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Wennerberg C, Ekstedt M, Schildmeijer K, Hellström A. Effects on patient activation of eHealth support in addition to standard care in patients after radical prostatectomy: Analysis of secondary outcome from a randomized controlled trial. PLoS One 2024; 19:e0308555. [PMID: 39255260 PMCID: PMC11386445 DOI: 10.1371/journal.pone.0308555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 07/23/2024] [Indexed: 09/12/2024] Open
Abstract
INTRODUCTION Prostate cancer is often treated with radical prostatectomy, but surgery can leave patients with side effects. Patients who actively take part in their rehabilitation have been shown to achieve better clinical outcomes. eHealth support has the potential to increase patient activation, but has rarely been evaluated in long-term randomized controlled trials. Therefore, we evaluated the effects on patient activation of eHealth support (electronic Patient Activation in Treatment at Home, ePATH) based on motivational theory. The aim was to investigate the effects of eHealth support on patient activation at 6 and 12 months after radical prostatectomy, compared with standard care alone, and associations with baseline patient activation and depression. METHODS A multicentre randomized controlled trial with two study arms was conducted. Men planned for radical prostatectomy at three county hospitals in southern Sweden were included and randomized to the intervention or control group. The effects of ePATH on the secondary outcome, patient activation, were evaluated for one year after surgery using the patient activation measure and analysed using a linear mixed model. RESULTS The study included 170 men during 2018-2019. In the intervention group, 64% (53/83) used ePATH. The linear mixed model showed no significant differences between groups in patient activation [β -2.32, P .39; CI -7.64-3.00]. Baseline patient activation [β 0.65, P < .001; CI 0.40-0.91] and depression [β -0.86, P .03; CI -1.64- -0.07] statistically impacted patient activation scores over one year. CONCLUSIONS ePATH had no impact on patient activation during long-term prostate cancer rehabilitation. However, patient activation at baseline and depression scores significantly influenced patient activation, underlining the need to assess these aspects in prostate cancer surgery rehabilitation. TRIAL REGISTRATION ISRCTN Registry ISRCTN18055968, (07/06/2018); https://www.isrctn.com/ISRCTN18055968; International Registered Report Identifier: RR2-10.2196/11625.
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Affiliation(s)
- Camilla Wennerberg
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Department of Surgery, Region Kalmar County, Kalmar, Sweden
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Department of Learning, Management, Informatics and Ethics, Karolinska Institutet, Solna, Sweden
| | | | - Amanda Hellström
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
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Schreuder A, Börnhorst C, Wolters M, Veidebaum T, Tornaritis M, Sina E, Russo P, Moreno LA, Molnar D, Lissner L, De Henauw S, Ahrens W, Vrijkotte T. Population trajectories and age-dependent associations of obesity risk factors with body mass index from childhood to adolescence across European regions: A two-cohort study. Pediatr Obes 2024; 19:e13088. [PMID: 38146220 DOI: 10.1111/ijpo.13088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 08/03/2023] [Accepted: 11/08/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE To investigate population trajectories of behavioural risk factors of obesity from childhood to adolescence and their associations with body mass index (BMI) in children across European regions. METHODS Data were harmonised between the European multi-centre IDEFICS/I.Family and the Amsterdam Born Children and their Development Cohort. Participants were aged 2.0-9.9 and 5.0-7.5 years at baseline, respectively, and were followed until age 18 years. Behavioural risk factors of interest included diet, physical activity, media use and sleep. Mixed effects models were used for statistical analyses to account for repeated measurements taken from the same child. RESULTS The study included a total of 14 328 individuals: 4114, 4582, 3220 and 2412 participants from Northern, Southern, Eastern Europe and Amsterdam, respectively. Risk factor means and prevalences changed with age, but the trajectories were mostly similar across regions. Almost no associations between behavioural factors and BMI were found at the age of 6 years. At 11 years, daily sugar-sweetened foods consumption, use of active transport, sports club membership and longer nocturnal sleep duration were negatively associated with BMI in most regions; positive associations were found with media use. Most associations at 11 years of age persisted to 15 years. CONCLUSIONS Whilst population trajectories of media use and nocturnal sleep duration are similar across European regions, those of other behavioural risk factors like active transport and daily vegetable consumption differ. Also, associations between behavioural risk factors and BMI become stronger with age and show similar patterns across regions.
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Affiliation(s)
- Anton Schreuder
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Claudia Börnhorst
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Maike Wolters
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Toomas Veidebaum
- National Institute for Health Development, Estonian Centre of Behavioral and Health Sciences, Tallinn, Estonia
| | | | - Elida Sina
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Paola Russo
- Institute of Food Sciences, National Research Council, Avellino, Italy
| | - Luis A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Faculty of Health Sciences, Universidad de Zaragoza, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición (CIBERObn), Madrid, Spain
| | - Denes Molnar
- Department of Pediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Lauren Lissner
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Institute of Statistics, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - Tanja Vrijkotte
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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van Linschoten RCA, Amini M, van Leeuwen N, Eijkenaar F, den Hartog SJ, Nederkoorn PJ, Hofmeijer J, Emmer BJ, Postma AA, van Zwam W, Roozenbeek B, Dippel D, Lingsma HF. Handling missing values in the analysis of between-hospital differences in ordinal and dichotomous outcomes: a simulation study. BMJ Qual Saf 2023; 32:742-749. [PMID: 37734955 DOI: 10.1136/bmjqs-2023-016387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023]
Abstract
Missing data are frequently encountered in registries that are used to compare performance across hospitals. The most appropriate method for handling missing data when analysing differences in outcomes between hospitals with a generalised linear mixed model is unclear. We aimed to compare methods for handling missing data when comparing hospitals on ordinal and dichotomous outcomes. We performed a simulation study using data from the Multicentre Randomised Controlled Trial of Endovascular Treatment for Acute Ischaemic Stroke in the Netherlands (MR CLEAN) Registry, a prospective cohort study in 17 hospitals performing endovascular therapy for ischaemic stroke in the Netherlands. The investigated methods for handling missing data, both case-mix adjustment variables and outcomes, were complete case analysis, single imputation, multiple imputation, single imputation with deletion of imputed outcomes and multiple imputation with deletion of imputed outcomes. Data were generated as missing completely at random (MCAR), missing at random and missing not at random (MNAR) in three scenarios: (1) 10% missing data in case-mix and outcome; (2) 40% missing data in case-mix and outcome; and (3) 40% missing data in case-mix and outcome with varying degree of missing data among hospitals. Bias and reliability of the methods were compared on the mean squared error (MSE, a summary measure combining bias and reliability) relative to the hospital effect estimates from the complete reference data set. For both the ordinal outcome (ie, the modified Rankin Scale) and a common dichotomised version thereof, all methods of handling missing data were biased, likely due to shrinkage of the random effects. The MSE of all methods was on average lowest under MCAR and with fewer missing data, and highest with more missing data and under MNAR. The 'multiple imputation, then deletion' method had the lowest MSE for both outcomes under all simulated patterns of missing data. Thus, when estimating hospital effects on ordinal and dichotomous outcomes in the presence of missing data, the least biased and most reliable method to handle these missing data is 'multiple imputation, then deletion'.
