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Contemporary Clinical Trials Communications logoLink to Contemporary Clinical Trials Communications
. 2015 Oct 23;1:5–16. doi: 10.1016/j.conctc.2015.08.001

Trend-constrained corrected score for proportional hazards model with covariate measurement error

Ming Zhu a,, Yijian Huang b
PMCID: PMC5935832  PMID: 29736434

Abstract

In many medical research studies, survival time is typically the primary outcome of interest. The Cox proportional hazards model is the most popular method to investigate the relationship between covariates and possibly right-censored survival time. However, in many clinical trials, the true covariates may not always be accurately measured due to natural biological fluctuation or instrument error. It is well know that for regression analysis in general, naively using mismeasured covariates in conventional inference procedures may incur substantial estimation bias. In the presence of covariate measurement error, several functional modeling methods have been proposed under the situation where the distribution of the measurement error is known. Among them are parametric corrected score and conditional score. Although both methods are consistent, each suffers from severe problem of multiple roots or absence of appropriate root when the measurement error is substantial. The problem persists even when the sample size is practically large. We conduct a detailed investigation on the pathological behaviors of parametric corrected score and propose an approach of incorporating additional estimating functions to remedy these pathological behaviors. The estimation and inference are then accomplished by means of quadratic inference function. Extensive simulation studies are conducted to evaluate the performance of proposed method.

Keywords: Cox proportional hazards model, Estimating equation, Functional modeling, Measurement error, Survival analysis

1. Introduction

The proportional hazards model is one of the most popular models to investigate the relationship between time to failure and covariates. However, in many clinical trials, the true covariates may not always be accurately measured due to natural biological fluctuation or instrument error. In some studies, the magnitude of measurement error could be substantial to the extent that it is comparable to or even larger than that of the true underlying covariate. A typical example is the HIV viral load in HIV/AIDS studies.

For regression analysis in general, naively using mismeasured covariates in conventional inference procedures may incur substantial estimation bias and several statistical methods have been suggested to address covariate measurement error; see the monograph of Carroll et al. for a good summary [1]. Regression calibration is used frequently to yield approximate estimation. However, it is well known that the regression calibration estimator is inconsistent in general. For consistent estimation, methods have been developed under either structural or functional modeling, i.e., with or without parametric distributional assumptions imposed on the true covariates. By definition, functional modeling approach might be more appealing, particularly for its robustness. Available functional modeling methods for Cox proportional hazards model include the conditional score [2], the parametric corrected score [3], [4], [5], and the nonparametric corrected score [5], [6], [7], [8]. The idea of the conditional score is to condition away the nuisance parameters based on certain sufficient statistics whereas the last two classes adopt a correction strategy by constructing a corrected estimating function with error-contaminated covariates that shares the same limit as a reference estimating function with true underlying covariates. If the reference estimating function admits consistent estimates only, the corrected estimating function shall inherit this property in a compact parameter space containing the true value. Conditional score and parametric corrected score are generally different. But in the case of the Cox proportional hazards model and normal measurement error, the conditional score and parametric corrected score estimators are asymptotically equivalent.

Although all three aforementioned methods produce consistent estimators, they all suffer from finite-sample pathological behaviors especially when the measurement error is substantial, which limit the applicability of these methods in practice. Recently, Huang [9] proposed an approach to incorporate additional estimating functions which constrain the derivatives of the parametric corrected score for loglinear model. This approach effectively remedies those pathological behaviors and also considerably improves the estimation efficiency. Huang's approach provides a promising general strategy to handle similarly ill-behaved estimating functions.

In this paper, we first conduct a detailed investigation on pathological behaviors of parametric corrected score and conditional score. After that, we propose an augmented estimation procedure in which additional estimating functions are added to the parametric corrected score for the proportional hazards model. In Section 2, we briefly describe the parametric corrected score and conditional score for the proportional hazards model and present the investigation results on the pathological behaviors when covariate measurement error is substantial. The proposed approach of incorporating additional estimating functions for the parametric corrected score is presented in Section 3. Simulation studies with practical sample size are reported in Section 4 together with an application to the ACTG 175 clinical trial data. Further discussion is given in Section 5. Technical details is collected in the Appendix.

2. Parametric corrected score and conditional score for proportional hazards model and their pathological behaviors

The proportional hazards model postulates that the cumulative hazard function Λ() of survival time T of an individual with a p-vector of covariate Z has the form

Λ(dt|Z)=exp(βZ)Λ0(dt)

where β is a p-vector parameter of interest and Λ0() is an unspecified underlying cumulative hazard function. Let C denotes the censoring time and adopt the usual independent censoring mechanism: given Z,C is independent of T.

The observed data, (Xii,Zi,i = 1,…,n), consist of n independent and identically distributed (i.i.d) replicates of {XTC,Δ≡I(T ≤ C),Z}. The standard inference procedure for Cox proportional hazards model is then to maximize the partial likelihood or, equivalently, to solve estimating function

ξ*(b,Λ˜0())=n1i=1n0τ(1Zi){dNi(t)Yi(t)exp(bZi)dΛ˜0(t)}, (1)

where Ni(t) = I(Xi ≤ t, Δi = 1) is the counting process, Yi(t) = IX i ≥ t) is the at-risk process and τ is a positive constant such that Pr(T ≥ τ) > 0. Profiling out Λ˜0(), the estimating function for β alone is

ξ(b)=n1i=1n0τ{Zij=1nYj(t)Zjexp(bZj)j=1nYj(t)exp(bZj)}dNi(t). (2)

Estimating function (2) is actually the usual partial score function.

