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Register a new userAn estimating equations approach to fitting latent exposure models with longitudinal health outcomes
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Added by
Brisa N. S\\'anchez
Publication date
2009
fields
Mathematical Statistics
and research's language is
English
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The analysis of data arising from environmental health studies which collect a large number of measures of exposure can benefit from using latent variable models to summarize exposure information. However, difficulties with estimation of model parameters may arise since existing fitting procedures for linear latent variable models require correctly specified residual variance structures for unbiased estimation of regression parameters quantifying the association between (latent) exposure and health outcomes. We propose an estimating equations approach for latent exposure models with longitudinal health outcomes which is robust to misspecification of the outcome variance. We show that compared to maximum likelihood, the loss of efficiency of the proposed method is relatively small when the model is correctly specified. The proposed equations formalize the ad-hoc regression on factor scores procedure, and generalize regression calibration. We propose two weighting schemes for the equations, and compare their efficiency. We apply this method to a study of the effects of in-utero lead exposure on child development.
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One of the most significant barriers to medication treatment is patients non-adherence to a prescribed medication regimen. The extent of the impact of poor adherence on resulting health measures is often unknown, and typical analyses ignore the time-varying nature of adherence. This paper develops a modeling framework for longitudinally recorded health measures modeled as a function of time-varying medication adherence or other time-varying covariates. Our framework, which relies on normal Bayesian dynamic linear models (DLMs), accounts for time-varying covariates such as adherence and non-dynamic covariates such as baseline health characteristics. Given the inefficiencies using standard inferential procedures for DLMs associated with infrequent and irregularly recorded response data, we develop an approach that relies on factoring the posterior density into a product of two terms; a marginal posterior density for the non-dynamic parameters, and a multivariate normal posterior density of the dynamic parameters conditional on the non-dynamic ones. This factorization leads to a two-stage process for inference in which the non-dynamic parameters can be inferred separately from the time-varying parameters. We demonstrate the application of this model to the time-varying effect of anti-hypertensive medication on blood pressure levels from a cohort of patients diagnosed with hypertension. Our model results are compared to ones in which adherence is incorporated through non-dynamic summaries.
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