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Affiliation(s)
- Reinier C A van Linschoten
- Public Health, Erasmus MC, Rotterdam, Netherlands
- Gastroenterology and Hepatology, Franciscus Gasthuis en Vlietland, Rotterdam, Netherlands
- Department of Gastroenterology & Hepatology, Erasmus MC, Rotterdam, Netherlands
| | | | | | - Frank Eijkenaar
- Erasmus School of Health Policy and Management, Erasmus Universiteit Rotterdam, Rotterdam, Netherlands
| | - Sanne J den Hartog
- Public Health, Erasmus MC, Rotterdam, Netherlands
- Neurology, Erasmus MC, Rotterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
| | | | - Jeannette Hofmeijer
- Neurology, Rijnstate Hospital, Arnhem, Netherlands
- Clinical Neurophysiology, University of Twente, Enschede, Netherlands
| | - Bart J Emmer
- Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Alida A Postma
- Radiology and Nuclear Medicine, MUMC+, Maastricht, Netherlands
- School for Mental Health and Sciences, Maastricht University, Maastricht, Netherlands
| | - Wim van Zwam
- Radiology and Nuclear Medicine, MUMC+, Maastricht, Netherlands
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Wennerberg C, Hellström A, Schildmeijer K, Ekstedt M. Effects of Web-Based and Mobile Self-Care Support in Addition to Standard Care in Patients After Radical Prostatectomy: Randomized Controlled Trial. JMIR Cancer 2023; 9:e44320. [PMID: 37672332 PMCID: PMC10512115 DOI: 10.2196/44320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 06/09/2023] [Accepted: 07/21/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Prostate cancer is a common form of cancer that is often treated with radical prostatectomy, which can leave patients with urinary incontinence and sexual dysfunction. Self-care (pelvic floor muscle exercises and physical activity) is recommended to reduce the side effects. As more and more men are living in the aftermath of treatment, effective rehabilitation support is warranted. Digital self-care support has the potential to improve patient outcomes, but it has rarely been evaluated longitudinally in randomized controlled trials. Therefore, we developed and evaluated the effects of digital self-care support (electronic Patient Activation in Treatment at Home [ePATH]) on prostate-specific symptoms. OBJECTIVE This study aimed to investigate the effects of web-based and mobile self-care support on urinary continence, sexual function, and self-care, compared with standard care, at 1, 3, 6, and 12 months after radical prostatectomy. METHODS A multicenter randomized controlled trial with 2 study arms was conducted, with the longitudinal effects of additional digital self-care support (ePATH) compared with those of standard care alone. ePATH was designed based on the self-determination theory to strengthen patients' activation in self-care through nurse-assisted individualized modules. Men planned for radical prostatectomy at 3 county hospitals in southern Sweden were included offline and randomly assigned to the intervention or control group. The effects of ePATH were evaluated for 1 year after surgery using self-assessed questionnaires. Linear mixed models and ordinal regression analyses were performed. RESULTS This study included 170 men (85 in each group) from January 2018 to December 2019. The participants in the intervention and control groups did not differ in their demographic characteristics. In the intervention group, 64% (53/83) of the participants used ePATH, but the use declined over time. The linear mixed model showed no substantial differences between the groups in urinary continence (β=-5.60; P=.09; 95% CI -12.15 to -0.96) or sexual function (β=-.12; P=.97; 95% CI -7.05 to -6.81). Participants in the intervention and control groups did not differ in physical activity (odds ratio 1.16, 95% CI 0.71-1.89; P=.57) or pelvic floor muscle exercises (odds ratio 1.51, 95% CI 0.86-2.66; P=.15). CONCLUSIONS ePATH did not affect postoperative side effects or self-care but reflected how this support may work in typical clinical conditions. To complement standard rehabilitation, digital self-care support must be adapted to the context and individual preferences for use and effect. TRIAL REGISTRATION ISRCTN Registry ISRCTN18055968; https://www.isrctn.com/ISRCTN18055968. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/11625.
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Affiliation(s)
- Camilla Wennerberg
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Department of Surgery, Region Kalmar County, Kalmar, Sweden
| | - Amanda Hellström
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
| | | | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Department of Learning, Management, Informatics and Ethics, Karolinska Institutet, Stockholm, Sweden
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Jahangiri M, Kazemnejad A, Goldfeld KS, Daneshpour MS, Mostafaei S, Khalili D, Moghadas MR, Akbarzadeh M. A wide range of missing imputation approaches in longitudinal data: a simulation study and real data analysis. BMC Med Res Methodol 2023; 23:161. [PMID: 37415114 PMCID: PMC10327316 DOI: 10.1186/s12874-023-01968-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 06/08/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Missing data is a pervasive problem in longitudinal data analysis. Several single-imputation (SI) and multiple-imputation (MI) approaches have been proposed to address this issue. In this study, for the first time, the function of the longitudinal regression tree algorithm as a non-parametric method after imputing missing data using SI and MI was investigated using simulated and real data. METHOD Using different simulation scenarios derived from a real data set, we compared the performance of cross, trajectory mean, interpolation, copy-mean, and MI methods (27 approaches) to impute missing longitudinal data using parametric and non-parametric longitudinal models and the performance of the methods was assessed in real data. The real data included 3,645 participants older than 18 years within six waves obtained from the longitudinal Tehran cardiometabolic genetic study (TCGS). The data modeling was conducted using systolic and diastolic blood pressure (SBP/DBP) as the outcome variables and included predictor variables such as age, gender, and BMI. The efficiency of imputation approaches was compared using mean squared error (MSE), root-mean-squared error (RMSE), median absolute deviation (MAD), deviance, and Akaike information criteria (AIC). RESULTS The longitudinal regression tree algorithm outperformed based on the criteria such as MSE, RMSE, and MAD than the linear mixed-effects model (LMM) for analyzing the TCGS and simulated data using the missing at random (MAR) mechanism. Overall, based on fitting the non-parametric model, the performance of the 27 imputation approaches was nearly similar. However, the SI traj-mean method improved performance compared with other imputation approaches. CONCLUSION Both SI and MI approaches performed better using the longitudinal regression tree algorithm compared with the parametric longitudinal models. Based on the results from both the real and simulated data, we recommend that researchers use the traj-mean method for imputing missing values of longitudinal data. Choosing the imputation method with the best performance is widely dependent on the models of interest and the data structure.