2.1. Parametric corrected score and conditional score

Split covariates Z=(ZaT,ZeT)T where Za are those covariates that can be accurately measured and Ze are covariates prone to measurement error and cannot be accurately measured. Though Ze cannot be measured directly, we can observe them through their surrogates We. Under the classical additive measurement error model, We = Ze + εe, where εe is the error vector and εe is assumed to be independent of (T,C,Z). In this paper, we assume that the distribution of εe is known; The situation where distribution of εe is unknown will be discussed in Section 5.

Let W = (Za,We) and ε = (0,εe). The observed data now consist of (Xii,Wi,i = 1,…,n) in the presence of covariate measurement error. It is well known that naively replacing Z by W in estimating functions (1) or (2) could incur substantial estimation bias. Denote the cumulant-generating function of ε as Ω(b)logE{exp(bε)} and its derivative Ω˙(b)Ω(b)/b. The parametric corrected score estimating function is given by

η*(b,Λ˜0())=n1i=1n0τ(1WiΩ˙(0))dNi(t)0τYi(t)exp{bWiΩ(b)}(1WiΩ˙(b))dΛ˜0(t). (3)

Further profiling out Λ˜0(), we obtain the corrected score for β [10]:

η(b)=n1i=1n0τ{Wi+Ω˙(b)Ω˙(0)j=1nYj(t)Wjexp(bWj)j=1nYj(t)exp(bWj)}dNi(t) (4)

which has the same expectation as reference (2) asymptotically for each and every finite b. The estimation is then to find the zero crossing of the above estimating function. The consistency and asymptotic normality of corrected score estimator are later established by Kong and Gu [11].

Huang and Wang [6] defined a root-consistent estimating function as such that every zero-crossing is consistent and showed that a normalized estimating function is root-consistent if its limit has a unique root at the estimand. By definition, reference (2) is a root-consistent estimating function and the new estimating function (4) shall inherit the root-consistency from (2). The root-consistency of (4) assures that in a compact parameter space containing the true parameter β, the parametric corrected score will admit a unique root asymptotically and the root is consistent and asymptotically normal.

When the measurement error is normally distributed and assume the variance matrix is Σ, the conditional score estimating function for the Cox proportional hazards model [12] can be written as

ηcon(b)=n1i=1n0τ{Wi+Σbj=1nYj(t)[Wj+ΣbdNj(t)]exp(b[Wj+ΣbdNj(t)])j=1nYj(t)exp(b[Wj+ΣbdNj(t)])}dNi(t) (5)

In fact, it can be shown that estimators from parametric corrected score and conditional score are asymptotically equivalent in the case of normal measurement error.

2.2. Pathological behaviors

When the magnitude of measurement error is small, the asymptotic results of parametric corrected score and conditional score provide a good approximation for practical purposes. However, when the measurement error increases, the pathological behaviors may start to arise [13]. These pathological behaviors include multiple zero-crossings or a single wrong zero-crossing that is inappropriate. These pathological behaviors may cause serious concerns when the measurement error is substantial and limit the applicability of parametric corrected score and conditional score in practice. In this section, we will conduct a detailed investigation of pathological behaviors for these two methods.

We first consider the parametric corrected score. Consider a single-covariate model with normal measurement error. In the absence of measurement error, the partial likelihood score function ξ(b) is monotonically decreasing and has a unique root. The asymptotic result suggests that the parametric corrected score η(b) should be monotonically decreasing as well in a compact parameter space containing the true parameter when the sample size is large. One may speculate the parametric corrected score to have an overall decreasing trend over the entire parameter space. But surprisingly, the overall trend of parametric corrected score in an unbounded parameter space is increasing. Function η(b) takes a value of −∞ when b = −∞ and a value of +∞ when b= + ∞. This observation suggests that the parametric corrected score η(b) has an odd number of roots. In our numerical studies, only single- and triple-root patterns have been observed and two typical plots of parametric corrected score are illustrated in Fig. 1. The same root patterns were observed in Huang's investigation of loglinear model [9].

Fig. 1.

Fig. 1

Observed root patterns of the parametric corrected score η(b). The true β is −1 and these two corrected curves correspond to the same profile score (with true covariates). Portion of a corrected curve is thickened to indicate negative derivative.

If we characterize a root by increase or decrease of η(⋅) around it, the increasing and decreasing roots correspond to local minimizers and maximizers of corresponding objective function, respectively. Therefore, an increasing root is considered as an inappropriate one. In the case of single-root pattern, the only root is increasing and thus inappropriate. For the triple-root pattern, an appropriate root exists since there is only one decreasing root. The single-root pattern is considered as root-finding failure.

We conduct a simulation study to exam the prevalence of single-root pattern. We consider a single covariate Z and generate it from various distributions: A) standard normal distribution, B) modified chi-square distribution, and C) uniform distribution with mean 0 and variance 1. To generate the modified chi-square distribution, the chi-square distribution with 1 degree of freedom was first truncated at 5 and then location-shifted to mean 0 and rescaled to variance 1. The measurement error follows standard normal distribution. The true coefficient was taken to be β = −1 and the baseline hazard is constant 1. Censoring was generated from a uniform distribution on [0,μ], where μ is chosen so that the censoring rate is ranged from 20% to 60%. These set-ups represent a practical scenario with substantial error contamination on the covariate. The results based on 1000 iterations are reported in Table 1. The prevalence of single-root patten is similar across different scenarios with various censoring rates. When the sample size is 100, the percentage of single-root pattern under all three distributions are close to or over 60%. Even when the sample size increases to 800, the prevalence of single-root pattern is still quite high.

