The resurrection of time as a continuous concept in biostatistics, - - PowerPoint PPT Presentation

the resurrection of time as a continuous concept in
SMART_READER_LITE
LIVE PREVIEW

The resurrection of time as a continuous concept in biostatistics, - - PowerPoint PPT Presentation

The resurrection of time as a continuous concept in biostatistics, demography and epidemiology Bendix Carstensen Steno Diabetes Center, Gentofte, Denmark & Department of Biostatistics, University of Copenhagen bxc@steno.dk


slide-1
SLIDE 1

The resurrection of time as a continuous concept in biostatistics, demography and epidemiology

Bendix Carstensen

Steno Diabetes Center, Gentofte, Denmark

& Department of Biostatistics, University of Copenhagen

bxc@steno.dk http://BendixCarstensen.com ISCB 37, Birmingham August 2016

1/ 15

slide-2
SLIDE 2

Inference in Multistate models

P.K. Andersen & N. Keiding Interpretability and Importance of Functionals in Competing Risks and Multistate Models, Stat Med, 2011 [?]:

  • 1. Do not condition on the future
  • 2. Do not regard individuals at risk after they have died
  • 3. Stick to this world

2/ 15

slide-3
SLIDE 3

Inference in Multistate models

P.K. Andersen & N. Keiding Interpretability and Importance of Functionals in Competing Risks and Multistate Models, Stat Med, 2011 [?]:

  • 1. Do not condition on the future
  • 2. Do not regard individuals at risk after they have died
  • 3. Stick to this world

2/ 15

slide-4
SLIDE 4

Inference in Multistate models

P.K. Andersen & N. Keiding Interpretability and Importance of Functionals in Competing Risks and Multistate Models, Stat Med, 2011 [?]:

  • 1. Do not condition on the future
  • 2. Do not regard individuals at risk after they have died
  • 3. Stick to this world

2/ 15

slide-5
SLIDE 5

Inference in Multistate models

P.K. Andersen & N. Keiding Interpretability and Importance of Functionals in Competing Risks and Multistate Models, Stat Med, 2011 [?]:

  • 1. Do not condition on the future
  • 2. Do not regard individuals at risk after they have died
  • 3. Stick to this world

2/ 15

slide-6
SLIDE 6

Conditioning on the future

◮ . . . also known as“Immortal time bias”

, see e.g.

  • S. Suissa:

Immortal time bias in pharmaco-epidemiology, Am. J. Epidemiol, 2008 [?].

◮ Including persons’ follow-up in the wrong state ◮ . . . namely one reached some time in the future ◮ Normally caused by classification of persons instead of

classification of follow-up time

3/ 15

slide-7
SLIDE 7

Conditioning on the future

◮ . . . also known as“Immortal time bias”

, see e.g.

  • S. Suissa:

Immortal time bias in pharmaco-epidemiology, Am. J. Epidemiol, 2008 [?].

◮ Including persons’ follow-up in the wrong state ◮ . . . namely one reached some time in the future ◮ Normally caused by classification of persons instead of

classification of follow-up time

3/ 15

slide-8
SLIDE 8

Conditioning on the future

◮ . . . also known as“Immortal time bias”

, see e.g.

  • S. Suissa:

Immortal time bias in pharmaco-epidemiology, Am. J. Epidemiol, 2008 [?].

◮ Including persons’ follow-up in the wrong state ◮ . . . namely one reached some time in the future ◮ Normally caused by classification of persons instead of

classification of follow-up time

3/ 15

slide-9
SLIDE 9

Conditioning on the future

◮ . . . also known as“Immortal time bias”

, see e.g.

  • S. Suissa:

Immortal time bias in pharmaco-epidemiology, Am. J. Epidemiol, 2008 [?].

◮ Including persons’ follow-up in the wrong state ◮ . . . namely one reached some time in the future ◮ Normally caused by classification of persons instead of

classification of follow-up time

3/ 15

slide-10
SLIDE 10

Conditioning on the future

◮ . . . also known as“Immortal time bias”

, see e.g.

  • S. Suissa:

Immortal time bias in pharmaco-epidemiology, Am. J. Epidemiol, 2008 [?].

◮ Including persons’ follow-up in the wrong state ◮ . . . namely one reached some time in the future ◮ Normally caused by classification of persons instead of

classification of follow-up time

3/ 15

slide-11
SLIDE 11

Why these mistakes?

◮ Time is usually absent from survival analysis results ◮ . . . because time is taken to be a response variable observed

for each person

◮ Unit of analysis is often seen as the person ◮ Non/Semi-parametric survival model interface invites this

misconception

◮ Persons classified by exposure (the latest, often) ◮ The real unit of observation should be person-time ◮ . . . intervals of time, each with different value of

◮ time ◮ other covariates 4/ 15

slide-12
SLIDE 12

Why these mistakes?