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Affiliation(s)
- Mina Jahangiri
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Anoshirvan Kazemnejad
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Keith S Goldfeld
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Maryam S Daneshpour
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shayan Mostafaei
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Moghadas
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahdi Akbarzadeh
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Wijesuriya R, Moreno‐Betancur M, Carlin JB, De Silva AP, Lee KJ. Evaluation of approaches for accommodating interactions and non-linear terms in multiple imputation of incomplete three-level data. Biom J 2022; 64:1404-1425. [PMID: 34914127 PMCID: PMC10174217 DOI: 10.1002/bimj.202000343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/19/2021] [Accepted: 06/05/2021] [Indexed: 12/14/2022]
Abstract
Three-level data structures arising from repeated measures on individuals clustered within larger units are common in health research studies. Missing data are prominent in such studies and are often handled via multiple imputation (MI). Although several MI approaches can be used to account for the three-level structure, including adaptations to single- and two-level approaches, when the substantive analysis model includes interactions or quadratic effects, these too need to be accommodated in the imputation model. In such analyses, substantive model compatible (SMC) MI has shown great promise in the context of single-level data. Although there have been recent developments in multilevel SMC MI, to date only one approach that explicitly handles incomplete three-level data is available. Alternatively, researchers can use pragmatic adaptations to single- and two-level MI approaches, or two-level SMC-MI approaches. We describe the available approaches and evaluate them via simulations in the context of three three-level random effects analysis models involving an interaction between the incomplete time-varying exposure and time, an interaction between the time-varying exposure and an incomplete time-fixed confounder, or a quadratic effect of the exposure. Results showed that all approaches considered performed well in terms of bias and precision when the target analysis involved an interaction with time, but the three-level SMC MI approach performed best when the target analysis involved an interaction between the time-varying exposure and an incomplete time-fixed confounder, or a quadratic effect of the exposure. We illustrate the methods using data from the Childhood to Adolescence Transition Study.
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Affiliation(s)
- Rushani Wijesuriya
- Department of PaediatricsFaculty of Medicine Dentistry and Health SciencesThe University of MelbourneParkvilleVictoriaAustralia
- Clinical Epidemiology and Biostatistics UnitMurdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Margarita Moreno‐Betancur
- Department of PaediatricsFaculty of Medicine Dentistry and Health SciencesThe University of MelbourneParkvilleVictoriaAustralia
- Clinical Epidemiology and Biostatistics UnitMurdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - John B. Carlin
- Department of PaediatricsFaculty of Medicine Dentistry and Health SciencesThe University of MelbourneParkvilleVictoriaAustralia
- Clinical Epidemiology and Biostatistics UnitMurdoch Children's Research InstituteParkvilleVictoriaAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Anurika P. De Silva
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Katherine J. Lee
- Department of PaediatricsFaculty of Medicine Dentistry and Health SciencesThe University of MelbourneParkvilleVictoriaAustralia
- Clinical Epidemiology and Biostatistics UnitMurdoch Children's Research InstituteParkvilleVictoriaAustralia
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Quartagno M, Carpenter JR. Substantive model compatible multilevel multiple imputation: A joint modeling approach. Stat Med 2022; 41:5000-5015. [PMID: 35959539 DOI: 10.1002/sim.9549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/03/2022] [Accepted: 07/25/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Substantive model compatible multiple imputation (SMC-MI) is a relatively novel imputation method that is particularly useful when the analyst's model includes interactions, non-linearities, and/or partially observed random slope variables. METHODS Here we thoroughly investigate a SMC-MI strategy based on joint modeling of the covariates of the analysis model. We provide code to apply the proposed strategy and we perform an extensive simulation work to test it in various circumstances. We explore the impact on the results of various factors, including whether the missing data are at the individual or cluster level, whether there are non-linearities and whether the imputation model is correctly specified. Finally, we apply the imputation methods to the motivating example data. RESULTS SMC-JM appears to be superior to standard JM imputation, particularly in presence of large variation in random slopes, non-linearities, and interactions. Results seem to be robust to slight mis-specification of the imputation model for the covariates. When imputing level 2 data, enough clusters have to be observed in order to obtain unbiased estimates of the level 2 parameters. CONCLUSIONS SMC-JM is preferable to standard JM imputation in presence of complexities in the analysis model of interest, such as non-linearities or random slopes.
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Affiliation(s)
- Matteo Quartagno
- Institute for Clinical Trials and Methodology, University College London, London, UK
| | - James R Carpenter
- Institute for Clinical Trials and Methodology, University College London, London, UK.,Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
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Wijesuriya R, Moreno-Betancur M, Carlin J, De Silva AP, Lee KJ. Multiple imputation approaches for handling incomplete three-level data with time-varying cluster-memberships. Stat Med 2022; 41:4385-4402. [PMID: 35893317 PMCID: PMC9540355 DOI: 10.1002/sim.9515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 11/06/2022]
Abstract
Three-level data arising from repeated measures on individuals clustered within higher-level units are common in medical research. A complexity arises when individuals change clusters over time, resulting in a cross-classified data structure. Missing values in these studies are commonly handled via multiple imputation (MI). If the three-level, cross-classified structure is modeled in the analysis, it also needs to be accommodated in the imputation model to ensure valid results. While incomplete three-level data can be handled using various approaches within MI, the performance of these in the cross-classified data setting remains unclear. We conducted simulations under a range of scenarios to compare these approaches in the context of an acute-effects cross-classified random effects substantive model, which models the time-varying cluster membership via simple additive random effects. The simulation study was based on a case study in a longitudinal cohort of students clustered within schools. We evaluated methods that ignore the time-varying cluster memberships by taking the first or most common cluster for each individual; pragmatic extensions of single- and two-level MI approaches within the joint modeling (JM) and the fully conditional specification (FCS) frameworks, using dummy indicators (DI) and/or imputing repeated measures in wide format to account for the cross-classified structure; and a three-level FCS MI approach developed specifically for cross-classified data. Results indicated that the FCS implementations performed well in terms of bias and precision while JM approaches performed poorly. Under both frameworks approaches using the DI extension should be used with caution in the presence of sparse data.
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Affiliation(s)
- Rushani Wijesuriya
- Department of Pediatrics, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Margarita Moreno-Betancur
- Department of Pediatrics, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - John Carlin
- Department of Pediatrics, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Center for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Anurika Priyanjali De Silva
- Center for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Katherine Jane Lee
- Department of Pediatrics, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Giovannetti AM, Pakenham KI, Presti G, Quartuccio ME, Confalonieri P, Bergamaschi R, Grobberio M, Di Filippo M, Micheli M, Brichetto G, Patti F, Copetti M, Kruger P, Solari A. A group resilience training program for people with multiple sclerosis: Study protocol of a multi-centre cluster-randomized controlled trial (multi-READY for MS). PLoS One 2022; 17:e0267245. [PMID: 35500015 PMCID: PMC9060330 DOI: 10.1371/journal.pone.0267245] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/01/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction REsilience and Activities for every DaY (READY) is an Acceptance and Commitment Therapy-based group resilience-training program that has preliminary empirical support in promoting quality of life and other psychosocial outcomes in people with multiple sclerosis (PwMS). Consistent with the Medical Research Council framework for developing and evaluating complex interventions, we conducted a pilot randomized controlled trial (RCT), followed by a phase III RCT. The present paper describes the phase III RCT protocol. Methods and analysis This is a multi-centre cluster RCT comparing READY with a group relaxation program (1:1 ratio) in 240 PwMS from eight centres in Italy (trial registration: isrctn.org Identifier: ISRCTN67194859). Both interventions are composed of 7 weekly sessions plus a booster session five weeks later. Resilience (primary outcome), mood, health-related quality of life, well-being and psychological flexibility will be assessed at baseline, after the booster session, and at three and six month follow-ups. If face-to-face group meetings are interrupted because of COVID-19 related-issues, participants will be invited to complete their intervention via teleconferencing. Relevant COVID-19 information will be collected and the COVID-19 Peritraumatic Distress scale will be administered (ancillary study) at baseline and 3-month follow-up. Analysis will be by intention-to-treat to show superiority of READY over relaxation. Longitudinal changes will be compared between the two arms using repeated-measures, hierarchical generalized linear mixed models. Conclusion It is expected that his study will contribute to the body of evidence on the efficacy and effectiveness of READY by comparing it with an active group intervention in frontline MS rehabilitation and clinical settings. Results will be disseminated in peer-reviewed journals and at other relevant conferences.
