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Developmental studies of mental disorders based on epidemiological data are often based on cross-sectional retrospective surveys. Under such designs, observations are right-censored, causing underestimation of lifetime prevalences and correlations, and inducing bias in latent trait models on the observations. In this paper we propose a Partial Likelihood (PL) method to estimate unbiased IRT models of lifetime predisposition to develop a certain outcome. A two-step estimation procedure corrects the IRT likelihood of outcome appearance with a function depending on (a) projected outcome frequencies at the end of the risk period, and (b) outcome censoring status at the time of the observation. Simulation results showed that the PL method yielded good recovery of true frequencies and intercepts. Slopes were best estimated when events were sufficiently correlated. When PL is applied to lifetime mental health disorders (assessed in the ESEMeD project surveys), estimated univariate prevalences were, on average, 1.4 times above raw estimates, and 2.06 higher in the case of bivariate prevalences.
Many large-scale standardized tests are intended to measure skills related to ability rather than the rate at which examinees can work. Time limits imposed on these tests make it difficult to distinguish between the effect of low proficiency and the effect of lack of time. This paper proposes a mixture cure-rate model approach to address this issue. Maximum likelihood estimation is proposed for parameter and variance estimation for three cases: when examinee parameters are to be estimated given precalibrated item parameters, when item parameters are to be calibrated given known examinee parameters, and when item parameters are to be estimated without assuming known examinee parameters. Large-sample properties are established for the cases under suitable regularity conditions. Simulation studies suggest that the proposed approach is appropriate for inferences concerning model parameters. In addition, not distinguishing between the effect of low proficiency and the effect of lack of time is shown to have considerable consequences for parameter estimation. A real data example is presented to demonstrate the new model. Choice of survival models for the latent power times is also discussed.
A version of the discrete proportional hazards model is developed for psychometrical applications. In such applications, a primary covariate that influences failure times is a latent variable representing a psychological construct. The Metropolis-Hastings algorithm is studied as a method for performing marginal likelihood inference on the item parameters. The model is illustrated with a real data example that relates the age at which teenagers first experience various substances to the latent ability to avoid the onset of such behaviors.
Classification and Regression Trees (CART), and their successors—bagging and random forests, are statistical learning tools that are receiving increasing attention. However, due to characteristics of censored data collection, standard CART algorithms are not immediately transferable to the context of survival analysis. Questions about the occurrence and timing of events arise throughout psychological and behavioral sciences, especially in longitudinal studies. The prediction power and other key features of tree-based methods are promising in studies where an event occurrence is the outcome of interest. This article reviews existing tree algorithms designed specifically for censored responses as well as recently developed survival ensemble methods, and introduces available computer software. Through simulations and a practical example, merits and limitations of these methods are discussed. Suggestions are provided for practical use.
The analysis of insurance and annuity products issued on multiple lives requires the use of statistical models which account for lifetime dependence. This paper presents a Dirichlet process mixture-based approach that allows to model dependent lifetimes within a group, such as married couples, accounting for individual as well as group-specific covariates. The model is analyzed in a fully Bayesian setting and illustrated to jointly model the lifetime of male–female couples in a portfolio of joint and last survivor annuities of a Canadian life insurer. The inferential approach allows to account for right censoring and left truncation, which are common features of data in survival analysis. The model shows improved in-sample and out-of-sample performance compared to traditional approaches assuming independent lifetimes and offers additional insights into the determinants of the dependence between lifetimes and their impact on joint and last survivor annuity prices.
Breast cancer is a major global health issue, especially among women. Previous research has indicated a possible association between psychiatric conditions, particularly schizophrenia, and an increased risk of breast cancer. However, the specific risk of breast cancer in women with schizophrenia, compared with those with other psychiatric disorders and the general population, remains controversial and needs further clarification.
Aims
To estimate the risk of breast cancer among people with schizophrenia compared with people with other psychiatric disorders and people in the general population.
