On the analysis of two-phase designs in cluster-correlated data settings

Optimal sampling allocation for outcome-dependent designs in cluster-correlated data settings

In clinical and public health studies, it is often the case that some variables relevant to the analysis are too difficult or costly to measure for all individuals in the population of interest. Rather, a subsample of these individuals must be identified for additional data collection. A sampling scheme that incorporates readily-available information for the entire target population at the design stage can increase the statistical efficiency of the intended analysis. While there is no universally optimal sampling design, under certain principles and restrictions, a well-designed and efficient sampling strategy can be implemented. In two-phase designs, efficiency can be gained by stratifying on the outcome and/or auxiliary information that is known at phase I. Additional gains in efficiency can be obtained by determining the optimal allocation of the sample sizes across the strata, which depends on the quantity that is being estimated. In this paper, the inference is concerned with one or multiple regression parameter(s) where the study units are naturally clustered and, thus, exhibit correlation in outcomes. We propose several allocation strategies within the framework of two-phase designs for the estimation of the regression parameter(s) obtained from weighted generalized estimating equations. The proposed methods extend existing theory to address the objective of the estimating regression parameters in cluster-correlated data settings by minimizing the asymptotic variance of the estimator subject to a fixed sample size. Through a comprehensive simulation study, we show that the proposed allocation schemes have the potential to yield substantial efficiency gains over alternative strategies.

Adaptive response-dependent two-phase designs: Some results on robustness and efficiency

Large cohort studies now routinely involve biobanks in which biospecimens are stored for use in future biomarker studies. In such settings, two-phase response-dependent sampling designs involve subsampling individuals in the cohort, assaying their biospecimen to measure an expensive biomarker, and using this data to estimate key parameters of interest under budgetary constraints. When analyses are based on inverse probability weighted estimating functions, recent work has described adaptive two-phase designs in which a preliminary phase of subsampling based on a standard design facilitates approximation of an optimal selection model for a second subsampling phase. In this article, we refine the definition of an optimal subsampling scheme within the framework of adaptive two-phase designs, describe how adaptive two-phase designs can be used when analyses are based on likelihood or conditional likelihood, and consider the setting of a continuous biomarker where the nuisance covariate distribution is estimated nonparametrically at the design stage and analysis stage as required; efficiency and robustness issues are investigated. We also explore these methods for the surrogate variable problem and describe a generalization to accommodate multiple stages of phase II subsampling. A study involving individuals with psoriatic arthritis is considered for illustration, where the aim is to assess the association between the biomarker MMP-3 and the development of joint damage.

Sampling strategies to evaluate the prognostic value of a new biomarker on a time-to-event end-point

BACKGROUND

The availability of large epidemiological or clinical data storing biological samples allow to study the prognostic value of novel biomarkers, but efficient designs are needed to select a subsample on which to measure them, for parsimony and economical reasons. Two-phase stratified sampling is a flexible approach to perform such sub-sampling, but literature on stratification variables to be used in the sampling and power evaluation is lacking especially for survival data.

METHODS

We compared the performance of different sampling designs to assess the prognostic value of a new biomarker on a time-to-event endpoint, applying a Cox model weighted by the inverse of the empirical inclusion probability.

RESULTS

Our simulation results suggest that case-control stratified (or post stratified) by a surrogate variable of the marker can yield higher performances than simple random, probability proportional to size, and case-control sampling. In the presence of high censoring rate, results showed an advantage of nested case-control and counter-matching designs in term of design effect, although the use of a fixed ratio between cases and controls might be disadvantageous. On real data on childhood acute lymphoblastic leukemia, we found that optimal sampling using pilot data is greatly efficient.

CONCLUSIONS

Our study suggests that, in our sample, case-control stratified by surrogate and nested case-control yield estimates and power comparable to estimates obtained in the full cohort while strongly decreasing the number of patients required. We recommend to plan the sample size and using sampling designs for exploration of novel biomarker in clinical cohort data.

