method is freely available on GitHub: https://github.com/tbaghfalaki/TSJM., Comment: arXiv admin note: text overlap with arXiv:2412.03797

Background: In clinical and epidemiological research, the integration of longitudinal measurements and time-to-event outcomes is vital for understanding relationships and improving risk prediction. However, as the number of longitudinal markers increases, joint model estimation becomes more complex, leading to long computation times and convergence issues. This study introduces a novel two-stage Bayesian approach for variable selection in joint models, illustrated through a practical application. Methods: Our approach conceptualizes the analysis in two stages. In the first stage, we estimate one-marker joint models for each longitudinal marker related to the event, allowing for bias reduction from informative dropouts through individual marker trajectory predictions. The second stage employs a proportional hazard model that incorporates expected current values of all markers as time-dependent covariates. We explore continuous and Dirac spike-and-slab priors for variable selection, utilizing Markov chain Monte Carlo (MCMC) techniques. Results: The proposed method addresses the challenges of parameter estimation and risk prediction with numerous longitudinal markers, demonstrating robust performance through simulation studies. We further validate our approach by predicting dementia risk using the Three-City (3C) dataset, a longitudinal cohort study from France. Conclusions: This two-stage Bayesian method offers an efficient process for variable selection in joint modeling, enhancing risk prediction capabilities in longitudinal studies. The accompanying R package VSJM, which is freely available at https://github.com/tbaghfalaki/VSJM, facilitates implementation, making this approach accessible for diverse clinical applications.

Dementia currently affects about 50 million people worldwide, and this number is rising. Since there is still no cure, the primary focus remains on preventing modifiable risk factors such as cardiovascular factors. It is now recognized that high blood pressure is a risk factor for dementia. An increasing number of studies suggest that blood pressure variability may also be a risk factor for dementia. However, these studies have significant methodological weaknesses and fail to distinguish between long-term and short-term variability. The aim of this work was to propose a new joint model that combines a mixed-effects model, which handles the residual variance distinguishing inter-visit variability from intra-visit variability, and an illness-death model that allows for interval censoring and semi-competing risks. A subject-specific random effect is included in the model for both variances. Risks can simultaneously depend on the current value and slope of the marker, as well as on each of the two components of the residual variance. The model estimation is performed by maximizing the likelihood function using the Marquardt-Levenberg algorithm. A simulation study validates the estimation procedure, which is implemented in an R package. The model was estimated using data from the Three-City (3C) cohort to study the impact of intra- and inter-visits blood pressure variability on the risk of dementia and death., Comment: 16 pages, 2 figures, 4 tables

The objective of this paper is to provide an introduction to the principles of Bayesian joint modeling of longitudinal measurements and time-to-event outcomes, as well as model implementation using the BUGS language syntax. This syntax can be executed directly using OpenBUGS or by utilizing convenient functions to invoke OpenBUGS and JAGS from R software. In this paper, all details of joint models are provided, ranging from simple to more advanced models. The presentation started with the joint modeling of a Gaussian longitudinal marker and time-to-event outcome. The implementation of the Bayesian paradigm of the model is reviewed. The strategies for simulating data from the JM are also discussed. A proportional hazard model with various forms of baseline hazards, along with the discussion of all possible association structures between the two sub-models are taken into consideration. The paper covers joint models with multivariate longitudinal measurements, zero-inflated longitudinal measurements, competing risks, and time-to-event with cure fraction. The models are illustrated by the analyses of several real data sets. All simulated and real data and code are available at \url{https://github.com/tbaghfalaki/JM-with-BUGS-and-JAGS}., Comment: 43 pages, 10 figures

Given the high incidence of cardio and cerebrovascular diseases (CVD), and its association with morbidity and mortality, its prevention is a major public health issue. A high level of blood pressure is a well-known risk factor for these events and an increasing number of studies suggest that blood pressure variability may also be an independent risk factor. However, these studies suffer from significant methodological weaknesses. In this work we propose a new location-scale joint model for the repeated measures of a marker and competing events. This joint model combines a mixed model including a subject-specific and time-dependent residual variance modeled through random effects, and cause-specific proportional intensity models for the competing events. The risk of events may depend simultaneously on the current value of the variance, as well as, the current value and the current slope of the marker trajectory. The model is estimated by maximizing the likelihood function using the Marquardt-Levenberg algorithm. The estimation procedure is implemented in a R-package and is validated through a simulation study. This model is applied to study the association between blood pressure variability and the risk of CVD and death from other causes. Using data from a large clinical trial on the secondary prevention of stroke, we find that the current individual variability of blood pressure is associated with the risk of CVD and death. Moreover, the comparison with a model without heterogeneous variance shows the importance of taking into account this variability in the goodness-of-fit and for dynamic predictions.

