scholarly journals Using generalized linear models to implement g‐estimation for survival data with time‐varying confounding

2021 ◽  
Author(s):  
Shaun R. Seaman ◽  
Ruth H. Keogh ◽  
Oliver Dukes ◽  
Stijn Vansteelandt
2019 ◽  
Vol 39 (7) ◽  
pp. 867-878 ◽  
Author(s):  
Benjamin Kearns ◽  
Matt D. Stevenson ◽  
Kostas Triantafyllopoulos ◽  
Andrea Manca

Background. Parametric modeling of survival data is important, and reimbursement decisions may depend on the selected distribution. Accurate predictions require sufficiently flexible models to describe adequately the temporal evolution of the hazard function. A rich class of models is available among the framework of generalized linear models (GLMs) and its extensions, but these models are rarely applied to survival data. This article describes the theoretical properties of these more flexible models and compares their performance to standard survival models in a reproducible case study. Methods. We describe how survival data may be analyzed with GLMs and their extensions: fractional polynomials, spline models, generalized additive models, generalized linear mixed (frailty) models, and dynamic survival models. For each, we provide a comparison of the strengths and limitations of these approaches. For the case study, we compare within-sample fit, the plausibility of extrapolations, and extrapolation performance based on data splitting. Results. Viewing standard survival models as GLMs shows that many impose a restrictive assumption of linearity. For the case study, GLMs provided better within-sample fit and more plausible extrapolations. However, they did not improve extrapolation performance. We also provide guidance to aid in choosing between the different approaches based on GLMs and their extensions. Conclusions. The use of GLMs for parametric survival analysis can outperform standard parametric survival models, although the improvements were modest in our case study. This approach is currently seldom used. We provide guidance on both implementing these models and choosing between them. The reproducible case study will help to increase uptake of these models.


2020 ◽  
Vol 02 ◽  
Author(s):  
RM Garcia ◽  
WF Vieira-Junior ◽  
JD Theobaldo ◽  
NIP Pini ◽  
GM Ambrosano ◽  
...  

Objective: To evaluate color and roughness of bovine enamel exposed to dentifrices, dental bleaching with 35% hydrogen peroxide (HP), and erosion/staining by red wine. Methods: Bovine enamel blocks were exposed to: artificial saliva (control), Oral-B Pro-Health (stannous fluoride with sodium fluoride, SF), Sensodyne Repair & Protect (bioactive glass, BG), Colgate Pro-Relief (arginine and calcium carbonate, AR), or Chitodent (chitosan, CHI). After toothpaste exposure, half (n=12) of the samples were bleached (35% HP), and the other half were not (n=12). The color (CIE L*a* b*, ΔE), surface roughness (Ra), and scanning electron microscopy were evaluated. Color and roughness were assessed at baseline, post-dentifrice and/or -dental bleaching, and after red wine. The data were subjected to analysis of variance (ANOVA) (ΔE) for repeated measures (Ra), followed by Tukey ́s test. The L*, a*, and b* values were analyzed by generalized linear models (a=0.05). Results: The HP promoted an increase in Ra values; however, the SF, BG, and AR did not enable this alteration. After red wine, all groups apart from SF (unbleached) showed increases in Ra values; SF and AR promoted decreases in L* values; AR demonstrated higher ΔE values, differing from the control; and CHI decreased the L* variation in the unbleached group. Conclusion: Dentifrices did not interfere with bleaching efficacy of 35% HP. However, dentifrices acted as a preventive agent against surface alteration from dental bleaching (BG, SF, and AR) or red wine (SF). Dentifrices can decrease (CHI) or increase (AR and SF) staining by red wine.


2020 ◽  
Vol 9 (16) ◽  
pp. 1105-1115
Author(s):  
Shuqing Wu ◽  
Xin Cui ◽  
Shaoyu Zhang ◽  
Wenqi Tian ◽  
Jiazhen Liu ◽  
...  

Aim: This real-world data study investigated the economic burden and associated factors of readmissions for cerebrospinal fluid leakage (CSFL) post-cranial, transsphenoidal, or spinal index surgeries. Methods: Costs of CSFL readmissions and index hospitalizations during 2014–2018 were collected. Readmission cost was measured as absolute cost and as percentage of index hospitalization cost. Factors associated with readmission cost were explored using generalized linear models. Results: Readmission cost averaged US$2407–6106, 35–94% of index hospitalization cost. Pharmacy costs were the leading contributor. Generalized linear models showed transsphenoidal index surgery and surgical treatment for CSFL were associated with higher readmission costs. Conclusion: CSFL readmissions are a significant economic burden in China. Factors associated with higher readmission cost should be monitored.


1989 ◽  
Vol 78 (5) ◽  
pp. 413-416
Author(s):  
Gerald Van Belle ◽  
Sue Leurgans ◽  
Pat Friel ◽  
Sunwei Guo ◽  
Mark Yerby

2021 ◽  
pp. 096228022110082
Author(s):  
Yang Li ◽  
Wei Ma ◽  
Yichen Qin ◽  
Feifang Hu

Concerns have been expressed over the validity of statistical inference under covariate-adaptive randomization despite the extensive use in clinical trials. In the literature, the inferential properties under covariate-adaptive randomization have been mainly studied for continuous responses; in particular, it is well known that the usual two-sample t-test for treatment effect is typically conservative. This phenomenon of invalid tests has also been found for generalized linear models without adjusting for the covariates and are sometimes more worrisome due to inflated Type I error. The purpose of this study is to examine the unadjusted test for treatment effect under generalized linear models and covariate-adaptive randomization. For a large class of covariate-adaptive randomization methods, we obtain the asymptotic distribution of the test statistic under the null hypothesis and derive the conditions under which the test is conservative, valid, or anti-conservative. Several commonly used generalized linear models, such as logistic regression and Poisson regression, are discussed in detail. An adjustment method is also proposed to achieve a valid size based on the asymptotic results. Numerical studies confirm the theoretical findings and demonstrate the effectiveness of the proposed adjustment method.


2021 ◽  
Vol 10 (6) ◽  
pp. 1211
Author(s):  
Li-Te Lin ◽  
Kuan-Hao Tsui

The relationship between serum dehydroepiandrosterone sulphate (DHEA-S) and anti-Mullerian hormone (AMH) levels has not been fully established. Therefore, we performed a large-scale cross-sectional study to investigate the association between serum DHEA-S and AMH levels. The study included a total of 2155 infertile women aged 20 to 46 years who were divided into four quartile groups (Q1 to Q4) based on serum DHEA-S levels. We found that there was a weak positive association between serum DHEA-S and AMH levels in infertile women (r = 0.190, p < 0.001). After adjusting for potential confounders, serum DHEA-S levels positively correlated with serum AMH levels in infertile women (β = 0.103, p < 0.001). Infertile women in the highest DHEA-S quartile category (Q4) showed significantly higher serum AMH levels (p < 0.001) compared with women in the lowest DHEA-S quartile category (Q1). The serum AMH levels significantly increased across increasing DHEA-S quartile categories in infertile women (p = 0.014) using generalized linear models after adjustment for potential confounders. Our data show that serum DHEA-S levels are positively associated with serum AMH levels.


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