◮ Time is usually absent from survival analysis results ◮ . . . because time is taken to be a response variable observed

for each person

◮ Unit of analysis is often seen as the person ◮ Non/Semi-parametric survival model interface invites this

misconception

◮ Persons classified by exposure (the latest, often) ◮ The real unit of observation should be person-time ◮ . . . intervals of time, each with different value of

◮ time ◮ other covariates 4/ 15

slide-13
SLIDE 13

Why these mistakes?

◮ Time is usually absent from survival analysis results ◮ . . . because time is taken to be a response variable observed

for each person

◮ Unit of analysis is often seen as the person ◮ Non/Semi-parametric survival model interface invites this

misconception

◮ Persons classified by exposure (the latest, often) ◮ The real unit of observation should be person-time ◮ . . . intervals of time, each with different value of

◮ time ◮ other covariates 4/ 15

slide-14
SLIDE 14

Why these mistakes?

◮ Time is usually absent from survival analysis results ◮ . . . because time is taken to be a response variable observed

for each person

◮ Unit of analysis is often seen as the person ◮ Non/Semi-parametric survival model interface invites this

misconception

◮ Persons classified by exposure (the latest, often) ◮ The real unit of observation should be person-time ◮ . . . intervals of time, each with different value of

◮ time ◮ other covariates 4/ 15

slide-15
SLIDE 15

Why these mistakes?

◮ Time is usually absent from survival analysis results ◮ . . . because time is taken to be a response variable observed

for each person

◮ Unit of analysis is often seen as the person ◮ Non/Semi-parametric survival model interface invites this

misconception

◮ Persons classified by exposure (the latest, often) ◮ The real unit of observation should be person-time ◮ . . . intervals of time, each with different value of

◮ time ◮ other covariates 4/ 15

slide-16
SLIDE 16

Why these mistakes?

◮ Time is usually absent from survival analysis results ◮ . . . because time is taken to be a response variable observed

for each person

◮ Unit of analysis is often seen as the person ◮ Non/Semi-parametric survival model interface invites this

misconception

◮ Persons classified by exposure (the latest, often) ◮ The real unit of observation should be person-time ◮ . . . intervals of time, each with different value of

◮ time ◮ other covariates 4/ 15

slide-17
SLIDE 17

Why these mistakes?

◮ Time is usually absent from survival analysis results ◮ . . . because time is taken to be a response variable observed

for each person

◮ Unit of analysis is often seen as the person ◮ Non/Semi-parametric survival model interface invites this

misconception

◮ Persons classified by exposure (the latest, often) ◮ The real unit of observation should be person-time ◮ . . . intervals of time, each with different value of

◮ time ◮ other covariates 4/ 15

slide-18
SLIDE 18

Why these mistakes?

◮ Time is usually absent from survival analysis results ◮ . . . because time is taken to be a response variable observed

for each person

◮ Unit of analysis is often seen as the person ◮ Non/Semi-parametric survival model interface invites this

misconception

◮ Persons classified by exposure (the latest, often) ◮ The real unit of observation should be person-time ◮ . . . intervals of time, each with different value of

◮ time ◮ other covariates 4/ 15

slide-19
SLIDE 19

Why these mistakes?

◮ Time is usually absent from survival analysis results ◮ . . . because time is taken to be a response variable observed

for each person

◮ Unit of analysis is often seen as the person ◮ Non/Semi-parametric survival model interface invites this

misconception

◮ Persons classified by exposure (the latest, often) ◮ The real unit of observation should be person-time ◮ . . . intervals of time, each with different value of

◮ time ◮ other covariates 4/ 15

slide-20
SLIDE 20

Time

◮ Time is a covariate — determinant of rates ◮ Response variable in survival / follow-up is bivariate:

◮ Differences on the timescale (risk time,“exposure”

)

◮ Events

◮ The relevant unit of observation is person-time:

◮ small intervals of follow-up —“empirical rates” ◮ (dit, yit): (event, (sojourn) time) for individual i at time t. ◮ y is the response time, t is the covariate time

◮ Covariates relate to each interval of follow-up ◮ Allows multiple timescales, e.g. age, duration, calendar time

5/ 15

slide-21
SLIDE 21

Time

◮ Time is a covariate — determinant of rates ◮ Response variable in survival / follow-up is bivariate:

◮ Differences on the timescale (risk time,“exposure”

)

◮ Events

◮ The relevant unit of observation is person-time:

◮ small intervals of follow-up —“empirical rates” ◮ (dit, yit): (event, (sojourn) time) for individual i at time t. ◮ y is the response time, t is the covariate time

◮ Covariates relate to each interval of follow-up ◮ Allows multiple timescales, e.g. age, duration, calendar time

5/ 15

slide-22
SLIDE 22

Time

◮ Time is a covariate — determinant of rates ◮ Response variable in survival / follow-up is bivariate:

◮ Differences on the timescale (risk time,“exposure”

)

◮ Events

◮ The relevant unit of observation is person-time:

◮ small intervals of follow-up —“empirical rates” ◮ (dit, yit): (event, (sojourn) time) for individual i at time t. ◮ y is the response time, t is the covariate time

◮ Covariates relate to each interval of follow-up ◮ Allows multiple timescales, e.g. age, duration, calendar time

5/ 15

slide-23
SLIDE 23

Time

◮ Time is a covariate — determinant of rates ◮ Response variable in survival / follow-up is bivariate:

◮ Differences on the timescale (risk time,“exposure”

)

◮ Events

◮ The relevant unit of observation is person-time:

◮ small intervals of follow-up —“empirical rates” ◮ (dit, yit): (event, (sojourn) time) for individual i at time t. ◮ y is the response time, t is the covariate time

◮ Covariates relate to each interval of follow-up ◮ Allows multiple timescales, e.g. age, duration, calendar time

5/ 15

slide-24
SLIDE 24

Time

◮ Time is a covariate — determinant of rates ◮ Response variable in survival / follow-up is bivariate:

◮ Differences on the timescale (risk time,“exposure”

)

◮ Events

◮ The relevant unit of observation is person-time:

◮ small intervals of follow-up —“empirical rates” ◮ (dit, yit): (event, (sojourn) time) for individual i at time t. ◮ y is the response time, t is the covariate time

◮ Covariates relate to each interval of follow-up ◮ Allows multiple timescales, e.g. age, duration, calendar time

5/ 15

slide-25
SLIDE 25

Time

◮ Time is a covariate — determinant of rates ◮ Response variable in survival / follow-up is bivariate:

◮ Differences on the timescale (risk time,“exposure”

)

◮ Events

◮ The relevant unit of observation is person-time:

◮ small intervals of follow-up —“empirical rates” ◮ (dit, yit): (event, (sojourn) time) for individual i at time t. ◮ y is the response time, t is the covariate time

◮ Covariates relate to each interval of follow-up ◮ Allows multiple timescales, e.g. age, duration, calendar time

5/ 15

slide-26
SLIDE 26

Time

◮ Time is a covariate — determinant of rates ◮ Response variable in survival / follow-up is bivariate:

◮ Differences on the timescale (risk time,“exposure”

)

◮ Events

◮ The relevant unit of observation is person-time:

◮ small intervals of follow-up —“empirical rates” ◮ (dit, yit): (event, (sojourn) time) for individual i at time t. ◮ y is the response time, t is the covariate time

◮ Covariates relate to each interval of follow-up ◮ Allows multiple timescales, e.g. age, duration, calendar time

5/ 15

slide-27
SLIDE 27

Time

◮ Time is a covariate — determinant of rates ◮ Response variable in survival / follow-up is bivariate:

◮ Differences on the timescale (risk time,“exposure”

)

◮ Events

◮ The relevant unit of observation is person-time:

◮ small intervals of follow-up —“empirical rates” ◮ (dit, yit): (event, (sojourn) time) for individual i at time t. ◮ y is the response time, t is the covariate time

◮ Covariates relate to each interval of follow-up ◮ Allows multiple timescales, e.g. age, duration, calendar time

5/ 15

slide-28
SLIDE 28

Time

◮ Time is a covariate — determinant of rates ◮ Response variable in survival / follow-up is bivariate:

◮ Differences on the timescale (risk time,“exposure”

)

◮ Events

◮ The relevant unit of observation is person-time:

◮ small intervals of follow-up —“empirical rates” ◮ (dit, yit): (event, (sojourn) time) for individual i at time t. ◮ y is the response time, t is the covariate time

◮ Covariates relate to each interval of follow-up ◮ Allows multiple timescales, e.g. age, duration, calendar time

5/ 15

slide-29
SLIDE 29

Time

◮ Time is a covariate — determinant of rates ◮ Response variable in survival / follow-up is bivariate:

◮ Differences on the timescale (risk time,“exposure”

)

◮ Events

◮ The relevant unit of observation is person-time:

◮ small intervals of follow-up —“empirical rates” ◮ (dit, yit): (event, (sojourn) time) for individual i at time t. ◮ y is the response time, t is the covariate time

◮ Covariates relate to each interval of follow-up ◮ Allows multiple timescales, e.g. age, duration, calendar time

5/ 15

slide-30
SLIDE 30

“Stick to this world”

In the paper by Andersen & Keiding this is primarily aimed at the use of“net survival” , that is the calculation of exp

t λc(s) ds

  • for a single cause of death

— formally for a non-exhaustive exit rate from a state. Survival probability in the situation where:

  • 1. all other causes of death are absent
  • 2. the mortality, λc from cause c is unchanged

. . . which is indeed not of this world.