We propose a novel methodology to quantify the effect of stochastic interventions on non-terminal time-to-events that lie on the pathway between an exposure and a terminal time-to-event outcome. Investigating these effects is particularly important in health disparities research when we seek to quantify inequities in timely delivery of treatment and its impact on patients survival time. Current approaches fail to account for semi-competing risks arising in this setting. Under the potential outcome framework, we define and provide identifiability conditions for causal estimands for stochastic direct and indirect effects. Causal contrasts are estimated in continuous time within a multistate modeling framework and analytic formulae for the estimators of the causal contrasts are developed. We show via simulations that ignoring censoring in mediator and or outcome time-to-event processes, or ignoring competing risks may give misleading results. This work demonstrates that rigorous definition of the direct and indirect effects and joint estimation of the outcome and mediator time-to-event distributions in the presence of semi-competing risks are crucial for valid investigation of mechanisms in continuous time. We employ this novel methodology to investigate the role of delaying treatment uptake in explaining racial disparities in cancer survival in a cohort study of colon cancer patients., Comment: 31 pages, 4 figures, 2 tables

Alzheimer's disease gradually affects several components including the cerebral dimension with brain atrophies, the cognitive dimension with a decline in various functions and the functional dimension with impairment in the daily living activities. Understanding how such dimensions interconnect is crucial for AD research. However it requires to simultaneously capture the dynamic and multidimensional aspects, and to explore temporal relationships between dimensions. We propose an original dynamic structural model that accounts for all these features. The model defines dimensions as latent processes and combines a multivariate linear mixed model and a system of difference equations to model trajectories and temporal relationships between latent processes in finely discrete time. Dimensions are simultaneously related to their observed (possibly multivariate) markers through nonlinear equations of observation. Parameters are estimated in the maximum likelihood framework enjoying a closed form for the likelihood. We demonstrate in a simulation study that this dynamic model in discrete time benefits the same causal interpretation of temporal relationships as models defined in continuous time as long as the discretization step remains small. The model is then applied to the data of the Alzheimer's Disease Neuroimaging Initiative. Three longitudinal dimensions (cerebral anatomy, cognitive ability and functional autonomy) measured by 6 markers are analyzed and their temporal structure is contrasted between different clinical stages of Alzheimer's disease. Keywords: causality, difference equations, latent process, longitudinal data, mixed models, multivariate data.

Joint models are used in ageing studies to investigate the association between longitudinal markers and a time-to-event, and have been extended to multiple markers and/or competing risks. The competing risk of death must be considered in the elderly because death and dementia have common risk factors. Moreover, in cohort studies, time-to-dementia is interval-censored because dementia is only assessed intermittently. So subjects can become demented and die between two follow-up visits without being diagnosed. To study pre-dementia cognitive decline, we propose a joint latent class model combining a (possibly multivariate) mixed model and an illness-death model handling both interval censoring (by accounting for a possible unobserved transition to dementia) and semi-competing risks. Parameters are estimated by maximum likelihood handling interval censoring. The correlation between the marker and the times-to-events is captured by latent classes, homogeneous groups with specific risks of death and dementia and profiles of cognitive decline. We propose markovian and semi-markovian versions. Both approaches are compared to a joint latent class model for standard competing risks through a simulation study, and then applied in a prospective cohort study of cerebral and functional ageing to distinguish different profiles of cognitive decline associated with risks of dementia and death. The comparison highlights that among demented subjects, mortality depends more on age than duration of dementia. This model distinguishes the so-called terminal pre-death decline (among non-demented subjects) from the pre-dementia decline.

