Smoothed quantile residual life regression analysis with application to the Korea HIV/AIDS cohort study

BACKGROUND

The residual life of a patient with human immunodeficiency virus (HIV) is of major interest to patients and their physicians. While existing analyses of HIV patient survival focus mostly on data collected at baseline, residual life analysis allows for dynamic analysis based on additional data collected over a period of time. As survival times typically exhibit a right-skewed distribution, the median provides a more useful summary of the underlying distribution than the mean. In this paper, we propose an efficient inference procedure that fits a semiparametric quantile regression model assessing the effect of longitudinal biomarkers on the residual life of HIV patients until the development of dyslipidemia, a disease becoming more prevalent among those with HIV.

METHODS

For estimation of model parameters, we propose an induced smoothing method that smooths nonsmooth estimating functions based on check functions. For variance estimation, we propose an efficient resampling-based estimator. The proposed estimators are theoretically justified. Simulation studies are used to evaluate their finite sample performances, including their prediction accuracy. We analyze the Korea HIV/AIDS cohort study data to examine the effects of CD4 (cluster of differentiation 4) cell count on the residual life of HIV patients to the onset of dyslipidemia.

RESULTS

The proposed estimator is shown to be consistent and normally distributed asymptotically. Under various simulation settings, our estimates are approximately unbiased. Their variances estimates are close to the empirical variances and their computational efficiency is superior to that of the nonsmooth counterparts. Two measures of prediction performance indicate that our method adequately reflects the dynamic character of longitudinal biomarkers and residual life. The analysis of the Korea HIV/AIDS cohort study data shows that CD4 cell count is positively associated with residual life to the onset of dyslipidemia but the effect is not statistically significant.

CONCLUSIONS

Our method enables direct prediction of residual lifetimes with a dynamic feature that accommodates data accumulated at different times. Our estimator significantly improves computational efficiency in variance estimation compared to the existing nonsmooth estimator. Analysis of the HIV/AIDS cohort study data reveals dynamic effects of CD4 cell count on the residual life to the onset of dyslipidemia.

Nonparametric inference on quantile lost lifespan

In this article, the existing concept of reversed percentile residual life, or percentile inactivity time, is recast to show that it can be used for routine analysis of time-to-event data under right censoring to summarize "life lost," which poses several advantages over the existing methods for survival analysis. An estimating equation approach is adopted to avoid estimation of the probability density function of the underlying time-to-event distribution to estimate the variance of the quantile estimator. Additionally a K-sample test statistic is proposed to test the ratio of the quantile lost lifespans. Simulation studies are performed to assess finite properties of the proposed K-sample statistic in terms of coverage probability and power. The proposed method is illustrated with a real data example from a breast cancer study.

Nonparametric restricted mean analysis across multiple follow-up intervals

We provide a nonparametric estimate of τ-restricted mean survival using follow-up information beyond τwhen appropriate to improve precision. The variance accounts for correlation between follow-up windows. Both asymptotic calculations and simulation studies recommend follow-up intervals spaced approximately τ/2 apart.