Informative censoring with an imprecise anchor event: Estimation of change over time and implications for longitudinal data analysis.

摘要

A number of methods have been developed to analyze longitudinal data with dropout. However, there is no uniformly accepted approach. Model performance, in terms of the bias and accuracy of the estimator, depends on the underlying missing data mechanism and it is unclear how existing methods will perform when little is known about the missing data mechanism.;Here we evaluate methods for estimating change over time in longitudinal studies with informative dropout in three settings: using a linear mixed effect (LME) estimator in the presence of multiple types of dropout; proposing an update to the pattern mixture modeling (PMM) approach in the presence of imprecision in identifying informative dropouts; and utilizing this new approach in the presence of prognostic factor by dropout interaction.;We demonstrate that amount of dropout, the proportion of dropout that is informative, and the variability in outcome all affect the performance of an LME estimator in data with a mixture of informative and non-informative dropout. When the amount of dropout is moderate to large (>20% overall) the potential for relative bias greater than 10% increases, especially with large variability in outcome measure, even under scenarios where only a portion of the dropouts are informative.;Under conditions where LME models do not perform well, it is necessary to take the missing data mechanism into account. We develop a method that extends the PMM approach to account for uncertainty in identifying informative dropouts. In scenarios with this uncertainty, the proposed method outperformed the traditional method in terms of bias and coverage.;In the presence of interaction between dropout and a prognostic factor, the LME model performed poorly, in terms of bias and coverage, in estimating prognostic factor-specific slopes and the interaction between the prognostic factor and time. The update to the PMM approach, proposed here, outperformed both the LME and traditional PMM.;Our work suggests that investigators must be cautious with any analysis of data with informative dropout. We found that particular attention must be paid to the model assumptions when the missing data mechanism is not well understood.