6/ 15

slide-31
SLIDE 31

“Stick to this world”

In the paper by Andersen & Keiding this is primarily aimed at the use of“net survival” , that is the calculation of exp

t λc(s) ds

  • for a single cause of death

— formally for a non-exhaustive exit rate from a state. Survival probability in the situation where:

  • 1. all other causes of death are absent
  • 2. the mortality, λc from cause c is unchanged

. . . which is indeed not of this world.

6/ 15

slide-32
SLIDE 32

“Stick to this world”

In the paper by Andersen & Keiding this is primarily aimed at the use of“net survival” , that is the calculation of exp

t λc(s) ds

  • for a single cause of death

— formally for a non-exhaustive exit rate from a state. Survival probability in the situation where:

  • 1. all other causes of death are absent
  • 2. the mortality, λc from cause c is unchanged

. . . which is indeed not of this world.

6/ 15

slide-33
SLIDE 33

“Stick to this world”

In the paper by Andersen & Keiding this is primarily aimed at the use of“net survival” , that is the calculation of exp

t λc(s) ds

  • for a single cause of death

— formally for a non-exhaustive exit rate from a state. Survival probability in the situation where:

  • 1. all other causes of death are absent
  • 2. the mortality, λc from cause c is unchanged

. . . which is indeed not of this world.

6/ 15

slide-34
SLIDE 34

“Stick to this world”

In the paper by Andersen & Keiding this is primarily aimed at the use of“net survival” , that is the calculation of exp

t λc(s) ds

  • for a single cause of death

— formally for a non-exhaustive exit rate from a state. Survival probability in the situation where:

  • 1. all other causes of death are absent
  • 2. the mortality, λc from cause c is unchanged

. . . which is indeed not of this world.

6/ 15

slide-35
SLIDE 35

“Stick to this world”

In the paper by Andersen & Keiding this is primarily aimed at the use of“net survival” , that is the calculation of exp

t λc(s) ds

  • for a single cause of death

— formally for a non-exhaustive exit rate from a state. Survival probability in the situation where:

  • 1. all other causes of death are absent
  • 2. the mortality, λc from cause c is unchanged

. . . which is indeed not of this world.

6/ 15

slide-36
SLIDE 36

Sticking to this world

◮ A further feature of“this world”

:

◮ it is continuous ◮ no thresholds in the effect of time ◮ specifically, death and disease rates vary smoothly by

◮ age ◮ calendar time ◮ disease duration ◮ . . . 7/ 15

slide-37
SLIDE 37

Sticking to this world

◮ A further feature of“this world”

:

◮ it is continuous ◮ no thresholds in the effect of time ◮ specifically, death and disease rates vary smoothly by

◮ age ◮ calendar time ◮ disease duration ◮ . . . 7/ 15

slide-38
SLIDE 38

Sticking to this world

◮ A further feature of“this world”

:

◮ it is continuous ◮ no thresholds in the effect of time ◮ specifically, death and disease rates vary smoothly by

◮ age ◮ calendar time ◮ disease duration ◮ . . . 7/ 15

slide-39
SLIDE 39

Sticking to this world

◮ A further feature of“this world”

:

◮ it is continuous ◮ no thresholds in the effect of time ◮ specifically, death and disease rates vary smoothly by

◮ age ◮ calendar time ◮ disease duration ◮ . . . 7/ 15

slide-40
SLIDE 40

Sticking to this world

◮ A further feature of“this world”

:

◮ it is continuous ◮ no thresholds in the effect of time ◮ specifically, death and disease rates vary smoothly by

◮ age ◮ calendar time ◮ disease duration ◮ . . . 7/ 15

slide-41
SLIDE 41

Sticking to this world

◮ A further feature of“this world”

:

◮ it is continuous ◮ no thresholds in the effect of time ◮ specifically, death and disease rates vary smoothly by

◮ age ◮ calendar time ◮ disease duration ◮ . . . 7/ 15

slide-42
SLIDE 42

Sticking to this world

◮ A further feature of“this world”

:

◮ it is continuous ◮ no thresholds in the effect of time ◮ specifically, death and disease rates vary smoothly by

◮ age ◮ calendar time ◮ disease duration ◮ . . . 7/ 15

slide-43
SLIDE 43

Sticking to this world

◮ A further feature of“this world”

:

◮ it is continuous ◮ no thresholds in the effect of time ◮ specifically, death and disease rates vary smoothly by

◮ age ◮ calendar time ◮ disease duration ◮ . . . 7/ 15

slide-44
SLIDE 44

DM mortality in Australia

◮ Rates will typically depend on several time scales ◮ Mortality among Australian DM patients:

a: (current) age — time since birth d: (current) duration of diabetes — time since diagnosis e: age at diagnosis of diabetes: e = a − d

◮ Only two time scales here: a and d ◮ log(λ(a, d)) = f (a) + g(d) + h(e) ◮ Separate effects are not identifiable — only the 2nd order ◮ — this is the APC-modeling problem again