Method
We utilised medical claims data of women aged 18 to 80 years in the Korean National Health Information Database from 2007 to 2018. Individuals with schizophrenia were defined as women with ICD-10 codes F20 or F25 (n = 224 612). The control groups were defined as women with other psychiatric disorders (n = 224 612) and women in the general Korean population (n = 449 224). Cases and controls were matched by index date and age, in a 1:1:2 ratio. We estimated the hazard of breast cancer using the Cox proportional hazards model, adjusting for insurance premiums and medical comorbidities. Among the people with schizophrenia, we used the landmark method to estimate the association between duration of antipsychotic medication use and the incidence of breast cancer.
Results
In multivariable Cox regression models, the hazard rate of breast cancer was 1.26 times higher in the people with schizophrenia than in the general population (95% CI: 1.20–1.32). In comparison with the psychiatric patient group, the hazard ratio was 1.17 (95% CI: 1.11–1.28). Among women with schizophrenia, the hazard of breast cancer was greater among those who took antipsychotic medications for 1 year or more compared with those who took antipsychotics for less than 6 months.
Conclusions
Women with schizophrenia have an elevated risk of breast cancer, and long-term use of antipsychotics is associated with an increased risk of breast cancer.
The serotonin 4 receptor (5-HT4R) is a promising target for the treatment of depression. Highly selective 5-HT4R agonists, such as prucalopride, have antidepressant-like and procognitive effects in preclinical models, but their clinical effects are not yet established.
Aims
To determine whether prucalopride (a 5-HT4R agonist and licensed treatment for constipation) is associated with reduced incidence of depression in individuals with no past history of mental illness, compared with anti-constipation agents with no effect on the central nervous system.
Method
Using anonymised routinely collected data from a large-scale USA electronic health records network, we conducted an emulated target trial comparing depression incidence over 1 year in individuals without prior diagnoses of major mental illness, who initiated treatment with prucalopride versus two alternative anti-constipation agents that act by different mechanisms (linaclotide and lubiprostone). Cohorts were matched for 121 covariates capturing sociodemographic factors, and historical and/or concurrent comorbidities and medications. The primary outcome was a first diagnosis of major depressive disorder (ICD-10 code F32) within 1 year of the index date. Robustness of the results to changes in model and population specification was tested. Secondary outcomes included a first diagnosis of six other neuropsychiatric disorders.
Results
Treatment with prucalopride was associated with significantly lower incidence of depression in the following year compared with linaclotide (hazard ratio 0.87, 95% CI 0.76–0.99; P = 0.038; n = 8572 in each matched cohort) and lubiprostone (hazard ratio 0.79, 95% CI 0.69–0.91; P < 0.001; n = 8281). Significantly lower risks of all mood disorders and psychosis were also observed. Results were similar across robustness analyses.
Conclusions
These findings support preclinical data and suggest a role for 5-HT4R agonists as novel agents in the prevention of major depression. These findings should stimulate randomised controlled trials to confirm if these agents can serve as a novel class of antidepressant within a clinical setting.
Generalized linear models extend classical linear models in two ways. They allow the fitting of a linear model to a dependent variable whose expected values have been transformed using a "link" function. They allow for a range of error families other than the normal. They are widely used to fit models to count data and to binomial-type data, including models with errors that may exhibit extra-binomial or extra-Poisson variation. The discussion extends to models in the generalized additive model framework, and to ordinal regression models. Survival analysis, also referred to as time-to-event analysis, is principally concerned with the time duration of a given condition, often but not necessarily sickness or death. In nonmedical contexts, it may be referred to as failure time or reliability analysis. Applications include the failure times of industrial machine components, electronic equipment, kitchen toasters, light bulbs, businesses, loan defaults, and more. There is an elegant methodology for dealing with "censoring" – where all that can be said is that the event of interest occured before or after a certain time, or in a specified interval.
While past research suggested that living arrangements are associated with suicide death, no study has examined the impact of sustained living arrangements and the change in living arrangements. Also, previous survival analysis studies only reported a single hazard ratio (HR), whereas the actual HR may change over time. We aimed to address these limitations using causal inference approaches.
