Mendelian randomization utilizes genetic variants as instrumental variables (IVs) to estimate the causal effect of an exposure variable on an outcome of interest even in the presence of unmeasured confounders. However, the popular inverse-variance weighted (IVW) estimator could be biased in the presence of weak IVs, a common challenge in MR studies. In this article, we develop a novel penalized inverse-variance weighted (pIVW) estimator, which adjusts the original IVW estimator to account for the weak IV issue by using a penalization approach to prevent the denominator of the pIVW estimator from being close to zero. Moreover, we adjust the variance estimation of the pIVW estimator to account for the presence of balanced horizontal pleiotropy. We show that the recently proposed debiased IVW (dIVW) estimator is a special case of our proposed pIVW estimator. We further prove that the pIVW estimator has smaller bias and variance than the dIVW estimator under some regularity conditions. We also conduct extensive simulation studies to demonstrate the performance of the proposed pIVW estimator. Furthermore, we apply the pIVW estimator to estimate the causal effects of five obesity-related exposures on three coronavirus disease 2019 (COVID-19) outcomes. Notably, we find that hypertensive disease is associated with an increased risk of hospitalized COVID-19; and peripheral vascular disease and higher body mass index are associated with increased risks of COVID-19 infection, hospitalized COVID-19, and critically ill COVID-19.

Competing risks data are commonly encountered in randomized clinical trials and observational studies. This paper considers the situation where the ending statuses of competing events have different clinical interpretations and/or are of simultaneous interest. In clinical trials, often more than one competing event has meaningful clinical interpretations even though the trial effects of different events could be different or even opposite to each other. In this paper, we develop estimation procedures and inferential properties for the joint use of multiple cumulative incidence functions (CIFs). Additionally, by incorporating longitudinal marker information, we develop estimation and inference procedures for weighted CIFs and related metrics. The proposed methods are applied to a COVID-19 in-patient treatment clinical trial, where the outcomes of COVID-19 hospitalization are either death or discharge from the hospital, two competing events with completely different clinical implications.

Graphical models play an important role in neuroscience studies, particularly in brain connectivity analysis. Typically, observations/samples are from several heterogenous groups and the group membership of each observation/sample is unavailable, which poses a great challenge for graph structure learning. In this paper, we propose a method which can achieve Simultaneous Clustering and Estimation of Heterogeneous Graphs (briefly denoted as SCEHG) for matrix-variate functional magnetic resonance imaging (fMRI) data. Unlike the conventional clustering methods which rely on the mean differences of various groups, the proposed SCEHG method fully exploits the group differences of conditional dependence relationships among brain regions for learning cluster structure. In essence, by constructing individual-level between-region network measures, we formulate clustering as penalized regression with grouping and sparsity pursuit, which transforms the unsupervised learning into supervised learning. A modified difference of convex programming with the alternating direction method of multipliers (DC-ADMM) algorithm is proposed to solve the corresponding optimization problem. We also propose a generalized criterion to specify the number of clusters. Extensive simulation studies illustrate the superiority of the SCEHG method over some state-of-the-art methods in terms of both clustering and graph recovery accuracy. We also apply the SCEHG procedure to analyze fMRI data associated with attention-deficit hyperactivity disorder (ADHD), which illustrates its empirical usefulness.

Modern neuroimaging technologies have substantially advanced the measurement of brain activity. Electroencephalogram (EEG) as a noninvasive neuroimaging technique measures changes in electrical voltage on the scalp induced by brain cortical activity. With its high temporal resolution, EEG has emerged as an increasingly useful tool to study brain connectivity. Challenges with modeling EEG signals of complex brain activity include interactions among unknown sources, low signal-to-noise ratio, and substantial between-subject heterogeneity. In this work, we propose a state space model that jointly analyzes multichannel EEG signals and learns dynamics of different sources corresponding to brain cortical activity. Our model borrows strength from spatially correlated measurements and uses low-dimensional latent states to explain all observed channels. The model can account for patient heterogeneity and quantify the effect of a subject's covariates on the latent space. The EM algorithm, Kalman filtering, and bootstrap resampling are used to fit the state space model and provide comparisons between patient diagnostic groups. We apply the developed approach to a case-control study of alcoholism and reveal significant attenuation of brain activity in response to visual stimuli in alcoholic subjects compared to healthy controls.