Small-sample inference for cluster-based outcome-dependent sampling schemes in resource-limited settings: Investigating low birthweight in Rwanda

The neonatal mortality rate in Rwanda remains above the United Nations Sustainable Development Goal 3 target of 12 deaths per 1000 live births. As part of a larger effort to reduce preventable neonatal deaths in the country, we conducted a study to examine risk factors for low birthweight. The data were collected via a cost-efficient cluster-based outcome-dependent sampling (ODS) scheme wherein clusters of individuals (health centers) were selected on the basis of, in part, the outcome rate of the individuals. For a given data set collected via a cluster-based ODS scheme, estimation for a marginal model may proceed via inverse-probability-weighted generalized estimating equations, where the cluster-specific weights are the inverse probability of the health center's inclusion in the sample. In this paper, we provide a detailed treatment of the asymptotic properties of this estimator, together with an explicit expression for the asymptotic variance and a corresponding estimator. Furthermore, motivated by the study we conducted in Rwanda, we propose a number of small-sample bias corrections to both the point estimates and the standard error estimates. Through simulation, we show that applying these corrections when the number of clusters is small generally reduces the bias in the point estimates, and results in closer to nominal coverage. The proposed methods are applied to data from 18 health centers and 1 district hospital in Rwanda.

Using Big Data to Estimate Dementia Prevalence in New Zealand: Protocol for an Observational Study

BACKGROUND

Dementia describes a cluster of symptoms that includes memory loss; difficulties with thinking, problem solving, or language; and functional impairment. Dementia can be caused by a number of neurodegenerative diseases, such as Alzheimer disease and cerebrovascular disease. Currently in New Zealand, most of the systematically collected and detailed information on dementia is obtained through a suite of International Residential Assessment Instrument (interRAI) assessments, including the home care, contact assessment, and long-term care facility versions. These versions of interRAI are standardized comprehensive geriatric assessments. Patients are referred to have an interRAI assessment by the Needs Assessment and Service Coordination (NASC) services after a series of screening processes. Previous estimates of the prevalence and costs of dementia in New Zealand have been based on international studies with different populations and health and social care systems. This new local knowledge will have implications for estimating the demographic distribution and socioeconomic impact of dementia in New Zealand.

OBJECTIVE

This study investigates the prevalence of dementia, risk factors for dementia, and drivers of the informal cost of dementia among people registered in the NASC database in New Zealand.

METHODS

This study aims to analyze secondary data routinely collected by the NASC and interRAI (home care and contact assessment versions) databases between July 1, 2014, and July 1, 2019, in New Zealand. The databases will be linked to produce an integrated data set, which will be used to (1) investigate the sociodemographic and clinical risk factors associated with dementia and other neurological conditions, (2) estimate the prevalence of dementia using weighting methods for complex samples, and (3) identify the cost of informal care per client (in number of hours of care provided by unpaid carers) and the drivers of such costs. We will use design-based survey methods for the estimation of prevalence and generalized estimating equations for regression models and correlated and longitudinal data.

RESULTS

The results will provide much needed statistics regarding dementia prevalence and risk factors and the cost of informal care for people living with dementia in New Zealand. Potential health inequities for different ethnic groups will be highlighted, which can then be used by decision makers to inform the development of policy and practice.

CONCLUSIONS

As of November 2020, there were no dementia prevalence studies or studies on informal care costs of dementia using national data from New Zealand. All existing studies have used data from other populations with substantially different demographic distributions. This study will give insight into the actual prevalence, risk factors, and informal care costs of dementia for the population with support needs in New Zealand. It will provide valuable information to improve health outcomes and better inform policy and planning.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/20225.

Selection models for efficient two-phase design of family studies

Family studies routinely employ biased sampling schemes in which individuals are randomly chosen from a disease registry and genetic and phenotypic data are obtained from their consenting relatives. We view this as a two-phase study and propose the use of an efficient selection model for the recruitment of families to form a phase II sample subject to budgetary constraints. Simple random sampling, balanced sampling and use of an approximately optimal selection model are considered where the latter is chosen to minimize the variance of parameters of interest. We consider the setting where family members provide current status data with respect to the disease and use copula models to address within-family dependence. The efficiency gains from the use of an optimal selection model over simple random sampling and balanced sampling schemes are investigated as is the robustness of optimal sampling to model misspecification. An application to a family study on psoriatic arthritis is given for illustration.