Table 1.

Prevalence (%) of single-root pattern for the parametric corrected score with E(X) = 0, Var(X) = 1, β = −1, and ε ∼ Normal(0,1).

Censoring rate Distribution of X Size
100 200 400 800
20% Normal 68.0 52.1 38.0 20.3
Modified chi-square 65.8 57.9 52.3 40.1
Uniform 64.5 51.9 37.6 19.6
40% Normal 62.4 49.0 36.3 17.8
Modified chi-square 64.4 58.0 50.9 43.1
Uniform 60.4 49.5 37.1 19.3
60% Normal 61.0 46.5 32.1 16.0
Modified chi-square 62.7 57.3 50.9 42.6
Uniform 58.5 47.9 36.8 21.2

For the conditional score, the patterns are more complicated. When the absolute value of β gets large, the estimating function fluctuates around zero and finally approaches zero as β goes to infinity. Therefore the conditional score may have many zero-crossings. When the β is not so extreme, two general patterns for the conditional scores are observed and plots from two simulation datasets are shown in Fig. 2. In the first pattern, the conditional score has one zero-crossing close to the true parameter. This single zero-crossing is decreasing and thus an appropriate one. In the second patten, the conditional score appears to have no proper zero-crossing near the truth though it may have multiple zero-crossings at extreme values of β. For conditional score, we define root-finding failure as following: we start with the naive estimator and search locally in the direction of the derivative of estimating function for a new estimator such that the 2-norm of the estimating functions decreases after each step. Repeat this step and we will eventually achieve a root or a local minimizer for the 2-norm of the estimating functions. We consider the latter case as root finding failure. Table 2 summarizes the prevalence of root-finding failure for the conditional score. The same simulation set up as in the corrected score is used. With a sample size of 100, the root-finding failure rate for conditional score varies from 3% to 5% for normal covariate and from 14% to 25% for modified chi-square covariate. As the sample size increases to 800, the failure rate drops to 0.2% for normal covariate but remains at least 14% for modified chi-square covariate.

Fig. 2.

Fig. 2

Observed root patterns of the conditional score estimating function. The true β is −1.

Table 2.

Prevalence (%) of root-finding failure for the conditional score with E(X) = 0, Var(X) = 1, β = −1, and ε∼ Normal(0,1).

Censoring rate Distribution of X Size
100 200 400 800
20% Normal 2.7 1.5 .6 .3
Modified chi-square 14.4 12.2 15.1 13.9
Uniform 3.1 1.6 .6 .1
40% Normal 4.6 2.3 .8 .2
Modified chi-square 20.0 16.7 20.9 18.7
Uniform 3.1 2.1 .3 .5
60% Normal 4.7 2.5 .7 .3
Modified chi-square 24.6 21.7 25.7 25.0
Uniform 5.7 2.7 1.4 1.0

The above investigation results show that, in the presence of substantial measurement error, both parametric corrected score and conditional score suffer from severe finite-sample pathological behaviors. Therefore improvements are required for these methods to have practical applicability. We observe that an appropriate zero-crossing of an estimating function should be a decreasing one. This observation suggests that the trend of estimating function is also informative and could be taken into account in the estimate determination. By Taylor expansion, the trend of estimating function may be quantified by its derivative. Recognizing this feature, Huang [9] proposed an approach to incorporate additional estimating functions which constrain the derivatives of the corrected score for the loglinear model. The estimation and inference are then accomplished by means of empirical likelihood. This approach effectively remedies the pathological behaviors of corrected score for loglinear model and also considerably improves the estimation efficiency. However, in the case of the Cox proportional hazards model, we are unable to construct additional estimating functions that effectively constrain the derivative of the parametric corrected score or conditional score because of the very nature of these two estimating functions. Nevertheless, Huang's approach provides an insight into a new approach to address pathological behaviors of estimating functions. If we could identify additional estimating functions that do not share the same wrong roots as the original estimating function, then by combining the original and additional estimating functions, pathological behaviors could be reduced or eliminated. But if either the original estimating function or the additional estimating functions vanish to zero, then wrong root sharing would easily arise. We have shown in the simulation that the conditional score would vanish to zero when the absolute value of parameter becomes large. Thus, the trend pattern of the parametric corrected score is more desirable than that of the conditional score and our method will be developed for the parametric corrected score.

3. Improving corrected score

3.1. Augmented estimation method

Motivated by Huang's trend-constrained corrected score [9], we first derive the following result:

Theorem 1

Under the proportional hazards model and the classical additive measurement error model,

ε[0τk1++kpexp{bWΩ(b)}b1k1bpkpdNi(t)|b=00τk1++kpY(t)exp{bWΩ(b)}b1k1bpkpdΛ0(t)|b=β]=0, (6)

for kl ≥ 0,l = 1,…,p, where bl,l = 1,…,p, is the lth element of b.

Equation (6) is useful in constructing additional estimating equations for β. When l=1pkl=0 and 1, one may obtain the usual parametric corrected score. When l=1pkl=2, the additional estimating functions are the upper triangular elements of the following symmetric matrix:

n1i=1n0τ[{WiΩ˙(0)}2Ω¨(0)]dNi(t)0τYi(t)exp{bWiΩ(b)}[{WiΩ˙(b)}2Ω¨(b)]dΛ˜0(t).