The case-crossover design of Maclure is widely used in epidemiology and other fields to study causal effects of transient treatments on acute outcomes. However, its validity and causal interpretation have only been justified under informal conditions. Here, we place the design in a formal counterfactual framework for the first time. Doing so helps to clarify its assumptions and interpretation. In particular, when the treatment effect is nonnull, we identify a previously unnoticed bias arising from strong common causes of the outcome at different person-times. We analyze this bias and demonstrate its potential importance with simulations. We also use our derivation of the limit of the case-crossover estimator to analyze its sensitivity to treatment effect heterogeneity, a violation of one of the informal criteria for validity. The upshot of this work for practitioners is that, while the case-crossover design can be useful for testing the causal null hypothesis in the presence of baseline confounders, extra caution is warranted when using the case-crossover design for point estimation of causal effects.

Many spatial phenomena exhibit interference, where exposures at one location may affect the response at other locations. Because interference violates the stable unit treatment value assumption, standard methods for causal inference do not apply. We propose a new causal framework to recover direct and spill-over effects in the presence of spatial interference, taking into account that exposures at nearby locations are more influential than exposures at locations further apart. Under the no unmeasured confounding assumption, we show that a generalized propensity score is sufficient to remove all measured confounding. To reduce dimensionality issues, we propose a Bayesian spline-based regression model accounting for a sufficient set of variables for the generalized propensity score. A simulation study demonstrates the accuracy and coverage properties. We apply the method to estimate the causal effect of wildland fires on air pollution in the Western United States over 2005-2018.

Two-phase studies such as case-cohort and nested case-control studies are widely used cost-effective sampling strategies. In the first phase, the observed failure/censoring time and inexpensive exposures are collected. In the second phase, a subgroup of subjects is selected for measurements of expensive exposures based on the information from the first phase. One challenging issue is how to utilize all the available information to conduct efficient regression analyses of the two-phase study data. This paper proposes a joint semiparametric modeling of the survival outcome and the expensive exposures. Specifically, we assume a class of semiparametric transformation models and a semiparametric density ratio model for the survival outcome and the expensive exposures, respectively. The class of semiparametric transformation models includes the proportional hazards model and the proportional odds model as special cases. The density ratio model is flexible in modeling multivariate mixed-type data. We develop efficient likelihood-based estimation and inference procedures and establish the large sample properties of the nonparametric maximum likelihood estimators. Extensive numerical studies reveal that the proposed methods perform well under practical settings. The proposed methods also appear to be reasonably robust under various model mis-specifications. An application to the National Wilms Tumor Study is provided.

Tensor regression analysis is finding vast emerging applications in a variety of clinical settings, including neuroimaging, genomics, and dental medicine. The motivation for this paper is a study of periodontal disease (PD) with an order-3 tensor response: multiple biomarkers measured at prespecified tooth-sites within each tooth, for each participant. A careful investigation would reveal considerable skewness in the responses, in addition to response missingness. To mitigate the shortcomings of existing analysis tools, we propose a new Bayesian tensor response regression method that facilitates interpretation of covariate effects on both marginal and joint distributions of highly skewed tensor responses, and accommodates missing-at-random responses under a closure property of our tensor model. Furthermore, we present a prudent evaluation of the overall covariate effects while identifying their possible variations on only a sparse subset of the tensor components. Our method promises Markov chain Monte Carlo (MCMC) tools that are readily implementable. We illustrate substantial advantages of our proposal over existing methods via simulation studies and application to a real data set derived from a clinical study of PD. The R package BSTN available in GitHub implements our model.

We develop sensitivity analyses for the sample average treatment effect in matched observational studies while allowing unit-level treatment effects to vary. The methods may be applied to studies using any optimal without-replacement matching algorithm. In contrast to randomized experiments and to paired observational studies, we show for general matched designs that over a large class of test statistics, any procedure bounding the worst-case expectation while allowing for arbitrary effect heterogeneity must be unnecessarily conservative if treatment effects are actually constant across individuals. We present a sensitivity analysis which bounds the worst-case expectation while allowing for effect heterogeneity, and illustrate why it is generally conservative if effects are constant. An alternative procedure is presented that is asymptotically sharp if treatment effects are constant, and that is valid for testing the sample average effect under additional restrictions which may be deemed benign by practitioners. Simulations demonstrate that this alternative procedure results in a valid sensitivity analysis for the weak null hypothesis under a host of reasonable data-generating processes. The procedures allow practitioners to assess robustness of estimated sample average treatment effects to hidden bias while allowing for effect heterogeneity in matched observational studies.