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Affiliation(s)
- Ambra Mara Giovannetti
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
- School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia
- * E-mail:
| | - Kenneth Ian Pakenham
- School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Giovambattista Presti
- Kore University Behavioral Lab, Faculty of Human and Social Sciences, Università degli Studi di Enna ’Kore’, Enna, Italy
| | | | - Paolo Confalonieri
- MS Centre, Unit of Neuroimmunology and Neuromuscular Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | | | - Monica Grobberio
- Laboratorio di neuropsicologia, UOSD psicologia clinica e UOC neurologia, ASST Lariana, Como, Italy
| | - Massimiliano Di Filippo
- Centro Malattie Demielinizzanti e Laboratori di Neurologia Sperimentale, Clinica Neurologica, Università degli Studi di Perugia, Perugia, Italy
| | - Mary Micheli
- Dipartimento Riabilitazione ASLUmbria2, Foligno, Italy
| | - Giampaolo Brichetto
- AISM Rehabilitation Service of Genoa, Italian Multiple Sclerosis Society, Genova, Italy
- Scientific Research Area, Italian MS Society Foundation, Genova, Italy
| | - Francesco Patti
- Neurology Clinic, Multiple Sclerosis Centre, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, Fondazione IRCSS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Paola Kruger
- Patient Expert, EUPATI Fellow (European Patients Academy for Therapeutic Innovation) Italy, Roma, Italy
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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10
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Rösel I, Serna-Higuita LM, Al Sayah F, Buchholz M, Buchholz I, Kohlmann T, Martus P, Feng YS. What difference does multiple imputation make in longitudinal modeling of EQ-5D-5L data? Empirical analyses of simulated and observed missing data patterns. Qual Life Res 2022; 31:1521-1532. [PMID: 34797507 PMCID: PMC9023409 DOI: 10.1007/s11136-021-03037-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Although multiple imputation is the state-of-the-art method for managing missing data, mixed models without multiple imputation may be equally valid for longitudinal data. Additionally, it is not clear whether missing values in multi-item instruments should be imputed at item or score-level. We therefore explored the differences in analyzing the scores of a health-related quality of life questionnaire (EQ-5D-5L) using four approaches in two empirical datasets. METHODS We used simulated (GR dataset) and observed missingness patterns (ABCD dataset) in EQ-5D-5L scores to investigate the following approaches: approach-1) mixed models using respondents with complete cases, approach-2) mixed models using all available data, approach-3) mixed models after multiple imputation of the EQ-5D-5L scores, and approach-4) mixed models after multiple imputation of EQ-5D 5L items. RESULTS Approach-1 yielded the highest estimates of all approaches (ABCD, GR), increasingly overestimating the EQ-5D-5L score with higher percentages of missing data (GR). Approach-4 produced the lowest scores at follow-up evaluations (ABCD, GR). Standard errors (0.006-0.008) and mean squared errors (0.032-0.035) increased with increasing percentages of simulated missing GR data. Approaches 2 and 3 showed similar results (both datasets). CONCLUSION Complete cases analyses overestimated the scores and mixed models after multiple imputation by items yielded the lowest scores. As there was no loss of accuracy, mixed models without multiple imputation, when baseline covariates are complete, might be the most parsimonious choice to deal with missing data. However, multiple imputation may be needed when baseline covariates are missing and/or more than two timepoints are considered.
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Affiliation(s)
- Inka Rösel
- Institute for Clinical Epidemiology and Applied Biostatistics, Medical University of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany
- Medical Clinic, Department of Sports Medicine, University Hospital Tuebingen, Tübingen, Germany
| | - Lina María Serna-Higuita
- Institute for Clinical Epidemiology and Applied Biostatistics, Medical University of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany.
| | - Fatima Al Sayah
- Alberta PROMs and EQ-5D Research and Support Unit (APERSU), School of Public Health, University of Alberta, Alberta, Canada
| | - Maresa Buchholz
- Institute for Nursing Science and Interprofessional Education, Medical University Greifswald, Greifswald, Germany
| | - Ines Buchholz
- Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany
| | - Thomas Kohlmann
- Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Applied Biostatistics, Medical University of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany
| | - You-Shan Feng
- Institute for Clinical Epidemiology and Applied Biostatistics, Medical University of Tübingen, Silcherstraße 5, 72076, Tübingen, Germany
- Institute for Community Medicine, Medical University Greifswald, Greifswald, Germany
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11
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Elhakeem A, Hughes RA, Tilling K, Cousminer DL, Jackowski SA, Cole TJ, Kwong ASF, Li Z, Grant SFA, Baxter-Jones ADG, Zemel BS, Lawlor DA. Using linear and natural cubic splines, SITAR, and latent trajectory models to characterise nonlinear longitudinal growth trajectories in cohort studies. BMC Med Res Methodol 2022; 22:68. [PMID: 35291947 PMCID: PMC8925070 DOI: 10.1186/s12874-022-01542-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 02/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Longitudinal data analysis can improve our understanding of the influences on health trajectories across the life-course. There are a variety of statistical models which can be used, and their fitting and interpretation can be complex, particularly where there is a nonlinear trajectory. Our aim was to provide an accessible guide along with applied examples to using four sophisticated modelling procedures for describing nonlinear growth trajectories. METHODS This expository paper provides an illustrative guide to summarising nonlinear growth trajectories for repeatedly measured continuous outcomes using (i) linear spline and (ii) natural cubic spline linear mixed-effects (LME) models, (iii) Super Imposition by Translation and Rotation (SITAR) nonlinear mixed effects models, and (iv) latent trajectory models. The underlying model for each approach, their similarities and differences, and their advantages and disadvantages are described. Their application and correct interpretation of their results is illustrated by analysing repeated bone mass measures to characterise bone growth patterns and their sex differences in three cohort studies from the UK, USA, and Canada comprising 8500 individuals and 37,000 measurements from ages 5-40 years. Recommendations for choosing a modelling approach are provided along with a discussion and signposting on further modelling extensions for analysing trajectory exposures and outcomes, and multiple cohorts. RESULTS Linear and natural cubic spline LME models and SITAR provided similar summary of the mean bone growth trajectory and growth velocity, and the sex differences in growth patterns. Growth velocity (in grams/year) peaked during adolescence, and peaked earlier in females than males e.g., mean age at peak bone mineral content accrual from multicohort SITAR models was 12.2 years in females and 13.9 years in males. Latent trajectory models (with trajectory shapes estimated using a natural cubic spline) identified up to four subgroups of individuals with distinct trajectories throughout adolescence. CONCLUSIONS LME models with linear and natural cubic splines, SITAR, and latent trajectory models are useful for describing nonlinear growth trajectories, and these methods can be adapted for other complex traits. Choice of method depends on the research aims, complexity of the trajectory, and available data. Scripts and synthetic datasets are provided for readers to replicate trajectory modelling and visualisation using the R statistical computing software.
