1
|
Curnow E, Hughes RA, Birnie K, Tilling K, Crowther MJ. Multiple imputation strategies for missing event times in a multi-state model analysis. Stat Med 2024; 43:1238-1255. [PMID: 38258282 DOI: 10.1002/sim.10011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
In clinical studies, multi-state model (MSM) analysis is often used to describe the sequence of events that patients experience, enabling better understanding of disease progression. A complicating factor in many MSM studies is that the exact event times may not be known. Motivated by a real dataset of patients who received stem cell transplants, we considered the setting in which some event times were exactly observed and some were missing. In our setting, there was little information about the time intervals in which the missing event times occurred and missingness depended on the event type, given the analysis model covariates. These additional challenges limited the usefulness of some missing data methods (maximum likelihood, complete case analysis, and inverse probability weighting). We show that multiple imputation (MI) of event times can perform well in this setting. MI is a flexible method that can be used with any complete data analysis model. Through an extensive simulation study, we show that MI by predictive mean matching (PMM), in which sampling is from a set of observed times without reliance on a specific parametric distribution, has little bias when event times are missing at random, conditional on the observed data. Applying PMM separately for each sub-group of patients with a different pathway through the MSM tends to further reduce bias and improve precision. We recommend MI using PMM methods when performing MSM analysis with Markov models and partially observed event times.
Collapse
Affiliation(s)
- Elinor Curnow
- Department of Statistics and Clinical Research, NHS Blood and Transplant, Bristol, UK
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Rachael A Hughes
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Kate Birnie
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Kate Tilling
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Michael J Crowther
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Red Door Analytics, Stockholm, Sweden
| |
Collapse
|
2
|
Joseph J, Pajewski NM, Dolor RJ, Ann Sellers M, Perdue LH, Peeples SR, Henrie AM, Woolard N, Jones WS, Benziger CP, Orkaby AR, Mixon AS, VanWormer JJ, Shapiro MD, Kistler CE, Polonsky TS, Chatterjee R, Chamberlain AM, Forman DE, Knowlton KU, Gill TM, Newby LK, Hammill BG, Cicek MS, Williams NA, Decker JE, Ou J, Rubinstein J, Choudhary G, Gazmuri RJ, Schmader KE, Roumie CL, Vaughan CP, Effron MB, Cooper-DeHoff RM, Supiano MA, Shah RC, Whittle JC, Hernandez AF, Ambrosius WT, Williamson JD, Alexander KP. Pragmatic evaluation of events and benefits of lipid lowering in older adults (PREVENTABLE): Trial design and rationale. J Am Geriatr Soc 2023; 71:1701-1713. [PMID: 37082807 PMCID: PMC10258159 DOI: 10.1111/jgs.18312] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/17/2023] [Accepted: 01/29/2023] [Indexed: 04/22/2023]
Abstract
Whether initiation of statins could increase survival free of dementia and disability in adults aged ≥75 years is unknown. PREVENTABLE, a double-blind, placebo-controlled randomized pragmatic clinical trial, will compare high-intensity statin therapy (atorvastatin 40 mg) with placebo in 20,000 community-dwelling adults aged ≥75 years without cardiovascular disease, disability, or dementia at baseline. Exclusion criteria include statin use in the prior year or for >5 years and inability to take a statin. Potential participants are identified using computable phenotypes derived from the electronic health record and local referrals from the community. Participants will undergo baseline cognitive testing, with physical testing and a blinded lipid panel if feasible. Cognitive testing and disability screening will be conducted annually. Multiple data sources will be queried for cardiovascular events, dementia, and disability; survival is site-reported and supplemented by a National Death Index search. The primary outcome is survival free of new dementia or persisting disability. Co-secondary outcomes are a composite of cardiovascular death, hospitalization for unstable angina or myocardial infarction, heart failure, stroke, or coronary revascularization; and a composite of mild cognitive impairment or dementia. Ancillary studies will offer mechanistic insights into the effects of statins on key outcomes. Biorepository samples are obtained and stored for future study. These results will inform the benefit of statins for increasing survival free of dementia and disability among older adults. This is a pioneering pragmatic study testing important questions with low participant burden to align with the needs of the growing population of older adults.
Collapse
Affiliation(s)
| | | | - Rowena J. Dolor
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Mary Ann Sellers
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | | | - Adam M. Henrie
- Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Office of Research and Development, Department of Veterans Affairs, Albuquerque, NM
| | - Nancy Woolard
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - W. Schuyler Jones
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Ariela R. Orkaby
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, and Division of Aging, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA
| | - Amanda S. Mixon
- Vanderbilt University Medical Center and Geriatric Research Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, TN
| | | | | | - Christine E. Kistler
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, NC
| | | | - Ranee Chatterjee
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | - Daniel E. Forman
- Department of Medicine, Sections of Geriatrics and Cardiology, University of Pittsburgh; Pittsburgh GRECC, VA Pittsburgh Healthcare System, Pittsburgh, PA
| | | | | | - L. Kristin Newby
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Bradley G. Hammill
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | | | - Jake E. Decker
- Section of Primary Care Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Jiafu Ou
- Cardiology Division, John Cochran VA Medical Center and Cardiology Division, Washington University School of Medicine, St. Louis, MO
| | - Jack Rubinstein
- Division of Cardiology, Cincinnati VAMC and Division of Cardiovascular Diseases, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Gaurav Choudhary
- Providence VA Medical Center, and Lifespan Cardiovascular Institute, and Alpert Medical School of Brown University, Providence RI
| | - Raúl J. Gazmuri
- Captain James A. Lovell Federal Health Care Center and Rosalind Franklin University of Medicine and Science, Chicago, IL
| | | | - Christianne L. Roumie
- Vanderbilt University Medical Center and Geriatric Research Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, TN
| | - Camille P. Vaughan
- Birmingham/Atlanta Geriatric Research Education and Clinical Center (GRECC), Department of Veterans Affairs, and Division of Geriatrics & Gerontology, Department of Medicine, Emory University, Atlanta, GA
| | - Mark B. Effron
- John Ochsner Heart and Vascular Institute, The University of Queensland Ochsner Clinical School, New Orleans, LA
| | | | | | - Raj C. Shah
- Family & Preventive Medicine and the Rush Alzheimer’s Disease Center, Rush University, Chicago, IL
| | | | - Adrian F. Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | | | | | - Karen P. Alexander
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| |
Collapse
|