Joint modelling of longitudinal and survival data is increasingly used in clinical trials on cancer. In prostate cancer for example, these models permit to account for the link between longitudinal measures of prostate-specific antigen (PSA) and the time of clinical recurrence when studying the risk of relapse. In practice, multiple types of relapse may occur successively. Distinguishing these transitions between health states would allow to evaluate, for example, how PSA trajectory and classical covariates impact the risk of dying after a distant recurrence post-radiotherapy, or to predict the risk of one specific type of clinical recurrence post-radiotherapy, from the PSA history. In this context, we present a joint model for a longitudinal process and a multi-state process which is divided into two sub-models: a linear mixed sub-model for longitudinal data, and a multi-state sub-model with proportional hazards for transition times, both linked by shared random effects. Parameters of this joint multi-state model are estimated within the maximum likelihood framework using an EM algorithm coupled to a quasi-Newton algorithm in case of slow convergence. It is implemented under R, by combining and extending the mstate and JM packages. The estimation program is validated by simulations and applied on pooled data from two cohorts of men with localized prostate cancer and treated by radiotherapy. Thanks to the classical covariates available at baseline and the PSA measurements collected repeatedly during the follow-up, we are able to assess the biomarker's trajectory, define the risks of transitions between health states, and quantify the impact of the PSA dynamics on each transition intensity., Comment: Added appendix

Joint models initially dedicated to a single longitudinal marker and a single time-to-event need to be extended to account for the rich longitudinal data of cohort studies. Multiple causes of clinical progression are indeed usually observed, and multiple longitudinal markers are collected when the true latent trait of interest is hard to capture (e.g. quality of life, functional dependency, cognitive level). These multivariate and longitudinal data also usually have nonstandard distributions (discrete, asymmetric, bounded,...). We propose a joint model based on a latent process and latent classes to analyze simultaneously such multiple longitudinal markers of different natures, and multiple causes of progression. A latent process model describes the latent trait of interest and links it to the observed longitudinal outcomes using flexible measurement models adapted to different types of data, and a latent class structure links the longitudinal and the cause-specific survival models. The joint model is estimated in the maximum likelihood framework. A score test is developed to evaluate the assumption of conditional independence of the longitudinal markers and each cause of progression given the latent classes. In addition, individual dynamic cumulative incidences of each cause of progression based on the repeated marker data are derived. The methodology is validated in a simulation study and applied on real data about cognitive aging coming from a large population-based study. The aim is to predict the risk of dementia by accounting for the competing death according to the profiles of semantic memory measured by two asymmetric psychometric tests.

Longitudinal studies could be complicated by left-censored repeated measures. For example, in Human Immunodeficiency Virus infection, there is a detection limit of the assay used to quantify the plasma viral load. Simple imputation of the limit of the detection or of half of this limit for left-censored measures biases estimations and their standard errors. In this paper, we review two likelihood-based methods proposed to handle left-censoring of the outcome in linear mixed model. We show how to fit these models using SAS Proc NLMIXED and we compare this tool with other programs. Indications and limitations of the programs are discussed and an example in the field of HIV infection is shown.

Bivariate linear mixed models are useful when analyzing longitudinal data of two associated markers. In this paper, we present a bivariate linear mixed model including random effects or first-order auto-regressive process and independent measurement error for both markers. Codes and tricks to fit these models using SAS Proc MIXED are provided. Limitations of this program are discussed and an example in the field of HIV infection is shown. Despite some limitations, SAS Proc MIXED is a useful tool that may be easily extendable to multivariate response in longitudinal studies.

This article studies a Newton-like method already used by several authors but which has not been thouroughly studied yet. We call it the robust-variance scoring (RVS) algorithm because the main version of the algorithm that we consider replaces minus the Hessian of the loglikelihood used in the Newton-Raphson algorithm by a matrix $G$ which is an estimate of the variance of the score under the true probability, which uses only the individual scores. Thus an iteration of this algorithm requires much less computations than an iteration of the Newton-Raphson algorithm. Moreover this estimate of the variance of the score estimates the information matrix at maximum. We have also studied a convergence criterion which has the nice interpretation of estimating the ratio of the approximation error over the statistical error; thus it can be used for stopping the iterative process whatever the problem. A simulation study confirms that the RVS algorithm is faster than the Marquardt algorithm (a robust version of the Newton-Raphson algorithm); this happens because the number of iterations needed by the RVS algorithm is barely larger than that needed by the Marquardt algorithm while the computation time for each iteration is much shorter. Also the coverage rates using the matrix $G$ are satisfactory., Comment: 27 pages, 2 Tables