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Affiliation(s)
- Ahmed Elhakeem
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Rachael A Hughes
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kate Tilling
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Diana L Cousminer
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Genetics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Spatial and Functional Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stefan A Jackowski
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Tim J Cole
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Alex S F Kwong
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Zheyuan Li
- School of Mathematics and Statistics, Henan University, Kaifeng, Henan, China
- Department of Statistics and Actuarial Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Struan F A Grant
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Genetics, University of Pennsylvania, Philadelphia, PA, USA
- Center for Spatial and Functional Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Babette S Zemel
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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12
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Ellinger J, Mess F, Blaschke S, Mall C. Health-related quality of life, motivational regulation and Basic Psychological Need Satisfaction in Education Outside the Classroom: an explorative longitudinal pilot study. BMC Public Health 2022; 22:49. [PMID: 34998374 PMCID: PMC8742160 DOI: 10.1186/s12889-021-12450-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 12/20/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Given a suboptimal state of mental health among children, an urgent need exists to seek approaches related to health promotion in this population's settings, such as in schools. Increased health-related quality of life (HRQoL) and improved school motivation could be crucial for children's mental health. Based on self-determination theory, paths can be identified that could lead to such improvements by strengthening the basic psychological needs (BPN). This study aimed to examine the impact on and the relationships among HRQoL, school motivation and BPN within the promising concept of education outside the classroom (EOtC). METHODS In this exploratory study, we employed a between-subjects cohort study design with no blinding or randomisation. We surveyed fifth graders (mean = 10.1 years) attending EOtC (experimental group [EG], n = 25) and normal indoor lessons (control group, [CG], n = 41) at the beginning (T1) and end (T2) of a semester. We used the translations of validated questionnaires and established linear mixed-effects models to evaluate whether the students in EOtC show higher scores of HRQoL and school motivation and, whether the satisfaction of BPN of autonomy (PAut), competence (PCom), social relatedness with classmates (PSRC) and teachers (PSRT) show associations with these outcomes. RESULTS Regarding intrinsic and identified motivational regulation, results showed significant increases over time in the overall sample and significant higher scores in the EG than in the CG. For HRQoL, no group differences were found, but a significant decrease over time in the EG. Regarding possible associations between the outcomes and BPN, such could only be found between HRQoL and PSRC, but not for the other BPN and not for motivational regulation and BPN. CONCLUSIONS Without having been able to explain this on the basis of increased BPN values, our results show that EOtC can support improvements in specific regulation types of school motivation. This could contribute to an improvement in the mental health situation in children, as school represents a major stressor for them. Future steps in terms of researching HRQoL in this setting are discussed, as this pilot study does preliminary work for necessary examinations, e.g. in structural equation approaches.
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Affiliation(s)
- Jan Ellinger
- Department of Sport and Health Sciences, Associate Professorship of Didactics in Sport and Health, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany.
| | - Filip Mess
- Department of Sport and Health Sciences, Associate Professorship of Didactics in Sport and Health, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany
| | - Simon Blaschke
- Department of Sport and Health Sciences, Associate Professorship of Didactics in Sport and Health, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany
| | - Christoph Mall
- Department of Sport and Health Sciences, Associate Professorship of Didactics in Sport and Health, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany
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13
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Hughes RA, Tilling K, Lawlor DA. Combining Longitudinal Data From Different Cohorts to Examine the Life-Course Trajectory. Am J Epidemiol 2021; 190:2680-2689. [PMID: 34215868 PMCID: PMC8634562 DOI: 10.1093/aje/kwab190] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 05/24/2021] [Accepted: 06/25/2021] [Indexed: 12/17/2022] Open
Abstract
Longitudinal data are necessary to reveal changes within an individual as he or she ages. However, rarely will a single cohort study capture data throughout a person's entire life span. Here we describe in detail the steps needed to develop life-course trajectories from cohort studies that cover different and overlapping periods of life. Such independent studies are probably from heterogenous populations, which raises several challenges, including: 1) data harmonization (deriving new harmonized variables from differently measured variables by identifying common elements across all studies); 2) systematically missing data (variables not measured are missing for all participants in a cohort); and 3) model selection with differing age ranges and measurement schedules. We illustrate how to overcome these challenges using an example which examines the associations of parental education, sex, and race/ethnicity with children's weight trajectories. Data were obtained from 5 prospective cohort studies (carried out in Belarus and 4 regions of the United Kingdom) spanning data collected from birth to early adulthood during differing calendar periods (1936-1964, 1972-1979, 1990-2012, 1996-2016, and 2007-2015). Key strengths of our approach include modeling of trajectories over wide age ranges, sharing of information across studies, and direct comparison of the same parts of the life course in different geographical regions and time periods. We also introduce a novel approach of imputing individual-level covariates of a multilevel model with a nonlinear growth trajectory and interactions.
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Affiliation(s)
- Rachael A Hughes
- Correspondence to Dr. Rachael Hughes, MRC Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, United Kingdom (e-mail: )
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14
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Imputation of missing values for electronic health record laboratory data. NPJ Digit Med 2021; 4:147. [PMID: 34635760 PMCID: PMC8505441 DOI: 10.1038/s41746-021-00518-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/13/2021] [Indexed: 11/08/2022] Open
Abstract
Laboratory data from Electronic Health Records (EHR) are often used in prediction models where estimation bias and model performance from missingness can be mitigated using imputation methods. We demonstrate the utility of imputation in two real-world EHR-derived cohorts of ischemic stroke from Geisinger and of heart failure from Sutter Health to: (1) characterize the patterns of missingness in laboratory variables; (2) simulate two missing mechanisms, arbitrary and monotone; (3) compare cross-sectional and multi-level multivariate missing imputation algorithms applied to laboratory data; (4) assess whether incorporation of latent information, derived from comorbidity data, can improve the performance of the algorithms. The latter was based on a case study of hemoglobin A1c under a univariate missing imputation framework. Overall, the pattern of missingness in EHR laboratory variables was not at random and was highly associated with patients' comorbidity data; and the multi-level imputation algorithm showed smaller imputation error than the cross-sectional method.