Integrative analyses based on statistically relevant associations between genomics and a wealth of intermediary phenotypes (such as imaging) provide vital insights into their clinical relevance in terms of the disease mechanisms. Estimates for uncertainty in the resulting integrative models are however unreliable unless inference accounts for the selection of these associations with accuracy. In this paper, we develop selection-aware Bayesian methods, which (1) counteract the impact of model selection bias through a "selection-aware posterior" in a flexible class of integrative Bayesian models post a selection of promising variables via ℓ1 -regularized algorithms; (2) strike an inevitable trade-off between the quality of model selection and inferential power when the same data set is used for both selection and uncertainty estimation. Central to our methodological development, a carefully constructed conditional likelihood function deployed with a reparameterization mapping provides tractable updates when gradient-based Markov chain Monte Carlo (MCMC) sampling is used for estimating uncertainties from the selection-aware posterior. Applying our methods to a radiogenomic analysis, we successfully recover several important gene pathways and estimate uncertainties for their associations with patient survival times.

A Bayesian design is proposed for randomized phase II clinical trials that screen multiple experimental treatments compared to an active control based on ordinal categorical toxicity and response. The underlying model and design account for patient heterogeneity characterized by ordered prognostic subgroups. All decision criteria are subgroup specific, including interim rules for dropping unsafe or ineffective treatments, and criteria for selecting optimal treatments at the end of the trial. The design requires an elicited utility function of the two outcomes that varies with the subgroups. Final treatment selections are based on posterior mean utilities. The methodology is illustrated by a trial of targeted agents for metastatic renal cancer, which motivated the design methodology. In the context of this application, the design is evaluated by computer simulation, including comparison to three designs that conduct separate trials within subgroups, or conduct one trial while ignoring subgroups, or base treatment selection on estimated response rates while ignoring toxicity.

Population-level disease risk varies between communities, and public health professionals are interested in mapping this spatial variation to monitor the locations of high-risk areas and the magnitudes of health inequalities. Almost all of these risk maps relate to a single severity of disease outcome, such as hospitalization, which thus ignores any cases of disease of a different severity, such as a mild case treated in a primary care setting. These spatially-varying risk maps are estimated from spatially aggregated disease count data, but the set of areal units to which these disease counts relate often varies by severity. Thus, the statistical challenge is to provide spatially comparable inference from multiple sets of spatially misaligned disease count data, and an additional complexity is that the spatial extents of the areal units for some severities are partially unknown. This paper thus proposes a novel spatial realignment approach for multivariate misaligned count data, and applies it to the first study delivering spatially comparable inference for multiple severities of the same disease. Inference is via a novel spatially smoothed data augmented MCMC algorithm, and the methods are motivated by a new study of respiratory disease risk in Scotland in 2017.

We propose a constrained maximum partial likelihood estimator for dimension reduction in integrative (e.g., pan-cancer) survival analysis with high-dimensional predictors. We assume that for each population in the study, the hazard function follows a distinct Cox proportional hazards model. To borrow information across populations, we assume that each of the hazard functions depend only on a small number of linear combinations of the predictors (i.e., "factors"). We estimate these linear combinations using an algorithm based on "distance-to-set" penalties. This allows us to impose both low-rankness and sparsity on the regression coefficient matrix estimator. We derive asymptotic results that reveal that our estimator is more efficient than fitting a separate proportional hazards model for each population. Numerical experiments suggest that our method outperforms competitors under various data generating models. We use our method to perform a pan-cancer survival analysis relating protein expression to survival across 18 distinct cancer types. Our approach identifies six linear combinations, depending on only 20 proteins, which explain survival across the cancer types. Finally, to validate our fitted model, we show that our estimated factors can lead to better prediction than competitors on four external datasets.

