Statistical modeling of longitudinal survey data with binary outcomes

Abstract

Data obtained from longitudinal surveys using complex multi-stage sampling designs contain cross-sectional dependencies among units caused by inherent hierarchies in the data, and within subject correlation arising due to repeated measurements. The statistical methods used for analyzing such data should account for stratification, clustering and unequal probability of selection as well as within-subject correlations due to repeated measurements. The complex multi-stage design approach has been used in the longitudinal National Population Health Survey (NPHS). This on-going survey collects information on health determinants and outcomes in a sample of the general Canadian population. This dissertation compares the model-based and design-based approaches used to determine the risk factors of asthma prevalence in the Canadian female population of the NPHS (marginal model). Weighted, unweighted and robust statistical methods were used to examine the risk factors of the incidence of asthma (event history analysis) and of recurrent asthma episodes (recurrent survival analysis). Missing data analysis was used to study the bias associated with incomplete data. To determine the risk factors of asthma prevalence, the Generalized Estimating Equations (GEE) approach was used for marginal modeling (model-based approach) followed by Taylor Linearization and bootstrap estimation of standard errors (design-based approach). The incidence of asthma (event history analysis) was estimated using weighted, unweighted and robust methods. Recurrent event history analysis was conducted using Anderson and Gill, Wei, Lin and Weissfeld (WLW) and Prentice, Williams and Peterson (PWP) approaches. To assess the presence of bias associated with missing data, the weighted GEE and pattern-mixture models were used.The prevalence of asthma in the Canadian female population was 6.9% (6.1-7.7) at the end of Cycle 5. When comparing model-based and design- based approaches for asthma prevalence, design-based method provided unbiased estimates of standard errors. The overall incidence of asthma in this population, excluding those with asthma at baseline, was 10.5/1000/year (9.2-12.1). For the event history analysis, the robust method provided the most stable estimates and standard errors. For recurrent event history, the WLW method provided stable standard error estimates. Finally, for the missing data approach, the pattern-mixture model produced the most stable standard errors To conclude, design-based approaches should be preferred over model-based approaches for analyzing complex survey data, as the former provides the most unbiased parameter estimates and standard errors.