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Fei T, Hanfelt JJ, Peng L. Latent Class Proportional Hazards Regression with Heterogeneous Survival Data. STATISTICS AND ITS INTERFACE 2023; 17:79-90. [PMID: 38222248 PMCID: PMC10786342 DOI: 10.4310/23-sii785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Heterogeneous survival data are commonly present in chronic disease studies. Delineating meaningful disease subtypes directly linked to a survival outcome can generate useful scientific implications. In this work, we develop a latent class proportional hazards (PH) regression framework to address such an interest. We propose mixture proportional hazards modeling, which flexibly accommodates class-specific covariate effects while allowing for the baseline hazard function to vary across latent classes. Adapting the strategy of nonparametric maximum likelihood estimation, we derive an Expectation-Maximization (E-M) algorithm to estimate the proposed model. We establish the theoretical properties of the resulting estimators. Extensive simulation studies are conducted, demonstrating satisfactory finite-sample performance of the proposed method as well as the predictive benefit from accounting for the heterogeneity across latent classes. We further illustrate the practical utility of the proposed method through an application to a mild cognitive impairment (MCI) cohort in the Uniform Data Set.
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Affiliation(s)
- Teng Fei
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 633 3rd Ave, Fl 3, New York, New York 10017, U.S.A
| | - John J Hanfelt
- Department of Biostatistics and Bioinformatics, Emory University, 1518 Clifton Road Northeast, Atlanta, Georgia 30322, U.S.A
| | - Limin Peng
- Department of Biostatistics and Bioinformatics, Emory University, 1518 Clifton Road Northeast, Atlanta, Georgia 30322, U.S.A
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Marye S, Atav S. The Affordable Care Act and child asthma: Lowering health care barriers by raising our voices. Nurs Outlook 2023; 71:102025. [PMID: 37494843 DOI: 10.1016/j.outlook.2023.102025] [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: 02/24/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND This policy discussion addresses the provisions of the Affordable Care Act (ACA) that impact children with asthma. PURPOSE The purpose of this policy paper is to inform health care professionals and lawmakers about ACA provisions affecting pediatric asthma care and provide recommendations for policy changes that can improve equitable care for children with asthma. METHODS The issues addressed involve discrimination, Medicaid policy oversight, quality improvement stategy, data collection, school-based health care funding, accountable care organization reimbursement, and the extension of dependent coverage. DISCUSSION Health care policy development that focuses on human rights, and not market valuation, could reduce health inequity among children with asthma. CONCLUSION Policy recommendations are presented to improve asthma care for a population that is largely vulnerable due to age, socioeconomic status, and discrimination.
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Affiliation(s)
- Stacey Marye
- Department of Nursing, University of North Carolina at Greensboro, Greensboro, NC.
| | - Serdar Atav
- Decker College of Nursing and Health Science, Binghamton University, State University of New York, Binghamton, NY.
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Zhao W, Peng L, Hanfelt J. Semiparametric latent class analysis of recurrent event data. J R Stat Soc Series B Stat Methodol 2022; 84:1175-1197. [DOI: 10.1111/rssb.12499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Wei Zhao
- Department of Biostatistics and BioinformaticsEmory University AtlantaUSA
- Zhongtai Securities Institute for Financial Studies Shandong University Jinan China
| | - Limin Peng
- Department of Biostatistics and BioinformaticsEmory University AtlantaUSA
| | - John Hanfelt
- Department of Biostatistics and BioinformaticsEmory University AtlantaUSA
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Omae K, Eguchi S. Quasi-linear Cox proportional hazards model with cross- L 1 penalty. BMC Med Res Methodol 2020; 20:182. [PMID: 32631280 PMCID: PMC7336640 DOI: 10.1186/s12874-020-01063-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 06/25/2020] [Indexed: 11/24/2022] Open
Abstract
Background To accurately predict the response to treatment, we need a stable and effective risk score that can be calculated from patient characteristics. When we evaluate such risks from time-to-event data with right-censoring, Cox’s proportional hazards model is the most popular for estimating the linear risk score. However, the intrinsic heterogeneity of patients may prevent us from obtaining a valid score. It is therefore insufficient to consider the regression problem with a single linear predictor. Methods we propose the model with a quasi-linear predictor that combines several linear predictors. This provides a natural extension of Cox model that leads to a mixture hazards model. We investigate the property of the maximum likelihood estimator for the proposed model. Moreover, we propose two strategies for getting the interpretable estimates. The first is to restrict the model structure in advance, based on unsupervised learning or prior information, and the second is to obtain as parsimonious an expression as possible in the parameter estimation strategy with cross- L1 penalty. The performance of the proposed method are evaluated by simulation and application studies. Results We showed that the maximum likelihood estimator has consistency and asymptotic normality, and the cross- L1-regularized estimator has root-n consistency. Simulation studies show these properties empirically, and application studies show that the proposed model improves predictive ability relative to Cox model. Conclusions It is essential to capture the intrinsic heterogeneity of patients for getting more stable and effective risk score. The proposed hazard model can capture such heterogeneity and achieve better performance than the ordinary linear Cox proportional hazards model.