Methods
Multi-point data from a general Japanese population sample were used. Participants reported their living arrangements twice within a 5-year time interval. After that, suicide death, non-suicide death and all-cause mortality were evaluated over 14 years. We used inverse probability weighted pooled logistic regression and cumulative incidence curve, evaluating the association of time-varying living arrangements with suicide death. We also studied non-suicide death and all-cause mortality to contextualize the association. Missing data for covariates were handled using random forest imputation.
Results
A total of 86,749 participants were analysed, with a mean age (standard deviation) of 51.7 (7.90) at baseline. Of these, 306 died by suicide during the 14-year follow-up. Persistently living alone was associated with an increased risk of suicide death (risk difference [RD]: 1.1%, 95% confidence interval [CI]: 0.3–2.5%; risk ratio [RR]: 4.00, 95% CI: 1.83–7.41), non-suicide death (RD: 7.8%, 95% CI: 5.2–10.5%; RR: 1.56, 95% CI: 1.38–1.74) and all-cause mortality (RD: 8.7%, 95% CI: 6.2–11.3%; RR: 1.60, 95% CI: 1.42–1.79) at the end of the follow-up. The cumulative incidence curve showed that these associations were consistent throughout the follow-up. Across all types of mortality, the increased risk was smaller for those who started to live with someone and those who transitioned to living alone. The results remained robust in sensitivity analyses.
Conclusions
Individuals who persistently live alone have an increased risk of suicide death as well as non-suicide death and all-cause mortality, whereas this impact is weaker for those who change their living arrangements.
Research on mobile-assisted language learning (MALL) has revealed that high rates of attrition among users can undermine the potential benefits of this learning method. To explore this issue, we surveyed 3,670 adult MALL users based on the Unified Theory of Acceptance and Use of Technology (UTAUT) and also conducted an in-depth analysis of their historical app usage data. The results of hierarchical k-means cluster analysis and recurrent event survival analysis revealed three major findings. First, three distinct profiles of learners were characterized by different MALL acceptance and engagement experiences. Second, those with greater MALL acceptance displayed more intense, frequent, and durable app usage (behavioral engagement). Lastly, high levels of MALL acceptance were associated with more frequent pauses in app usage but also (a) longer active usage, (b) shorter breaks before returning to the app, and, ultimately, (c) fewer dropouts. We argue that persistence is a multidimensional process involving cyclical phases of engagement, disengagement, dormancy, and reengagement, with each aspect, like intensity, frequency, and duration, building up cumulatively over time. Implications for promoting persistent MALL engagement are discussed.
This study serves as an exemplar to demonstrate the scalability of a research approach using survival analysis applied to general practice electronic health record data from multiple sites. Collection of these data, the subsequent analysis, and the preparation of practice-specific reports were performed using a bespoke distributed data collection and analysis software tool.
Background:
Statins are a very commonly prescribed medication, yet there is a paucity of evidence for their benefits in older patients. We examine the relationship between statin prescriptions for general practice patients over 75 and all-cause mortality.
Methods:
We carried out a retrospective cohort study using survival analysis applied to data extracted from the electronic health records of five Australian general practices.
Findings:
The data from 8025 patients were analysed. The median duration of follow-up was 6.48 years. Overall, 52 015 patient-years of data were examined, and the outcome of death from any cause was measured in 1657 patients (21%), with the remainder being censored. Adjusted all-cause mortality was similar for participants not prescribed statins versus those who were (HR 1.05, 95% CI 0.92–1.20, P = 0.46), except for patients with diabetes for whom all-cause mortality was increased (HR = 1.29, 95% CI: 1.00–1.68, P = 0.05). In contrast, adjusted all-cause mortality was significantly lower for patients deprescribed statins compared to those who were prescribed statins (HR 0.81, 95% CI 0.70–0.93, P < 0.001), including among females (HR = 0.75, 95% CI: 0.61–0.91, P < 0.001) and participants treated for secondary prevention (HR = 0.72, 95% CI: 0.60–0.86, P < 0.001). This study demonstrated the scalability of a research approach using survival analysis applied to general practice electronic health record data from multiple sites. We found no evidence of increased mortality due to statin-deprescribing decisions in primary care.