8/ 15

slide-45
SLIDE 45

DM mortality in Australia

◮ Rates will typically depend on several time scales ◮ Mortality among Australian DM patients:

a: (current) age — time since birth d: (current) duration of diabetes — time since diagnosis e: age at diagnosis of diabetes: e = a − d

◮ Only two time scales here: a and d ◮ log(λ(a, d)) = f (a) + g(d) + h(e) ◮ Separate effects are not identifiable — only the 2nd order ◮ — this is the APC-modeling problem again

8/ 15

slide-46
SLIDE 46

DM mortality in Australia

◮ Rates will typically depend on several time scales ◮ Mortality among Australian DM patients:

a: (current) age — time since birth d: (current) duration of diabetes — time since diagnosis e: age at diagnosis of diabetes: e = a − d

◮ Only two time scales here: a and d ◮ log(λ(a, d)) = f (a) + g(d) + h(e) ◮ Separate effects are not identifiable — only the 2nd order ◮ — this is the APC-modeling problem again

8/ 15

slide-47
SLIDE 47

DM mortality in Australia

◮ Rates will typically depend on several time scales ◮ Mortality among Australian DM patients:

a: (current) age — time since birth d: (current) duration of diabetes — time since diagnosis e: age at diagnosis of diabetes: e = a − d

◮ Only two time scales here: a and d ◮ log(λ(a, d)) = f (a) + g(d) + h(e) ◮ Separate effects are not identifiable — only the 2nd order ◮ — this is the APC-modeling problem again

8/ 15

slide-48
SLIDE 48

DM mortality in Australia

◮ Rates will typically depend on several time scales ◮ Mortality among Australian DM patients:

a: (current) age — time since birth d: (current) duration of diabetes — time since diagnosis e: age at diagnosis of diabetes: e = a − d

◮ Only two time scales here: a and d ◮ log(λ(a, d)) = f (a) + g(d) + h(e) ◮ Separate effects are not identifiable — only the 2nd order ◮ — this is the APC-modeling problem again

8/ 15

slide-49
SLIDE 49

DM mortality in Australia

◮ Rates will typically depend on several time scales ◮ Mortality among Australian DM patients:

a: (current) age — time since birth d: (current) duration of diabetes — time since diagnosis e: age at diagnosis of diabetes: e = a − d

◮ Only two time scales here: a and d ◮ log(λ(a, d)) = f (a) + g(d) + h(e) ◮ Separate effects are not identifiable — only the 2nd order ◮ — this is the APC-modeling problem again

8/ 15

slide-50
SLIDE 50

DM mortality in Australia

◮ Rates will typically depend on several time scales ◮ Mortality among Australian DM patients:

a: (current) age — time since birth d: (current) duration of diabetes — time since diagnosis e: age at diagnosis of diabetes: e = a − d

◮ Only two time scales here: a and d ◮ log(λ(a, d)) = f (a) + g(d) + h(e) ◮ Separate effects are not identifiable — only the 2nd order ◮ — this is the APC-modeling problem again

8/ 15

slide-51
SLIDE 51

DM mortality in Australia

◮ Rates will typically depend on several time scales ◮ Mortality among Australian DM patients:

a: (current) age — time since birth d: (current) duration of diabetes — time since diagnosis e: age at diagnosis of diabetes: e = a − d

◮ Only two time scales here: a and d ◮ log(λ(a, d)) = f (a) + g(d) + h(e) ◮ Separate effects are not identifiable — only the 2nd order ◮ — this is the APC-modeling problem again

8/ 15

slide-52
SLIDE 52

DM mortality in Australia

◮ Rates will typically depend on several time scales ◮ Mortality among Australian DM patients:

a: (current) age — time since birth d: (current) duration of diabetes — time since diagnosis e: age at diagnosis of diabetes: e = a − d

◮ Only two time scales here: a and d ◮ log(λ(a, d)) = f (a) + g(d) + h(e) ◮ Separate effects are not identifiable — only the 2nd order ◮ — this is the APC-modeling problem again

8/ 15

slide-53
SLIDE 53

20 40 60 80 0.2 0.5 1.0 2.0 5.0 10.0 20.0 50.0 100.0 200.0 Age Mortality per 1000 PY 5 10 15 20 25 0.5 1.0 1.5 2.0 Duration RR

  • 40

50 60 70 80 90 0.5 1.0 1.5 2.0 Age at DM dx RR

9/ 15

slide-54
SLIDE 54

Australia DM mortality

◮ APC parametrization used (on the log-rate scale)

◮ age at diagnosis, e, constrained to be 0 on average, with average

slope 0

◮ duration of diabetes, d, constrained to be 0 at d = 2 years ◮ current age, a, models the age effect for duration 2 years

◮ Classical reporting of time scale effects as separate is not

sensible:

◮ “. . . the effect of diabetes duration for a fixed age. . . ” ◮ — don’t people get older as the duration of disease increase?