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Affiliation(s)
- Katsuhiro Omae
- Department of Clinical Biostatistics, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Kyoto, Japan.
| | - Shinto Eguchi
- The Institute of Statistical Mathematics, Midori-cho, Tachikawa, Tokyo, Japan
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Vanasse A, Courteau J, Courteau M, Benigeri M, Chiu YM, Dufour I, Couillard S, Larivée P, Hudon C. Healthcare utilization after a first hospitalization for COPD: a new approach of State Sequence Analysis based on the '6W' multidimensional model of care trajectories. BMC Health Serv Res 2020; 20:177. [PMID: 32143702 PMCID: PMC7059729 DOI: 10.1186/s12913-020-5030-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 02/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background Published methods to describe and visualize Care Trajectories (CTs) as patterns of healthcare use are very sparse, often incomplete, and not intuitive for non-experts. Our objectives are to propose a typology of CTs one year after a first hospitalization for Chronic Obstructive Pulmonary Disease (COPD), and describe CT types and compare patients’ characteristics for each CT type. Methods This is an observational cohort study extracted from Quebec’s medico-administrative data of patients aged 40 to 84 years hospitalized for COPD in 2013 (index date). The cohort included patients hospitalized for the first time over a 3-year period before the index date and who survived over the follow-up period. The CTs consisted of sequences of healthcare use (e.g. ED-hospital-home-GP-respiratory therapists, etc.) over a one-year period. The main variable was a CT typology, which was generated by a ‘tailored’ multidimensional State Sequence Analysis, based on the “6W” model of Care Trajectories. Three dimensions were considered: the care setting (“where”), the reason for consultation (“why”), and the speciality of care providers (“which”). Patients were grouped into specific CT types, which were compared in terms of care use attributes and patients’ characteristics using the usual descriptive statistics. Results The 2581 patients were grouped into five distinct and homogeneous CT types: Type 1 (n = 1351, 52.3%) and Type 2 (n = 748, 29.0%) with low healthcare and moderate healthcare use respectively; Type 3 (n = 216, 8.4%) with high healthcare use, mainly for respiratory reasons, with the highest number of urgent in-hospital days, seen by pulmonologists and respiratory therapists at primary care settings; Type 4 (n = 100, 3.9%) with high healthcare use, mainly cardiovascular, high ED visits, and mostly seen by nurses in community-based primary care; Type 5 (n = 166, 6.4%) with high healthcare use, high ED visits and non-urgent hospitalisations, and with consultations at outpatient clinics and primary care settings, mainly for other reasons than respiratory or cardiovascular. Patients in the 3 highest utilization CT types were older, and had more comorbidities and more severe condition at index hospitalization. Conclusions The proposed method allows for a better representation of the sequences of healthcare use in the real world, supporting data-driven decision making.
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Affiliation(s)
- Alain Vanasse
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada. .,Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada.
| | - Josiane Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Mireille Courteau
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Mike Benigeri
- École de santé publique de l'Université de Montréal, 7101 avenue du Parc, Montréal, QC, H3N 1X9, Canada
| | - Yohann M Chiu
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Isabelle Dufour
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Simon Couillard
- Service de pneumologie, Département de Médecine, Université de Sherbrooke, 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Pierre Larivée
- Service de pneumologie, Département de Médecine, Université de Sherbrooke, 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada
| | - Catherine Hudon
- Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier universitaire de Sherbrooke (CRCHUS), 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada.,Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, 3001 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada
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