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Biostatistics Advance Access published online on April 14, 2005
Biostatistics, doi:10.1093/biostatistics/kxi018
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Published by Oxford University Press 2005.
Received February 12, 2004
Revised December 20, 2004
Accepted January 10, 2005

Article

Analysis of Clustered Recurrent Event Data with Application to Hospitalization Rates among Renal Failure Patients

Douglas E. Schaubel 1* and Jianwen Cai 2

1 Department of Biostatistics, University of Michigan, Ann Arbor, MI, 48109-2029, U.S.A.
2 Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599-7420, U.S.A.

* To whom correspondence should be addressed.
Douglas E. Schaubel, E-mail: deschau{at}umich.edu


  Abstract

End-stage renal disease (commonly referred to as renal failure) is of increasing concern in the United States and many countries worldwide. Incidence rates have increased, while the supply of donor organs has not kept pace with the demand. Although renal transplantation has generally been shown to be superior to dialysis with respect to mortality, very little research has been directed towards comparing transplant and wait-list patients with respect to morbidity. Using national data from the Scientific Registry of Transplant Recipients (SRTR), we compare transplant and wait-list hospitalization rates. Hospitalizations are subject to two levels of dependence. In addition to the dependence among within-patient events, patients are also clustered by listing center. We propose two marginal methods to analyze such clustered recurrent event data; the first model postulates a common baseline event rate, while the second features cluster-specific baseline rates. Our results indicate that kidney transplantation offers a significant decrease in hospitalization, but that the effect is negated by a waiting time (until transplant) of more than two years. Moreover, graft failure (GF) results in a significant increase in the hospitalization rate which is greatest in the first month post-GF, but remains significantly elevated up to four years later. We also compare results from the proposed models to those based on a frailty model, with the various methods compared and contrasted.

Keywords: clustered failure time data; frailty model; proportional means model recurrent events; semi-parametric model; transplant.
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