论文标题

通过使用双变量不同系数进行竞争的风险建模来了解Covid-19的动态影响

Understanding the dynamic impact of COVID-19 through competing risk modeling with bivariate varying coefficients

论文作者

Wu, Wenbo, Kalbfleisch, John D., Taylor, Jeremy M. G., Kang, Jian, He, Kevin

论文摘要

2019年冠状病毒病(COVID-19)大流行对依靠肾脏透析的末期肾脏疾病患者产生了深远的影响。由美国医疗保险和医疗补助服务中心的请求的激励,我们对2020年的入院后医院再入院和死亡的分析表明,自大流行开始以来,Covid-19效应随后时间和时间的变化很大。但是,COVID-19效应轨迹的复杂动力学不能以现有的变化系数模型来表征。为了解决这个问题,我们提出了一个双变量不同的系数模型,以在特定原因的危险框架内进行竞争风险,其中使用张量产生B-Splines来估计COVID-19效应的表面。开发了一种有效的牛顿近端算法,以促进新模型与透析患者的大规模医疗保险数据拟合。引入了基于差异的各向异性惩罚,以减轻模型过度拟合和估计轨迹的摇摆。在确定最佳调谐参数时,考虑了各种交叉验证方法。假设测试程序旨在检查共同或分别(共同或单独的大流行发作以来的时间)是否随着后的时间和自大流行以来的时间有显着变化。进行仿真实验以评估估计准确性,I型错误率,统计能力和模型选择程序。对Medicare透析患者的应用证明了所提出方法的现实表现。

The coronavirus disease 2019 (COVID-19) pandemic has exerted a profound impact on patients with end-stage renal disease relying on kidney dialysis to sustain their lives. Motivated by a request by the U.S. Centers for Medicare & Medicaid Services, our analysis of their postdischarge hospital readmissions and deaths in 2020 revealed that the COVID-19 effect has varied significantly with postdischarge time and time since the onset of the pandemic. However, the complex dynamics of the COVID-19 effect trajectories cannot be characterized by existing varying coefficient models. To address this issue, we propose a bivariate varying coefficient model for competing risks within a cause-specific hazard framework, where tensor-product B-splines are used to estimate the surface of the COVID-19 effect. An efficient proximal Newton algorithm is developed to facilitate the fitting of the new model to the massive Medicare data for dialysis patients. Difference-based anisotropic penalization is introduced to mitigate model overfitting and the wiggliness of the estimated trajectories; various cross-validation methods are considered in the determination of optimal tuning parameters. Hypothesis testing procedures are designed to examine whether the COVID-19 effect varies significantly with postdischarge time and the time since pandemic onset, either jointly or separately. Simulation experiments are conducted to evaluate the estimation accuracy, type I error rate, statistical power, and model selection procedures. Applications to Medicare dialysis patients demonstrate the real-world performance of the proposed methods.

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