◮ must be reported jointly ◮ show select fitted values to illustrate the actual effects (and

their relative size)

10/ 15

slide-55
SLIDE 55

Australia DM mortality

◮ APC parametrization used (on the log-rate scale)

◮ age at diagnosis, e, constrained to be 0 on average, with average

slope 0

◮ duration of diabetes, d, constrained to be 0 at d = 2 years ◮ current age, a, models the age effect for duration 2 years

◮ Classical reporting of time scale effects as separate is not

sensible:

◮ “. . . the effect of diabetes duration for a fixed age. . . ” ◮ — don’t people get older as the duration of disease increase?

◮ must be reported jointly ◮ show select fitted values to illustrate the actual effects (and

their relative size)

10/ 15

slide-56
SLIDE 56

Australia DM mortality

◮ APC parametrization used (on the log-rate scale)

◮ age at diagnosis, e, constrained to be 0 on average, with average

slope 0

◮ duration of diabetes, d, constrained to be 0 at d = 2 years ◮ current age, a, models the age effect for duration 2 years

◮ Classical reporting of time scale effects as separate is not

sensible:

◮ “. . . the effect of diabetes duration for a fixed age. . . ” ◮ — don’t people get older as the duration of disease increase?

◮ must be reported jointly ◮ show select fitted values to illustrate the actual effects (and

their relative size)

10/ 15

slide-57
SLIDE 57

Australia DM mortality

◮ APC parametrization used (on the log-rate scale)

◮ age at diagnosis, e, constrained to be 0 on average, with average

slope 0

◮ duration of diabetes, d, constrained to be 0 at d = 2 years ◮ current age, a, models the age effect for duration 2 years

◮ Classical reporting of time scale effects as separate is not

sensible:

◮ “. . . the effect of diabetes duration for a fixed age. . . ” ◮ — don’t people get older as the duration of disease increase?

◮ must be reported jointly ◮ show select fitted values to illustrate the actual effects (and

their relative size)

10/ 15

slide-58
SLIDE 58

Australia DM mortality

◮ APC parametrization used (on the log-rate scale)

◮ age at diagnosis, e, constrained to be 0 on average, with average

slope 0

◮ duration of diabetes, d, constrained to be 0 at d = 2 years ◮ current age, a, models the age effect for duration 2 years

◮ Classical reporting of time scale effects as separate is not

sensible:

◮ “. . . the effect of diabetes duration for a fixed age. . . ” ◮ — don’t people get older as the duration of disease increase?

◮ must be reported jointly ◮ show select fitted values to illustrate the actual effects (and

their relative size)

10/ 15

slide-59
SLIDE 59

Australia DM mortality

◮ APC parametrization used (on the log-rate scale)

◮ age at diagnosis, e, constrained to be 0 on average, with average

slope 0

◮ duration of diabetes, d, constrained to be 0 at d = 2 years ◮ current age, a, models the age effect for duration 2 years

◮ Classical reporting of time scale effects as separate is not

sensible:

◮ “. . . the effect of diabetes duration for a fixed age. . . ” ◮ — don’t people get older as the duration of disease increase?

◮ must be reported jointly ◮ show select fitted values to illustrate the actual effects (and

their relative size)

10/ 15

slide-60
SLIDE 60

Australia DM mortality

◮ APC parametrization used (on the log-rate scale)

◮ age at diagnosis, e, constrained to be 0 on average, with average

slope 0

◮ duration of diabetes, d, constrained to be 0 at d = 2 years ◮ current age, a, models the age effect for duration 2 years

◮ Classical reporting of time scale effects as separate is not

sensible:

◮ “. . . the effect of diabetes duration for a fixed age. . . ” ◮ — don’t people get older as the duration of disease increase?

◮ must be reported jointly ◮ show select fitted values to illustrate the actual effects (and

their relative size)

10/ 15

slide-61
SLIDE 61

Australia DM mortality

◮ APC parametrization used (on the log-rate scale)

◮ age at diagnosis, e, constrained to be 0 on average, with average

slope 0

◮ duration of diabetes, d, constrained to be 0 at d = 2 years ◮ current age, a, models the age effect for duration 2 years

◮ Classical reporting of time scale effects as separate is not

sensible:

◮ “. . . the effect of diabetes duration for a fixed age. . . ” ◮ — don’t people get older as the duration of disease increase?

◮ must be reported jointly ◮ show select fitted values to illustrate the actual effects (and

their relative size)

10/ 15

slide-62
SLIDE 62

Australia DM mortality

◮ APC parametrization used (on the log-rate scale)

◮ age at diagnosis, e, constrained to be 0 on average, with average

slope 0

◮ duration of diabetes, d, constrained to be 0 at d = 2 years ◮ current age, a, models the age effect for duration 2 years

◮ Classical reporting of time scale effects as separate is not

sensible:

◮ “. . . the effect of diabetes duration for a fixed age. . . ” ◮ — don’t people get older as the duration of disease increase?