By profiling out Λ˜0(), we obtain

n1i=1n0τ[{WiΩ˙(0)}2Ω¨(0)j=1nYj(t)exp{bWjΩ(b)}[{WjΩ˙(b)}2Ω¨(b)]j=1nYj(t)exp{bWjΩ(b)}]dNi(t) (7)

The additional estimating functions would be helpful if both parametric corrected score and additional estimating function are close to 0 around the truth (not necessarily having roots) and the additional estimating function is not close to 0 when the parametric corrected score is close to 0 at any point far away from the truth. Fig. 3 shows four typical patterns of parametric corrected score and corresponding additional estimating function based on Equation (7) for a single-covariate model with true parameter β = −1. Plot (a) is the ideal scenario. The parametric corrected score have three zero-crossings. The additional estimating function shares the same decreasing zero-crossing as the parametric corrected score. Moreover, they do not share any wrong zero-crossings. In plot (b), the parametric corrected score have three zero-crossings and two of them are close to each other. In this case, discriminating the two roots around the truth is not very important since they are close to each other anyway. In plots (c) and (d), the parametric corrected score has a single wrong zero-crossing but the additional estimating function is not close to 0 near this wrong zero-crossing. Both estimating functions are close to 0 around the truth.

Fig. 3.

Fig. 3

Parametric corrected score and additional estimation function based on Equation (7) for a single-covariate model with β = −1.

3.2. Estimation and inference

With the additional estimating functions, we have more estimating functions than the number of parameters. Available methods to synthesize estimating functions that exceed the number of parameters include empirical likelihood [14] and quadratic inference function (QIF) method [15]. In this research, we shall use the quadratic inference function method to determine the estimate since the estimating functions are not sums of iid terms, thus the empirical likelihood would be computational difficult.

Let φ(b) denotes the estimating functions. φ(b) is comprised of the original parametric corrected score and additional estimating functions. The quadratic inference function takes the form

Q(b;Cˆ)=φ(b)Cˆ1(b)φ(b), (8)

where Cˆ(b) is any consistent estimator for the asymptotic variance of φ(b). Then the estimator is defined as the minimizer of (8) and is consistent for the true value of b. Furthermore, the estimator is asymptotically efficient in the class of consistent estimators based on linear combination of parametric corrected score and additional estimating functions. The construction of a quadratic inference function helps to solve both aspects of pathological behaviors of the parametric corrected score. Firstly, in the case of multiple zero-crossings, the introduction of additional estimating functions helps to pick up the right zero-crossing out from multiple ones if the additional estimating functions do not share the same wrong roots as the original parametric corrected score. Secondly, the problem of no appropriate zero-crossing could be solved by minimizing the quadratic inference function.

We name the method to incorporate additional estimating functions based on (6) as the augmented parametric corrected score. One important special case is the method incorporating the upper triangular elements of matrix (7) and was termed the second order augmented parametric corrected score. Augmented parametric corrected scores with higher order are also available, with additional estimating functions corresponding to kl such that l=1pkl>2. In Section 4, we will conduct extensive simulation studies to evaluate the performance of the augmented parametric corrected score and its applicability in practice.

Fig. 4 plots quadratic inference functions corresponding to the two datasets in Fig. 1. The second order augmented parametric corrected score is adopted. The formula for a consistent estimator of the asymptotic variance of φ(b) is given in Appendix.

Fig. 4.

Fig. 4

Quadratic inference functions for the two datasets in Fig. 1.

The interval estimation can be easily achieved by inverting the hypothesis testing statistics. As an inference function, Q(b;Cˆ) has similar properties as the log-likelihood function [15].

  • (a)

    Q(β0)Q(βˆ) is asymptotically chi-squared with degree of freedom p;

  • (b)

    the profile test statistics Q(ψ0,λˆ0)Q(ψˆ,λˆ), where (ψ,λ) is a partitioning of the parameter of β, is asymptotically chi-squared as a test of H:ψ=ψ0, with degree of freedom equal to the dimension of ψ.

4. Numerical studies

4.1. Simulations

Extensive simulations studies were conducted to evaluate the performance of augmented parametric corrected score. For reference and comparison, the ideal, naive, regression calibration, conditional score, and parametric corrected score were also studied. The ideal estimator used the ordinary partial score function with true covariates and, of course, it is not a realistic estimator. The naive approach uses the mismeasured surrogates in place of true covariates in the partial score function. For the regression calibration method, Ze is replaced by E(Ze|Za,We) in the partial score function. For the proposed approach, the optimization algorithm of Nelder and Mead [16] will be used.