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15
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Georgin-Lavialle S, Terrier B, Guedon AF, Heiblig M, Comont T, Lazaro E, Lacombe V, Terriou L, Ardois S, Bouaziz JD, Mathian A, Le Guenno G, Aouba A, Outh R, Meyer A, Roux-Sauvat M, Ebbo M, Zhao LP, Bigot A, Jamilloux Y, Guillotin V, Flamarion E, Henneton P, Vial G, Jachiet V, Rossignol J, Vinzio S, Weitten T, Vinit J, Deligny C, Humbert S, Samson M, Magy-Bertrand N, Moulinet T, Bourguiba R, Hanslik T, Bachmeyer C, Sebert M, Kostine M, Bienvenu B, Biscay P, Liozon E, Sailler L, Chasset F, Audemard-Verger A, Duroyon E, Sarrabay G, Borlot F, Dieval C, Cluzeau T, Marianetti P, Lobbes H, Boursier G, Gerfaud-Valentin M, Jeannel J, Servettaz A, Audia S, Larue M, Henriot B, Faucher B, Graveleau J, de Sainte Marie B, Galland J, Bouillet L, Arnaud C, Ades L, Carrat F, Hirsch P, Fenaux P, Fain O, Sujobert P, Kosmider O, Mekinian A. Further characterization of clinical and laboratory features occurring in VEXAS syndrome in a large-scale analysis of multicenter case-series of 116 French patients. Br J Dermatol 2021; 186:564-574. [PMID: 34632574 DOI: 10.1111/bjd.20805] [Citation(s) in RCA: 180] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND A new autoinflammatory syndrome related to somatic mutations of UBA1 was recently described and called VEXAS syndrome. OBJECTIVE To describe clinical characteristics, laboratory findings and outcomes of VEXAS syndrome. DESIGN Case-series. SETTING Patients referred to a French multicenter registry between November 2020 and May 2021. PATIENTS 116 patients with VEXAS syndrome. MEASUREMENTS Frequency and median of parameters and vital status, from diagnosis to the end of the follow-up. RESULTS Main clinical features were skin lesions (83.5%), non-infectious fever (63.6%), weight loss (62%), lung involvement (49.6%), ocular symptoms (38.8%), relapsing chondritis (36.4%), venous thrombosis (34.7%), lymph nodes (33.9%), and arthralgia (27.3%). Hematological disease was present in 58 cases (50%), considered as myelodysplastic syndrome (MDS, n= 58) and monoclonal gammapathy of unknown significance (n=12).UBA1 mutations included p.M41T (44.8%), p.M41V (30.2%), p.M41L (18.1%), and splice mutations (6.9%). After a median follow-up of 3.0 years, 18 patients died (15.5%), from infectious origin (n=9) and MDS progression (n=3). Unsupervised analysis identified 3 clusters: cluster 1 (47%) with mild-to-moderate disease; cluster 2 (16%) with underlying MDS and higher mortality rates; cluster 3 (37%) with constitutional manifestations, higher C-reactive protein levels and less frequent chondritis. Five-year probability of survival was 84.2% in cluster 1, 50.5 % in cluster 2, and 89.6% in cluster 3. UBA1 p.Met41Leu mutation was associated with a better prognosis. CONCLUSION VEXAS syndrome displays a large spectrum of organ manifestations and shows different clinical and prognostic profiles. It also raises a potential impact of the identified UBA1 mutation.
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Affiliation(s)
- S Georgin-Lavialle
- Sorbonne Université, AP-HP, Hôpital Tenon, service de médecine interne, CEREMAIA, F-75020, Paris, France
| | - B Terrier
- University of Paris, AP-HP, Cochin Hospital, Department of Internal Medicine, F-75014, Paris, France
| | - A F Guedon
- Sorbonne Université, Inserm, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, Département de Santé Publique, Hôpital Saint-Antoine, APHP, Paris
| | | | - T Comont
- University Hospital of Toulouse, Department of Internal Medicine and Clinical Immunology, Toulouse, France
| | - E Lazaro
- Department of Internal Medicine and Infectious Diseases, Hôpital Haut-Lévêque, Bordeaux, France
| | - V Lacombe
- Department of Internal Medicine, Angers University Hospital, Angers, France
| | - L Terriou
- Department of Internal Medicine, Lille University Hospital, Lille, France
| | - S Ardois
- Service de médecine interne, CHU de Rennes, Rennes, France
| | - J-D Bouaziz
- Université de Paris, Service de dermatologie, Hôpital Saint Louis, APHP, INSERM U944, Paris, France
| | - A Mathian
- Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, French National Referral Center for Systemic Lupus Erythematosus, Antiphospholipid Antibody Syndrome and Other Autoimmune Disorders, Service de Médecine Interne 2, Institut E3M, Paris, France
| | - G Le Guenno
- University Hospital Centre of Bordeaux, Saint Andre Hospital, Department of Internal Medicine and Clinical Immunology, F-33000 Bordeaux, France, CHU de Clermont-Ferrand, Hôpital Estaing, service de médecine interne, Clermont-Ferrand, France
| | - A Aouba
- Caen Université, Hôpital de Caen, Department of Internal Medicine, Caen, France
| | - R Outh
- Service de médecine interne et générale, Centre Hospitalier de Perpignan, Perpignan, France
| | - A Meyer
- Service d'immunologie clinique et médecine interne, Nouvel Hôpital Civil, CHU Strasbourg
| | - M Roux-Sauvat
- GHND, Centre Hospitalier Pierre Oudot, 30 avenue du Médipôle, BP 40348, 38302 Bourgoin-Jallieu Cedex
| | - M Ebbo
- Aix Marseille Université, AP-HM, Hôpital de la Timone, Department of Internal Medicine, Marseille, France
| | - L P Zhao
- APHP, Hematology department, CHU of Saint Louis, Paris, France
| | - A Bigot
- 19University of Tours, Tours, France, Department of Internal Medicine and Clinical
| | - Y Jamilloux
- University Hospital of Lyon, Hospices Civils de Lyon, Department of Internal Medicine and Clinical Immunology, Lyon, France
| | - V Guillotin
- University Hospital Centre of Bordeaux, Saint Andre Hospital, Department of Internal Medicine and Clinical Immunology, F-33000 Bordeaux, France, CHU de Clermont-Ferrand, Hôpital Estaing, service de médecine interne, Clermont-Ferrand, France
| | - E Flamarion
- Université de Paris, Service de médecine interne, HEGP Paris, France
| | - P Henneton
- Service de Médecine Vasculaire, CHU Montpellier, 80 Av Augustin Fliche, Montpellier, 34090
| | - G Vial
- University Hospital Centre of Bordeaux, Saint Andre Hospital, Department of Internal Medicine and Clinical Immunology, F-33000 Bordeaux, France, CHU de Clermont-Ferrand, Hôpital Estaing, service de médecine interne, Clermont-Ferrand, France
| | - V Jachiet
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75012, Paris, France
| | - J Rossignol
- Université de Paris, Service d'hématologie, Necker Enfants Malades, Paris, France
| | - S Vinzio
- Univ. Grenoble Alpes, Inserm, U1036, CHU Grenoble Alpes, CEA, IRIG-BCI, 38000, Grenoble, France
| | - T Weitten
- Service de médecine interne, Centre Hospitalier (CHICAS), GAP, France
| | - J Vinit
- Service de médecine interne, Centre Hospitalier, Chalons, France