◮ must be reported jointly ◮ show select fitted values to illustrate the actual effects (and

their relative size)

10/ 15

slide-63
SLIDE 63

40 50 60 70 80 1 2 5 10 20 50 100 Age at follow−up All cause mortality rate per 1000 PY

11/ 15

slide-64
SLIDE 64

20 40 60 80 0.2 0.5 1.0 2.0 5.0 10.0 20.0 50.0 100.0 200.0 Age Mortality per 1000 PY 5 10 15 20 25 0.5 1.0 1.5 2.0 Duration RR

  • 40

50 60 70 80 90 0.5 1.0 1.5 2.0 Age at DM dx RR

12/ 15

slide-65
SLIDE 65

Joint reporting of time effects

◮ Only possible in graphical form ◮ Reveals structures that can only be seen with difficulty from

the separate effects

◮ . . . as well as structures that cannot ◮ Always has the form of predictions of rates: ◮ requires access to estimates of the predicted rates ◮ . . . which is a bit of a detour from Cox-type models.

13/ 15

slide-66
SLIDE 66

Joint reporting of time effects

◮ Only possible in graphical form ◮ Reveals structures that can only be seen with difficulty from

the separate effects

◮ . . . as well as structures that cannot ◮ Always has the form of predictions of rates: ◮ requires access to estimates of the predicted rates ◮ . . . which is a bit of a detour from Cox-type models.

13/ 15

slide-67
SLIDE 67

Joint reporting of time effects

◮ Only possible in graphical form ◮ Reveals structures that can only be seen with difficulty from

the separate effects

◮ . . . as well as structures that cannot ◮ Always has the form of predictions of rates: ◮ requires access to estimates of the predicted rates ◮ . . . which is a bit of a detour from Cox-type models.

13/ 15

slide-68
SLIDE 68

Joint reporting of time effects

◮ Only possible in graphical form ◮ Reveals structures that can only be seen with difficulty from

the separate effects

◮ . . . as well as structures that cannot ◮ Always has the form of predictions of rates: ◮ requires access to estimates of the predicted rates ◮ . . . which is a bit of a detour from Cox-type models.

13/ 15

slide-69
SLIDE 69

Joint reporting of time effects

◮ Only possible in graphical form ◮ Reveals structures that can only be seen with difficulty from

the separate effects

◮ . . . as well as structures that cannot ◮ Always has the form of predictions of rates: ◮ requires access to estimates of the predicted rates ◮ . . . which is a bit of a detour from Cox-type models.

13/ 15

slide-70
SLIDE 70

Joint reporting of time effects

◮ Only possible in graphical form ◮ Reveals structures that can only be seen with difficulty from

the separate effects

◮ . . . as well as structures that cannot ◮ Always has the form of predictions of rates: ◮ requires access to estimates of the predicted rates ◮ . . . which is a bit of a detour from Cox-type models.

13/ 15

slide-71
SLIDE 71

Summary & Conclusions

◮ The world is continuous ◮ Effects of time likely to be continuously, smoothly varying ◮ A single time scale is rarely sufficient ◮ Different timescales require joint reportng ◮ Continuous time formulae easiest to handle

and statistical models should reflect this:

◮ Parametric form of time-effects allow direct implementation of

probability theory

◮ Corrolary: Choice of time scales is an empirical problem

◮ Non/Semi-parametric survival model not well suited for this ◮ Stick to this world: Fewer tables — more graphs!

Thanks for your attention

14/ 15

slide-72
SLIDE 72

Summary & Conclusions

◮ The world is continuous ◮ Effects of time likely to be continuously, smoothly varying ◮ A single time scale is rarely sufficient ◮ Different timescales require joint reportng ◮ Continuous time formulae easiest to handle

and statistical models should reflect this:

◮ Parametric form of time-effects allow direct implementation of

probability theory

◮ Corrolary: Choice of time scales is an empirical problem

◮ Non/Semi-parametric survival model not well suited for this ◮ Stick to this world: Fewer tables — more graphs!

Thanks for your attention

14/ 15

slide-73
SLIDE 73

Summary & Conclusions

◮ The world is continuous ◮ Effects of time likely to be continuously, smoothly varying ◮ A single time scale is rarely sufficient ◮ Different timescales require joint reportng ◮ Continuous time formulae easiest to handle

and statistical models should reflect this:

◮ Parametric form of time-effects allow direct implementation of

probability theory

◮ Corrolary: Choice of time scales is an empirical problem

◮ Non/Semi-parametric survival model not well suited for this ◮ Stick to this world: Fewer tables — more graphs!

Thanks for your attention

14/ 15

slide-74
SLIDE 74

Summary & Conclusions

◮ The world is continuous ◮ Effects of time likely to be continuously, smoothly varying ◮ A single time scale is rarely sufficient ◮ Different timescales require joint reportng ◮ Continuous time formulae easiest to handle

and statistical models should reflect this:

◮ Parametric form of time-effects allow direct implementation of

probability theory

◮ Corrolary: Choice of time scales is an empirical problem

◮ Non/Semi-parametric survival model not well suited for this ◮ Stick to this world: Fewer tables — more graphs!

