A semi-Markov model for stroke with piecewise-constant hazards in the presence of left, right and interval censoring

作者：Kapetanakis Venediktos^*; Matthews Fiona E; Hout Ardo

来源：Statistics in Medicine, 2013, 32(4): 697-713.

DOI：10.1002/sim.5534

• censored data
• semi-Markov model
• multi-state modelling
• piecewise-constant hazards
• EM algorithm
• stroke

This paper presents a parametric method of fitting semi-Markov models with piecewise-constant hazards in the presence of left, right and interval censoring. We investigate transition intensities in a three-state illnessdeath model with no recovery. We relax the Markov assumption by adjusting the intensity for the transition from state 2 (illness) to state 3 (death) for the time spent in state 2 through a time-varying covariate. This involves the exact time of the transition from state 1 (healthy) to state 2. When the data are subject to left or interval censoring, this time is unknown. In the estimation of the likelihood, we take into account interval censoring by integrating out all possible times for the transition from state 1 to state 2. For left censoring, we use an ExpectationMaximisation inspired algorithm. A simulation study reflects the performance of the method. The proposed combination of statistical procedures provides great flexibility. We illustrate the method in an application by using data on stroke onset for the older population from the UK Medical Research Council Cognitive Function and Ageing Study.

• 出版日期2013-2-20