As shown in previous section, both conditional score and parametric corrected score have high prevalence of root-finding failure. To utilize all simulated data and conduct a fair comparison, we propose the following re-defined conditional score and re-defined parametric corrected score. If an appropriate zero-crossing could be found, the estimators will take the value of zero-crossing. But if root-finding failure occurs, the estimators will be defined as the local minimizer of the 2-norm of the estimating functions closest to the naive estimator. Operationally, we will use the following modified Newton–Raphson algorithm. We start with the naive estimator and calculate the Newton–Raphson step size. Since the goal is to find a root or local minimizer, we need prevent overshooting. In our simulation, we cap the step size at .2. During each iteration, we compare the 2-norm evaluated at new estimator to that evaluated at current estimator. If the 2-norm evaluated at new estimator is smaller, then the new estimator will be accepted and the algorithm continues to the next iteration. Otherwise, we will halve the step size and calculate the new estimator again. Iterations will be repeated until that i) the absolute value of estimating function is less than 10−6 or ii) the step size has been halved for more than 10 time during any single iteration. If criteria i) is satisfied, the algorithm converges to a zero-crossing and a root is identified in this case. If criteria ii) is satisfied, the algorithm converges to a local minimizer and root-finding failure occurs. Comparing to the original definition that estimators take the values of zero-crossings of estimating function, this new definition actually benefits the conditional score and corrected score. As shown in Fig. 1, Fig. 2, in the case of root-finding failure, zero-crossings of conditional score and corrected score are at extreme and far away from the true value.

In the simulation, we consider both single- and double-covariate models. In the single-covariate models, the true covariate X is of mean 0 and variance 1. The true regression coefficient was set to be −1 and the baseline hazard is constant 1. The measurement error follows the standard normal distribution. Two different distributions of X were studied: A) standard normal distribution and B) modified chi-square distribution. To generate the modified chi-square distribution, the chi-square distribution with 1 degree of freedom was first truncated at 5 and then location-shifted to mean 0 and rescaled to variance 1. Censoring time was generated from a uniform distribution on [0,μ] and we will consider two different settings of censoring rate at 20% and 60%.

In the double-covariate models, true covariate X follows bivariate normal distribution with mean (0,0), variance (1,1) and correlation coefficient of .5. The first covariate was subject to a standard normal measurement error, whereas the second covariate was accurately measured. The regression coefficients were set to (−1,1) and the baseline hazard is constant 1. Censoring time was also generated from a uniform distribution on [0,μ], where μ is chosen so that the censoring rate is 20% or 60%.

Sample sizes 100, 200, 400, 800, and 1600 were investigated. For each scenario, 1000 samples were simulated. We report the results on point and interval estimation separately.

Table 3, Table 4 summarize the simulation results on the estimators in the single-covariate models with censoring rates of 20% and 60% respectively. The quantile–quantile plots are shown in Fig. 5, Fig. 6. For each scenario, the mean bias, and standard deviation were calculated. For augmented parametric corrected score, three sets of additional estimating functions were considered where k = 2,3,4. As expected, the naive estimator has substantial bias under both scenarios. The regression calibration estimator shows moderate bias, with larger bias in modified chi-square covariate case than normal covariate case. The re-defined conditional score shows slight bias under both scenarios, probably due to its left skewness. The quantile–quantile plots show that the re-defined conditional score deviates from normality considerably even when the sample size is 1600. It also has a much larger standard deviation comparing to the re-defined parametric corrected score and the augmented parametric corrected score. The re-defined parametric corrected score is unbiased for both scenarios and the standard deviation is small. All three augmented corrected scores are consistent under both scenarios, and they become less biased as sample size increases. In comparison with higher-order augmented corrected scores, the second order augmented corrected score seems more favorable overall in terms of bias and standard error. Compared to the re-defined parametric corrected score, the second order augmented corrected score has a larger standard deviation when the sample size is small. But the standard deviation of augmented corrected score decreases rapidly as the sample size increases and is smaller than that of the re-defined corrected score when then sample size is 1600.

Table 3.

Simulation summary statistics for the single-covariate models with 20% censoring rate: Ideal, naive(NV), regression calibration (RC), re-defined conditional score (ConS), re-defined parametric corrected score (CS), and first k augmented parametric corrected score (ACS: k), k = 2, 3, 4.

Size Ideal
NV
RC
ConS
CS
ACS: 2
ACS: 3
ACS: 4
B SD B SD B SD F B SD F B SD B SD B SD B SD
Normal covariate
100 −15 154 593 99 148 254 2.7 −376 920 68.0 −11 287 46 431 −43 414 −103 381
200 −8 104 602 65 189 163 1.5 −251 719 52.1 −89 273 −60 330 −130 348 −172 351
400 −5 73 601 48 195 113 .6 −202 575 38.0 −146 282 −99 287 −153 313 −184 327
800 1 49 604 32 206 76 .3 −99 351 20.0 −129 267 −87 246 −83 226 −123 256
1600 1 36 605 23 208 53 0 −43 200 5.6 −75 206 −45 163 −60 178 −62 166
χ2 Covariate
100 −25 204 639 91 242 247 14.4 −485 1221 65.8 145 241 110 387 41 409 9 409
200 −5 136 640 63 267 155 12.2 −396 1022 57.9 47 241 −10 351 −81 381 −128 381
400 −6 98 642 43 280 101 15.1 −329 895 52.3 −21 237 −10 285 −76 306 −122 323
800 −3 70 641 32 281 72 13.9 −249 740 40.1 −70 245 −34 241 −81 237 −95 241
1600 0 47 644 21 289 47 12.5 −139 486 30.3 −82 242 −9 152 −29 133 −42 139

Note: F: root-finding failure (%); B: mean bias (×103); SD: standard deviation(×103).

Table 4.

Simulation summary statistics for the single-covariate models with 60% censoring rate: Ideal, naive(NV), regression calibration (RC), re-defined conditional score (ConS), re-defined parametric corrected score (CS), and first k augmented parametric corrected score (ACS: k), k = 2, 3, 4.