Thanks for your attention

14/ 15

slide-75
SLIDE 75

Summary & Conclusions

◮ The world is continuous ◮ Effects of time likely to be continuously, smoothly varying ◮ A single time scale is rarely sufficient ◮ Different timescales require joint reportng ◮ Continuous time formulae easiest to handle

and statistical models should reflect this:

◮ Parametric form of time-effects allow direct implementation of

probability theory

◮ Corrolary: Choice of time scales is an empirical problem

◮ Non/Semi-parametric survival model not well suited for this ◮ Stick to this world: Fewer tables — more graphs!

Thanks for your attention

14/ 15

slide-76
SLIDE 76

Summary & Conclusions

◮ The world is continuous ◮ Effects of time likely to be continuously, smoothly varying ◮ A single time scale is rarely sufficient ◮ Different timescales require joint reportng ◮ Continuous time formulae easiest to handle

and statistical models should reflect this:

◮ Parametric form of time-effects allow direct implementation of

probability theory

◮ Corrolary: Choice of time scales is an empirical problem

◮ Non/Semi-parametric survival model not well suited for this ◮ Stick to this world: Fewer tables — more graphs!

Thanks for your attention

14/ 15

slide-77
SLIDE 77

Summary & Conclusions

◮ The world is continuous ◮ Effects of time likely to be continuously, smoothly varying ◮ A single time scale is rarely sufficient ◮ Different timescales require joint reportng ◮ Continuous time formulae easiest to handle

and statistical models should reflect this:

◮ Parametric form of time-effects allow direct implementation of

probability theory

◮ Corrolary: Choice of time scales is an empirical problem

◮ Non/Semi-parametric survival model not well suited for this ◮ Stick to this world: Fewer tables — more graphs!

Thanks for your attention

14/ 15

slide-78
SLIDE 78

Summary & Conclusions

◮ The world is continuous ◮ Effects of time likely to be continuously, smoothly varying ◮ A single time scale is rarely sufficient ◮ Different timescales require joint reportng ◮ Continuous time formulae easiest to handle

and statistical models should reflect this:

◮ Parametric form of time-effects allow direct implementation of

probability theory

◮ Corrolary: Choice of time scales is an empirical problem

◮ Non/Semi-parametric survival model not well suited for this ◮ Stick to this world: Fewer tables — more graphs!

Thanks for your attention

14/ 15

slide-79
SLIDE 79

Summary & Conclusions

◮ The world is continuous ◮ Effects of time likely to be continuously, smoothly varying ◮ A single time scale is rarely sufficient ◮ Different timescales require joint reportng ◮ Continuous time formulae easiest to handle

and statistical models should reflect this:

◮ Parametric form of time-effects allow direct implementation of

probability theory

◮ Corrolary: Choice of time scales is an empirical problem

◮ Non/Semi-parametric survival model not well suited for this ◮ Stick to this world: Fewer tables — more graphs!

Thanks for your attention

14/ 15

slide-80
SLIDE 80

Summary & Conclusions

◮ The world is continuous ◮ Effects of time likely to be continuously, smoothly varying ◮ A single time scale is rarely sufficient ◮ Different timescales require joint reportng ◮ Continuous time formulae easiest to handle

and statistical models should reflect this:

◮ Parametric form of time-effects allow direct implementation of

probability theory

◮ Corrolary: Choice of time scales is an empirical problem

◮ Non/Semi-parametric survival model not well suited for this ◮ Stick to this world: Fewer tables — more graphs!

Thanks for your attention

14/ 15

slide-81
SLIDE 81

Summary & Conclusions

◮ The world is continuous ◮ Effects of time likely to be continuously, smoothly varying ◮ A single time scale is rarely sufficient ◮ Different timescales require joint reportng ◮ Continuous time formulae easiest to handle

and statistical models should reflect this:

◮ Parametric form of time-effects allow direct implementation of

probability theory

◮ Corrolary: Choice of time scales is an empirical problem

◮ Non/Semi-parametric survival model not well suited for this ◮ Stick to this world: Fewer tables — more graphs!

Thanks for your attention

14/ 15

slide-82
SLIDE 82

Summary & Conclusions

◮ The world is continuous ◮ Effects of time likely to be continuously, smoothly varying ◮ A single time scale is rarely sufficient ◮ Different timescales require joint reportng ◮ Continuous time formulae easiest to handle

and statistical models should reflect this:

◮ Parametric form of time-effects allow direct implementation of

probability theory

◮ Corrolary: Choice of time scales is an empirical problem

◮ Non/Semi-parametric survival model not well suited for this ◮ Stick to this world: Fewer tables — more graphs!

Thanks for your attention

14/ 15

slide-83
SLIDE 83

References