In this chapter, I analyze data on over 300 individual members of the communist regimes in Bulgaria, Czechoslovakia, East Germany, Hungary, Poland, and Romania. I explore how an abrupt post-Stalinist transition in the wake of the Soviet dictator’s death affected elite cohesion and the relationship between ruling coalitions and their coercive subordinates. Specifically, I test whether breakdowns in elite cohesion led to more punishment of coercive agency chiefs, and their more frequent removal from office. My test of this argument exploits both variation in elite cohesion across Stalinist and post-Stalinist regimes, and variation in Soviet authority over different types of coercive agents. I analyze original data on members of communist ruling coalitions to estimate survival models of their tenures. I find that the tenures of Defense Ministers and secret police chiefs were similar under Stalinist coalitions, but secret police chiefs had significantly shorter tenures than Defense Ministers under post-Stalinist coalitions.
Low birth weight (BW) is consistently correlated with increased parental risk of subsequent cardiovascular disease, but the links with offspring placental weight (PW) are mostly unexplored. We have investigated the associations between parental coronary heart disease (CHD) and offspring BW and PW using the Walker cohort, a collection of 48,000 birth records from Dundee, Scotland, from the 1950s and 1960s. We linked the medical history of 13,866 mothers and 8,092 fathers to their offspring’s records and performed Cox survival analyses modelling maternal and paternal CHD risk by their offspring’s BW, PW, and the ratio between both measurements. We identified negative associations between offspring BW and both maternal (hazard ratio [HR]: 0.91, 95% confidence interval [CI]: 0.88–0.95) and paternal (HR: 0.96, 95% CI: 0.93–1.00) CHD risk, the stronger maternal correlation being consistent with previous reports. Offspring PW to BW ratio was positively associated with maternal CHD risk (HR: 1.14, 95% CI: 1.08–1.21), but the associations with paternal CHD were not significant. These analyses provide additional evidence for intergenerational associations between early growth and parental disease, identifying directionally opposed correlations of maternal CHD with offspring BW and PW, and highlight the importance of the placenta as a determinant of early development and adult disease.
Many of the dependent variables analyzed in the social sciences involve a time period of nonoccurrence prior to their occurrence. Demographers study death; but one cannot die without being born. Thus, one’s death is preceded by a time period after the person has been born during which time they do not die. Such a dependent variable is referred to as a time-to-event variable because there must be a time period of nonoccurrence before the event occurs. Such analyses have several names. The broadest ones are survival analysis or hazard analysis, owing to their early development in biostatistics and epidemiology, where researchers modeled the occurrence of death. The event of death was referred to as a hazard. Persons over a time interval not experiencing the hazard, that is, not dying, were referred to as surviving the hazard. There are two main types of survival models, continuous-time models and discrete-time methods. We direct most of our attention in this chapter to continuous-time models of survival analysis, and specifically to the Cox proportional hazard model. In the last section of the chapter, we focus on discrete-time survival models.
This study considers data from 5 waves of the English Longitudinal Study of Ageing (ELSA). We aim to study the impact of demographic and self-rated health variables including disability and diseases on the survival of the population aged 50+. The disability variables that we consider are mobility impairment, difficulties in performing Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). One of the problems with the survey study is missing observations. This may happen due to different reasons, such as errors, nonresponse and temporary withdrawals. We address this problem by applying single and multiple imputation methods. We then fit a Generalized Linear model (GLM) and Generalized Linear Mixed model (GLMM) to our data and show that a GLMM performs better than a GLM in terms of information criteria. We also look at the predictability of our models in terms of the time-dependent receiver operating characteristic (ROC) and the area of ROC, i.e. AUC. We conclude that among the disability factors, IADL and among the diseases, cancer significantly affect the survival of the English population aged 50 and older.