| | - C Deligny
- Service de Rhumatologie - Médecine Interne 5D · CHU de Martinique - Hôpital P. Zobda-Quitman, France
| | - S Humbert
- CHU de Besançon, Service de Médecine Interne, Besançon, France
| | - M Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - N Magy-Bertrand
- CHU de Besançon, Service de Médecine Interne, Besançon, France
| | - T Moulinet
- Department of Internal Medicine and Clinical Immunology, Regional Competence Center for Systemic and Autoimmune Rare Diseases, Nancy University Hospital, UMR 7365, IMoPA, Lorraine University, CNRS, Vandoeuvre-lès-Nancy, France
| | - R Bourguiba
- Sorbonne Université, AP-HP, Hôpital Tenon, service de médecine interne, CEREMAIA, F-75020, Paris, France
| | - T Hanslik
- AP-HP, Hôpital Ambroise Paris, service de médecine interne, Paris, France
| | - C Bachmeyer
- Sorbonne Université, AP-HP, Hôpital Tenon, service de médecine interne, CEREMAIA, F-75020, Paris, France
| | - M Sebert
- APHP, Hematology department, CHU of Saint Louis, Paris, France
| | - M Kostine
- Department of Rheumatology, Hôpital Haut-Lévesque, Bordeaux, France
| | - B Bienvenu
- Hôpital Saint Joseph, service de médecine interne, Marseille, France
| | - P Biscay
- Clinique Mutualiste Pessac Médecine Interne, Pessac, France
| | - E Liozon
- Service de Médecine Interne, CHU Dupuytren, Limoges, France
| | - L Sailler
- University Hospital of Toulouse, Department of Internal Medicine, Toulouse, France
| | - F Chasset
- Sorbonne Université, Hôpital Tenon, service de dermatologie et allergologie et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75020, Paris, France
| | - A Audemard-Verger
- 19University of Tours, Tours, France, Department of Internal Medicine and Clinical
| | - E Duroyon
- Service d'Hématologie Biologique, DMU BioPhyGen GH AP-HP. Centre-University de Paris
| | - G Sarrabay
- Laboratory of Rare and Autoinflammatory Genetic Diseases and Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), CHU Montpellier, University of Montpellier, Montpellier, France
| | - F Borlot
- Service de médecine Interne, CH Béziers, France
| | - C Dieval
- Service de médecine interne et hématologie, CH régional, Rochefort, France
| | - T Cluzeau
- Hematology department, CHU of Nice, Cote d'Azur University, Nice, France
| | - P Marianetti
- CHU de REIMS, Service de médecine interne, maladies infectieuses, immunologie clinique
| | - H Lobbes
- University Hospital Centre of Bordeaux, Saint Andre Hospital, Department of Internal Medicine and Clinical Immunology, F-33000 Bordeaux, France, CHU de Clermont-Ferrand, Hôpital Estaing, service de médecine interne, Clermont-Ferrand, France
| | - G Boursier
- Laboratory of Rare and Autoinflammatory Genetic Diseases and Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), CHU Montpellier, University of Montpellier, Montpellier, France
| | - M Gerfaud-Valentin
- University Hospital of Lyon, Hospices Civils de Lyon, Department of Haematology, Lyon, France
| | - J Jeannel
- Université de Paris, Service de médecine interne, HEGP Paris, France
| | - A Servettaz
- CHU de REIMS, Service de médecine interne, maladies infectieuses, immunologie clinique
| | - S Audia
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - M Larue
- APHP, Service de rhumatologie, Hôpital Henri Mondor, Créteil, France
| | - B Henriot
- Service de médecine interne, Centre Hospitalier René Pleven, Dinan, France
| | - B Faucher
- Aix Marseille Université, AP-HM, Hôpital de la Timone, Department of Internal Medicine, Marseille, France
| | - J Graveleau
- CHU de Nantes Hôtel Dieu, Service de Médecine Interne, Nantes, France
| | - B de Sainte Marie
- University Hospital Centre of Bordeaux, Saint Andre Hospital, Department of Internal Medicine and Clinical Immunology, F-33000 Bordeaux, France, CHU de Clermont-Ferrand, Hôpital Estaing, service de médecine interne, Clermont-Ferrand, France
| | - J Galland
- Service de médecine interne, hôpital Fleyriat, Centre hospitalier Bourg-en-Bresse, France
| | - L Bouillet
- Univ. Grenoble Alpes, Inserm, U1036, CHU Grenoble Alpes, CEA, IRIG-BCI, 38000, Grenoble, France
| | - C Arnaud
- University Hospital of Toulouse, Department of Internal Medicine, Toulouse, France
| | - L Ades
- APHP, Hematology department, CHU of Saint Louis, Paris, France
| | - F Carrat
- Sorbonne Université, Inserm, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, Département de Santé Publique, Hôpital Saint-Antoine, APHP, Paris
| | - P Hirsch
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, service d'hématologie biologique, F-75012, Paris, France
| | - P Fenaux
- APHP, Hematology department, CHU of Saint Louis, Paris, France
| | - O Fain
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75012, Paris, France
| | - P Sujobert
- CHU de Besançon, Service de Médecine Interne, Besançon, France
| | - O Kosmider
- Service d'Hématologie Biologique, DMU BioPhyGen GH AP-HP. Centre-University de Paris
| | - A Mekinian
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), F-75012, Paris, France
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16
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Anstey KJ, Peters R, Mortby ME, Kiely KM, Eramudugolla R, Cherbuin N, Huque MH, Dixon RA. Association of sex differences in dementia risk factors with sex differences in memory decline in a population-based cohort spanning 20-76 years. Sci Rep 2021; 11:7710. [PMID: 33833259 PMCID: PMC8032756 DOI: 10.1038/s41598-021-86397-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/08/2021] [Indexed: 01/06/2023] Open
Abstract
Sex differences in late-life memory decline may be explained by sex differences in dementia risk factors. Episodic memory and dementia risk factors were assessed in young, middle-aged and older adults over 12 years in a population-based sample (N = 7485). For men in midlife and old age, physical, cognitive and social activities were associated with less memory decline, and financial hardship was associated with more. APOE e4 and vascular risk factors were associated with memory decline for women in midlife. Depression, cognitive and physical activity were associated with memory change in older women. Incident midlife hypertension (β = - 0.48, 95% CI - 0.87, - 0.09, p = 0.02) was associated with greater memory decline in women and incident late-life stroke accounted for greater memory decline in men (β = - 0.56, 95% CI - 1.12, - 0.01), p = 0.05). Women have fewer modifiable risk factors than men. Stroke and hypertension explained sex differences in memory decline for men and women respectively.
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Affiliation(s)
- Kaarin J Anstey
- School of Psychology, University of New South Wales, Sydney, Australia.