Size Ideal
NV
RC
ConS
CS
ACS: 2
ACS: 3
ACS: 4
B SD B SD B SD F B SD F B SD B SD B SD B SD
Normal covariate
100 −24 206 550 134 57 335 4.7 −429 1014 61.0 −27 301 94 478 −24 502 −90 551
200 −15 142 562 88 109 206 2.5 −272 738 46.5 −101 303 10 298 −99 347 −188 395
400 −8 97 563 63 119 142 .7 −197 578 32.1 −139 305 −27 235 −96 257 −152 294
800 −2 65 567 42 132 96 .3 −100 379 16.0 −113 271 −33 189 −72 199 −103 223
1600 1 46 567 30 133 69 0 −51 238 4.9 −68 205 −17 128 −38 125 −57 148
χ2 covaraite
100 −66 351 687 124 351 288 24.6 −259 1154 62.7 247 297 196 459 219 531 260 568
200 −24 239 691 84 370 190 21.7 −291 1042 57.3 133 287 81 359 44 429 54 496
400 −16 159 693 57 382 124 25.7 −202 841 50.9 57 268 37 322 −22 368 −52 423
800 −9 112 693 40 385 86 25.0 −172 684 42.6 −8 263 1 280 −55 276 −94 306
1600 0 78 697 28 394 60 21.5 −77 412 34.0 −29 258 −3 232 −29 194 −57 207

Note: Same as in that of Table 3.

Fig. 5.

Fig. 5

Quantile–quantile plots for β in the single-covariate models with 20% censoring rate, where β = −1. Red, yellow, green, blue, and black correspond to sample sizes 100, 200, 400, 800, and 1600.

Fig. 6.

Fig. 6

Quantile–quantile plots for β in the single-covariate models with 60% censoring rate, where β = −1. Red, yellow, green, blue, and black correspond to sample sizes 100, 200, 400, 800, and 1600.

Table 5, Table 6 show the simulation results for the double-covariate models. As expected, when two covariates are correlated, the measurement error generally has impact not only on the mismeasured covariate but also on that of the accurately measured one. The relative performance of all estimators is similar to what was observed in the single-covariate models. For multiple-covariate models, each set of additional estimating functions contains more than one element. For example, when k = 2, the additional estimating functions includes three elements in the upper triangle of matrix (3.7). Various augmented corrected score could be constructed depending on the additional estimating functions chosen. Since the second order augmented corrected score shows a more favorable overall performance in the single-covariates models, we consider only the second order augmented corrected score and augmented corrected scores using a subset of the three elements in this simulation. Simulation results show that the second order augmented corrected score performs better than two other augmented corrected scores. The bias of the second order augmented corrected score reduced quickly as sample size increased. Meanwhile, it also has the smallest standard deviation.

Table 5.

Simulation summary statistics for the double-covariate models with 20% censoring rate: Ideal, naive(NV), regression calibration (RC), re-defined conditional score (ConS), re-defined parametric corrected score (CS), and augmented parametric corrected score (ACS: 1/3, ACS: 2/3, ACS: 2).

Size Ideal
NV
RC
ConS
CS
ACS: 1/3
ACS: 2/3
ACS: 2
B SD B SD B SD F B SD F B SD B SD B SD B SD
100 β1 −23 175 637 101 66 381 57.5 215 348 72.0 267 322 170 532 245 514 308 538
β2 23 171 −400 142 −113 246 −67 336 −100 327 −60 456 −97 404 −142 399
200 β1 −13 114 648 66 136 224 46.9 155 315 62.8 186 294 −18 382 42 375 92 339
β2 16 117 −412 101 −154 161 −35 310 −47 286 54 349 18 327 −20 276
400 β1 −5 82 649 48 168 144 33.4 65 297 46.2 71 280 −89 301 −56 277 −28 255
β2 4 80 −416 68 −177 103 5 257 15 243 85 269 60 233 40 210
800 β1 −2 55 651 33 181 93 20.0 22 224 30.5 −3 252 −99 282 −80 262 −56 220
β2 1 56 −420 52 −185 74 16 186 44 203 88 255 72 230 52 186
1600 β1 −2 40 652 23 185 66 8.0 −13 178 10.5 −43 207 −71 219 −67 204 −61 190
β2 1 39 −419 34 −186 49 21 134 45 155 59 180 57 163 51 145

F: root-finding failure (%); B: mean bias (×103); SD: standard deviation(×103).

ACS: 1/3 and ACS: 2/3 correspond to the additional estimating functions containing the (1,1) element and the first row elements of matrix (7), respectively. ACS: 2 is the second order augmented parametric corrected score.

Table 6.

Simulation summary statistics for the double-covariate models with 60% censoring rate: Ideal, naive(NV), regression calibration (RC), re-defined conditional score (ConS), re-defined parametric corrected score (CS), and augmented parametric corrected score (ACS: 1/3, ACS: 2/3, ACS: 2).