In examining the effect of Chinese talent-attracting programs launched by the Chinese government, with few exceptions, studies have rarely assessed these programs empirically and pertinently. We intend to fill the gap by assessing an important central government program – the Youth Thousand Talents Program – in Chapter Five. We start with proposing a transnational migration matrix of the academics to clarify the dynamic mechanism of achieving an academic brain gain at the high end. The transnational migration matrix suggests that the academics with high ability have competitiveness in both overseas and domestic academic job markets and can especially enjoy a higher salary and academic reputation in the host (overseas) academic job market due to the more mature mechanism of academic evaluation relative to their home country. The results show that some scholars whose last employer’s academic ranking is among the world’s Top 100 have stronger willingness to return. Compared to scholars with an overseas tenure-track position, those with a tenure position or a permanent position tended to stay overseas, the rate of their staying abroad increased with ages.
In the UK, the incidence and prevalence of inflammatory bowel disease (IBD) is increasing in paediatric populations. Environmental factors including acute gastroenteritis episodes (AGE) may impact IBD development. Infant rotavirus vaccination has been shown to significantly reduce AGE. This study aims to explore the association between vaccination with live oral rotavirus vaccines and IBD development. A population-based cohort study was used, analysing primary care data from the Clinical Practice Research Datalink Aurum. Participants included children born in the UK from 2010 to 2015, followed from a minimum of 6 months old to a maximum of 7 years old. The primary outcome was IBD, and the primary exposure was rotavirus vaccination. Cox regression analysis with random intercepts for general practices was undertaken, with adjustment for potential confounding factors. In a cohort of 907,477 children, IBD was recorded for 96 participants with an incidence rate of 2.1 per 100,000 person-years at risk. The univariable analysis hazard ratio (HR) for rotavirus vaccination was 1.45 (95% confidence interval (CI) 0.93–2.28). Adjustment in the multivariable model attenuated the HR to 1.19 (95% CI 0.53–2.69). This study shows no statistically significant association between rotavirus vaccination and development of IBD. However, it provides further evidence for the safety of live rotavirus vaccination.
Using a corpus linguistic approach, this article aims to answer the question of which factors contribute to a better chance of survival for words in the early Middle English lexicon. Because of the cognitive benefits of rhyme that have been shown in modern studies, there is a particular interest in rhyming position as a potential factor; other factors include frequency, suffix and geographical spread. The data are analysed using survival analysis, random forests and conditional inference trees in R. The results show that geographical spread is the most important factor, usually in combination with particular suffixes. Rhyme is not generally a significant factor in the same vein, and its importance seems to be restricted to individual cases.
This study examines the influence of founding conditions and decisions on new companies' performance, analysing how both environmental context and organisational dynamics interact to determine their success. It distinguishes between two different success indicators: survival and profitable growth. An empirical study conducted using a sample of 3,722 new agri-food companies in two different periods, one of economic stability and the other of recession, showed that founding conditions had long-lasting effects on post-entry performance. The economic context acted as a moderator of the relationship between individual factors and success. Adverse environmental conditions were also a determinant of success, making surviving firms more competitive and resilient. The results reflect the survival of the fitter principle by showing that early profitability reduced the risk of failure and made firms more likely to become profitable in the medium term. Internationalisation strategies developed organisational capabilities that created an imprint for adaptability and growth.
From 1 January 2022 to 4 September 2022, a total of 53 996 mpox cases were confirmed globally. Cases are predominantly concentrated in Europe and the Americas, while other regions are also continuously observing imported cases. This study aimed to estimate the potential global risk of mpox importation and consider hypothetical scenarios of travel restrictions by varying passenger volumes (PVs) via airline travel network. PV data for the airline network, and the time of first confirmed mpox case for a total of 1680 airports in 176 countries (and territories) were extracted from publicly available data sources. A survival analysis technique in which the hazard function was a function of effective distance was utilised to estimate the importation risk. The arrival time ranged from 9 to 48 days since the first case was identified in the UK on 6 May 2022. The estimated risk of importation showed that regardless of the geographic region, most locations will have an intensified importation risk by 31 December 2022. Travel restrictions scenarios had a minor impact on the global airline importation risk against mpox, highlighting the importance to enhance local capacities for the identification of mpox and to be prepared to carry out contact tracing and isolation.