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia.
- Centre for Research on Ageing Health and Wellbeing, School of Population Health, The Australian National University, Canberra, Australia.
| | - Ruth Peters
- School of Psychology, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia
| | - Moyra E Mortby
- School of Psychology, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia
| | - Kim M Kiely
- School of Psychology, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia
| | - Ranmalee Eramudugolla
- School of Psychology, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, 139 Barker Street, Randwick, NSW, 2031, Australia
| | - Nicolas Cherbuin
- Centre for Research on Ageing Health and Wellbeing, School of Population Health, The Australian National University, Canberra, Australia
| | - Md Hamidul Huque
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Roger A Dixon
- Department of Psychology, University of Alberta, Edmonton, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
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17
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The dynamics of metabolic syndrome development from its isolated components among Iranian adults: findings from 17 years of the Tehran lipid and glucose study (TLGS). J Diabetes Metab Disord 2021; 20:95-105. [PMID: 34178824 DOI: 10.1007/s40200-020-00717-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 12/22/2020] [Indexed: 12/20/2022]
Abstract
Background Evaluating the process of changes in the Metabolic Syndrome (MetS) components over time is one of the ways to study of the MetS natural history. This study aimed to determine the trend of changes in the progression of MetS from its isolated components. Methods This longitudinal study was performed on four follow-up periods of the Tehran Lipid and Glucose Study (TLGS) between 1999 and 2015. The research population consisted of 3905 adults over the age of 18 years. MetS was diagnosed based on the Joint Interim Statement (JIS). The considered components were abdominal obesity, hypertension, hyperglycemia, and dyslipidemia. Results The highest incidence of MetS from its components was related to hypertension in the short term (3.6-year intervals). In the long run, however, the highest increase in the MetS incidence occurred due to abdominal obesity. Overall, the incidence of MetS increased due to obesity and dyslipidemia, but decreased due to the other factors. Nonetheless, the trend of MetS incidence from all components increased in total. The most common components were dyslipidemia with a decreasing trend and obesity with an increasing trend during the study. Conclusion The results indicated that obesity and hypertension components played a more important role in the further development of MetS compared to other components in the Iranian adult population. This necessitates careful and serious attention in preventive and control planning.
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18
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Bagheri P, Khalil D, Seif M, Khedmati Morasae E, Bahramali E, Azizi F, Rezaianzadeh A. The dynamics of metabolic syndrome development from its isolated components among iranian children and adolescents: Findings from 17 Years of the Tehran Lipid and Glucose Study (TLGS). Diabetes Metab Syndr 2021; 15:99-108. [PMID: 33321311 DOI: 10.1016/j.dsx.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/28/2020] [Accepted: 12/03/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Careful evaluation of the progression trend of the metabolic syndrome (MetS) in children and adolescents (C&A) is one of the important methods of studying the natural history of MetS in them. This study was performed to determine the trend of changes in the progression of MetS from its components. METHODS This was a longitudinal study which was performed on data from 4 follow-up periods of Tehran Lipid and Glucose Study (TLGS) between 1999 and 2015. The research population consisted of 6-18-year-old children and adolescents creating 3895-person population. The criteria for the diagnosis of MetS was joint interim statement (JIS). The considered components were central adiposity, high blood pressure, insulin resistance, and dyslipidemia. RESULTS In this study, in the long term, the highest increase in the MetS' incidence in boys occurred in obesity and in girls in dyslipidemia and in total mode, in obesity. But in the short term (3.6 year follow-up periods) in the first to fourth periods, in total mode, the highest incidence occurred in dyslipidemia, hyperglycemia, dyslipidemia, and obesity. In terms of trend, in total mode, the highest increase in MetS incidence was related to the obesity component. Also, the incidence of MetS from all components was declining in overall mode. Also, the most common components at the beginning and end of the study in all groups were dyslipidemia with a decreasing and obesity with an increasing trend, respectively. CONCLUSION It seems that in Iranian C&As, obesity and dyslipidemia components play a more important role in the further development of the MetS than other components. This matter requires careful and serious attention in preventive and control planning.
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Affiliation(s)
- Pezhman Bagheri
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Davood Khalil
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mozhgan Seif
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | - Ehsan Bahramali
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran.
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Abbas Rezaianzadeh
- Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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19
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Wijesuriya R, Moreno-Betancur M, Carlin JB, Lee KJ. Evaluation of approaches for multiple imputation of three-level data. BMC Med Res Methodol 2020; 20:207. [PMID: 32787781 PMCID: PMC7422505 DOI: 10.1186/s12874-020-01079-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/12/2020] [Indexed: 12/30/2022] Open
Abstract
Background Three-level data arising from repeated measures on individuals who are clustered within larger units are common in health research studies. Missing data are prominent in such longitudinal studies and multiple imputation (MI) is a popular approach for handling missing data. Extensions of joint modelling and fully conditional specification MI approaches based on multilevel models have been developed for imputing three-level data. Alternatively, it is possible to extend single- and two-level MI methods to impute three-level data using dummy indicators and/or by analysing repeated measures in wide format. However, most implementations, evaluations and applications of these approaches focus on the context of incomplete two-level data. It is currently unclear which approach is preferable for imputing three-level data. Methods In this study, we investigated the performance of various MI methods for imputing three-level incomplete data when the target analysis model is a three-level random effects model with a random intercept for each level. The MI methods were evaluated via simulations and illustrated using empirical data, based on a case study from the Childhood to Adolescence Transition Study, a longitudinal cohort collecting repeated measures on students who were clustered within schools. In our simulations we considered a number of different scenarios covering a range of different missing data mechanisms, missing data proportions and strengths of level-2 and level-3 intra-cluster correlations. Results We found that all of the approaches considered produced valid inferences about both the regression coefficient corresponding to the exposure of interest and the variance components under the various scenarios within the simulation study. In the case study, all approaches led to similar results. Conclusion Researchers may use extensions to the single- and two-level approaches, or the three-level approaches, to adequately handle incomplete three-level data. The two-level MI approaches with dummy indicator extension or the MI approaches based on three-level models will be required in certain circumstances such as when there are longitudinal data measured at irregular time intervals. However, the single- and two-level approaches with the DI extension should be used with caution as the DI approach has been shown to produce biased parameter estimates in certain scenarios.
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Affiliation(s)
- Rushani Wijesuriya
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia. .,Clinical Epidemiology and Biostatistics Unit, Department of Paediatrics, University of Melbourne, Parkville, VIC, 3052, Australia.
| | - Margarita Moreno-Betancur
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia.,Clinical Epidemiology and Biostatistics Unit, Department of Paediatrics, University of Melbourne, Parkville, VIC, 3052, Australia
| | - John B Carlin
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia.,Clinical Epidemiology and Biostatistics Unit, Department of Paediatrics, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Katherine J Lee
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, VIC, 3052, Australia.,Clinical Epidemiology and Biostatistics Unit, Department of Paediatrics, University of Melbourne, Parkville, VIC, 3052, Australia
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