Size Ideal
NV
RC
ConS
CS
ACS: 1/3
ACS: 2/3
ACS: 2
B SD B SD B SD F B SD F B SD B SD B SD B SD
100 β1 −32 242 610 140 −13 513 43.3 96 428 64.8 239 320 225 668 326 666 392 660
β2 33 245 −352 206 −40 336 −27 408 −72 362 −50 536 −104 500 147 465
200 β1 −20 160 617 95 59 286 36.1 29 393 57.8 145 300 14 387 93 360 140 344
β2 21 161 −362 138 −81 209 24 344 −8 301 48 369 −7 310 −41 264
400 β1 −6 109 619 65 97 182 21.5 −2 293 40.4 45 279 −65 321 −9 273 30 241
β2 6 111 −366 97 −106 137 31 225 36 254 79 301 35 246 6 197
800 β1 −1 72 621 45 112 120 10.8 −23 249 25.7 −16 257 −73 267 −32 213 −9 192
β2 2 76 −369 69 −115 94 34 198 55 214 72 236 40 189 23 160
1600 β1 −2 53 622 33 114 87 7.6 −24 186 11.3 −46 212 −55 193 −40 171 −29 162
β2 0 53 −371 46 −117 65 28 142 47 161 46 162 36 140 26 124

Note: Same as in that of Table 5.

Table 7, Table 8 report the coverage of three types of 95% confidence intervals in the single- and double-covariate models. All three scenarios use the second order augmented corrected score. In constructing the confidence interval, we use two different approaches: inverting the hypothese testing statistics as introduced in Section 2.2, and the Wald-type confidence interval. For the former, we use two critical values based on the asymptotic chi-square distribution and the bootstrap calibration [17]. Bootstrap size of 500 is used for the bootstrap calibration. The Wald-type confidence interval and test based one with chi-square distribution critical values have poor coverage when the sample size is small, but improve with larger sample size. The coverage probability of test based confidence interval using bootstrap-calibrated critical value is close to the nominal level of 95% for all sample sizes, but this method is much more computational intensive.

Table 7.

Coverage of 95% confidence interval for the second order augmented parametric corrected score with 20% censoring rate. C (chi-square distribution), BC (bootstrap calibration) and W (Wald-type) indicate the type of confidence interval.

Size 100
200
400
800
1600
C BC W C BC W C BC W C BC W C BC W
Single-covariate: normal covariate
β 90.2 96.8 87.0 91.7 96.6 91.1 87.1 96.6 93.8 87.6 97.1 94.8 91.8 95.6 94.9
Single-covariate: χ2 covariate
β 82.0 92.9 76.8 88.8 92.2 84.3 87.6 94.3 85.6 90.0 94.6 89.2 91.6 94.8 91.8
Double-covariate
β1 75.8 94.5 78.4 86.3 95.4 87.3 88.3 96.3 94.0 89.7 96.7 95.8 89.4 96.2 97.2
β2 79.2 93.0 83.9 86.8 93.8 92.3 88.1 92.3 95.6 86.7 93.5 96.2 89.4 95.5 97.6

Table 8.

Coverage of 95% confidence interval for the second order augmented parametric corrected score with 60% censoring rate. C (chi-square distribution), BC (bootstrap calibration) and W (Wald-type) indicate the type of confidence interval.

Size 100
200
400
800
1600
C BC W C BC W C BC W C BC W C BC W
Single-covariate: normal covariate
β 89.5 97.6 86.8 94.2 96.7 92.0 91.5 96.8 94.7 93.6 96.2 96.3 98.5 95.5 97.5
Single-covariate: χ2 covariate
β 87.5 93.7 73.9 89.7 92.4 79.1 88.4 93.2 80.4 90.4 93.9 85.8 91.8 94.3 88.6
Double-covariate
β1 92.0 92.6 80.7 93.8 96.6 89.6 92.6 94.9 94.1 93.2 96.9 95.8 92.6 96.2 98.0
β2 92.0 93.9 87.3 93.5 94.5 93.7 92.3 92.7 96.0 91.5 93.4 96.3 92.7 95.8 97.1

4.2. Application to ACTG 175 data

We apply the proposed approach to the AIDS Clinical Trial Group (ACTG) 175 study, a randomized clinical trial to evaluate four treatments in HIV-infected patients with an initial screening CD4 counts of between 200 and 500 per cubic millimeter. A total of 2467 patients were enrolled and an almost equal number of patients were randomized into each of the four treatment groups: zidovudine alone (ZDV), zidovudine plus didanosine (ZDV + ddI), zidovudine plus zalcitabine (ZDV + ddC), and zalcitabine alone (ddC). We are interested in assessing the effect of baseline CD4 count on time to AIDS or death in antiretroviral-naive patients. Among all study patients, 1067 had no prior antiretroviral therapy at enrollment, among which 1036 patients had two CD4 measurements prior to the start of treatment and within 3 weeks of randomization. For this analysis, we will consider the subset of 1036 patients. The median length of follow-up was 32 months, and 85 events were observed.

We consider a Cox regression mode with 4 covariates: the true baseline log(CD4) and three indicators for the four treatments with ZDV group as the reference. We define the baseline log(CD4) as the average of the two log(CD4) measurements. From the duplicated measurements, we estimated the variance for error and true underlying log(CD4) to be .033 and .076 respectively. Note that the variance of measurement error is estimated using two replicated measurements of baseline log(CD). Therefore there is an additional estimating function for the variance of measurement error. Table 9 shows the estimators based on the naive, conditional score, parametric corrected score, and the proposed augmented corrected score. In comparison, the naive approach gives an coefficient estimator of log(CD4) with substantially smaller magnitude. All the other approaches have similar estimates for all coefficients.

Table 9.