Alzheimer's disease (AD) is a progressive and polygenic disorder that affects millions of individuals each year. Given that there have been few effective treatments yet for AD, it is highly desirable to develop an accurate model to predict the full disease progression profile based on an individual's genetic characteristics for early prevention and clinical management. This work uses data composed of all four phases of the Alzheimer's Disease Neuroimaging Initiative (ADNI) study, including 1740 individuals with 8 million genetic variants. We tackle several challenges in this data, characterized by large-scale genetic data, interval-censored outcome due to intermittent assessments, and left truncation in one study phase (ADNIGO). Specifically, we first develop a semiparametric transformation model on interval-censored and left-truncated data and estimate parameters through a sieve approach. Then we propose a computationally efficient generalized score test to identify variants associated with AD progression. Next, we implement a novel neural network on interval-censored data (NN-IC) to construct a prediction model using top variants identified from the genome-wide test. Comprehensive simulation studies show that the NN-IC outperforms several existing methods in terms of prediction accuracy. Finally, we apply the NN-IC to the full ADNI data and successfully identify subgroups with differential progression risk profiles. Data used in the preparation of this article were obtained from the ADNI database.

Pediatric cancer treatment, especially for brain tumors, can have profound and complicated late effects. With the survival rates increasing because of improved detection and treatment, a more comprehensive understanding of the impact of current treatments on neurocognitive function and brain structure is critically needed. A frontline medulloblastoma clinical trial (SJMB03) has collected data, including treatment, clinical, neuroimaging, and cognitive variables. Advanced methods for modeling and integrating these data are critically needed to understand the mediation pathway from the treatment through brain structure to neurocognitive outcomes. We propose an integrative Bayesian mediation analysis approach to model jointly a treatment exposure, a high-dimensional structural neuroimaging mediator, and a neurocognitive outcome and to uncover the mediation pathway. The high-dimensional imaging-related coefficients are modeled via a binary Ising-Gaussian Markov random field prior (BI-GMRF), addressing the sparsity, spatial dependency, and smoothness and increasing the power to detect brain regions with mediation effects. Numerical simulations demonstrate the estimation accuracy, power, and robustness. For the SJMB03 study, the BI-GMRF method has identified white matter microstructure that is damaged by cancer-directed treatment and impacts late neurocognitive outcomes. The results provide guidance on improving treatment planning to minimize long-term cognitive sequela for pediatric brain tumor patients.

Standard Mendelian randomization (MR) analysis can produce biased results if the genetic variant defining an instrumental variable (IV) is confounded and/or has a horizontal pleiotropic effect on the outcome of interest not mediated by the treatment variable. We provide novel identification conditions for the causal effect of a treatment in the presence of unmeasured confounding by leveraging a possibly invalid IV for which both the IV independence and exclusion restriction assumptions may be violated. The proposed Mendelian randomization mixed-scale treatment effect robust identification (MR MiSTERI) approach relies on (i) an assumption that the treatment effect does not vary with the possibly invalid IV on the additive scale; (ii) that the confounding bias does not vary with the possibly invalid IV on the odds ratio scale; and (iii) that the residual variance for the outcome is heteroskedastic with respect to the possibly invalid IV. Although assumptions (i) and (ii) have, respectively, appeared in the IV literature, assumption (iii) has not; we formally establish that their conjunction can identify a causal effect even with an invalid IV. MR MiSTERI is shown to be particularly advantageous in the presence of pervasive heterogeneity of pleiotropic effects on the additive scale. We propose a simple and consistent three-stage estimator that can be used as a preliminary estimator to a carefully constructed efficient one-step-update estimator. In order to incorporate multiple, possibly correlated, and weak invalid IVs, a common challenge in MR studies, we develop a MAny Weak Invalid Instruments (MR MaWII MiSTERI) approach for strengthened identification and improved estimation accuracy. Both simulation studies and UK Biobank data analysis results demonstrate the robustness of the proposed methods.

Correlated binary response data with covariates are ubiquitous in longitudinal or spatial studies. Among the existing statistical models, the most well-known one for this type of data is the multivariate probit model, which uses a Gaussian link to model dependence at the latent level. However, a symmetric link may not be appropriate if the data are highly imbalanced. Here, we propose a multivariate skew-elliptical link model for correlated binary responses, which includes the multivariate probit model as a special case. Furthermore, we perform Bayesian inference for this new model and prove that the regression coefficients have a closed-form unified skew-elliptical posterior with an elliptical prior. The new methodology is illustrated by an application to COVID-19 data from three different counties of the state of California, USA. By jointly modeling extreme spikes in weekly new cases, our results show that the spatial dependence cannot be neglected. Furthermore, the results also show that the skewed latent structure of our proposed model improves the flexibility of the multivariate probit model and provides a better fit to our highly imbalanced dataset.