Comparison of regression coefficient estimators in the ACTG 175 data.

log(CD4)
ZDV + ddl
ZDV + ddC
ddl
Est Var Est Var Est Var Est Var
NV −1.838 .1183 −.652 .0881 −.895 .1006 −.598 .0802
ConS −2.172 .1698 −.659 .0916 −.892 .1024 −.604 .0835
CS −2.177 .1678 −.659 .0900 −.892 .1012 −.604 .0819
ACS −2.177 .1422 −.657 .0991 −.876 .1028 −.596 .0827
.1678 .0905 .0964 .0811

Note: For proposed estimator, the first row of variance estimator is obtained by inverting hypothese testing statistics with bootstrap critical value; the second row of values is from sandwich variance estimator. Est: Estimated coefficient; Var: Variance.

5. Discussion

Measurement error is a common issue for many clinical trials. The main reason for the presence of measurement error is study participants' natural biological fluctuation. The imprecision of measurement tool is another contributor. One example of measurement error is from the Nutritional Prevention of Cancer (NPC) trial, which involved multiple recurrences of skin cancers, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) [18]. Baseline plasma selenium as an important prognostic risk factor for BCC and SCC is subject to substantial measurement error. The aforementioned AIDS Clinical Trial Group (ACTG) 175 study is another example of measurement error in clinical trial.

For proportional hazards model with covariate measurement error, several consistent methods have been proposed under the functional modeling framework, including the conditional score and the parametric corrected score. However, when the measurement error is substantial to the extent that the errors are comparable to the true covariates in variance, both methods might experience pathological behaviors and root finding failure. Recently, Huang [9] developed a novel approach to incorporate additional estimating functions which constrain the derivatives of the parametric corrected score. That approach proves effective and eliminates finite sample pathological behaviors of parametric corrected score for the loglinear model. Motivated by Huang's approach, we conduct an investigation on the pathological behaviors of parametric corrected score and conditional score and propose an augmented parametric corrected score for the proportional hazards model by incorporating additional estimating functions to the original parametric corrected score. Results of simulation studies show the proposed approach is effective in eliminating pathological behaviors even with small sample size and substantial measurement error. The variance of proposed estimator appears to be larger than the parametric corrected score when sample size is smaller than 400, but it decreases rapidly and become smaller than the parametric corrected score as the sample size increases to 400. With the ability of eliminating finite sample pathological behaviors of conditional score and the parametric corrected score, this proposed augmented parametric corrected score could be widely used for time-to-event data in clinical trials where covariate measurement error issue is of concern.

In this paper, we have only considered the situation where the distribution of the measurement error is known. With additional data available on the measurement error, the parametric distribution imposed on the measurement error may be spared. With the availability of replicated mismeasured covariates, Huang and Wang [7] developed a nonparametric corrected score method for the proportional hazards model. Extension of the approach of incorporating additional estimating functions to the nonparametric corrected score is currently under study.

Contributor Information

Ming Zhu, Email: ming.zhu@abbvie.com.

Yijian Huang, Email: yhuang5@emory.edu.

Appendix.

A Asymptotic variance of estimating function

For simplicity, we consider the single-covariate model given in Section 2.2. The second order augmented corrected score has the form

φ(b)=n1i=1n0τ{(Wi+bσ2Wi2σ2)j=1nYj(t)exp(bWj)(Wj(Wjbσ2)2σ2)j=1nYj(t)exp(bWj)}dNi(t).

With functional delta method [7], straightforward algebra gives

n1/2φ(b)=n1/2i=1n(Bi1Bi2)+op(1)

where

Bi1=0τ{(Wi+bσ2Wi2σ2)ε{Y(t)exp(bW)(W(Wbσ2)2σ2)}ε{Y(t)exp(bW)}}dNi(t),and
Bi2=0τ{exp(bWi)(Wi(Wibσ2)2σ2)ε{Y(t)exp(bW)}ε{Y(t)exp(bW)(W(Wbσ2)2σ2)}exp(bWi)[ε{Y(t)exp(bW)}]2}Yi(t)dEN(t).

Thus, n1/2φ(b) is asymptotically a sum of iid random variables.

For fixed b, n1/2φ(b) is asymptotically normal with a covariance matrix Σ(b) that can be consistently estimated by

Σˆ(b)=ni=1n{ωi(b)ω¯(b)}{ωi(b)ω¯(b)}

where ωi(b) = n−1(Bi3 − Bi4), ω¯(b)=n1i=1nωi(b), and Bi3 and Bi4 are defined as

Bi3=0τ{(Wi+bσ2Wi2σ2)εˆ{Y(t)exp(bW)(W(Wbσ2)2σ2)}εˆ{Y(t)exp(bW)}}dNi(t),and
Bi4=0τ{exp(bWi)(Wi(Wibσ2)2σ2)εˆ{Y(t)exp(bW)}εˆ{Y(t)exp(bW)(W(Wbσ2)2σ2)}exp(bWi)[εˆ{Y(t)exp(bW)}]2}Yi(t)dεˆN(t).

Asymptotic variance of other augmented corrected scores could be derived similarly.

B Proof of Theorem 1

Given

ε[exp{bWΩ(b)}|Z]=exp(bZ)

under additive measurement error model, one may obtain

ε[0τYk1++kpexp{bWΩ(b)}b1k1bpkpdΛ0(t)|Z]=l=1pZlkl0τY(t)exp(bZ)dΛ0(t)

and

ε[0τk1++kpexp{bWΩ(b)}b1k1bpkpdN(t)|b=0|Z]=l=1pZlklN(τ).

Then given the fact that M(t)=N(t)0tY(u)exp(βZ)dΛ0(u) is a mean zero martingale, Equation (6) is implied by the above two equations.

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