Title:
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Outlier effects on robust joint modelling of longitudinal and survival date
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Robust joint modelling is an emerging field of research. Through the advancements in electronic patient
healthcare records, the popularly of joint modelling approaches has grown rapidly in recent years providing
simultaneous analysis of longitudinal and survival data. This research advances previous work through the
development of a novel robust joint modelling methodology for one of the most common types of standard joint
models, that which links a linear mixed model with a Cox proportional hazards model. Through t-distributional
assumptions, longitudinal outliers are accommodated with their detrimental impact being down weighed and
thus providing more efficient and reliable estimates.
The robust joint modelling technique and its major benefits are showcased through the analysis of Northern
Irish end stage renal disease patients. With an ageing population and growing prevalence of chronic kidney
disease within the United Kingdom, there is a pressing demand to investigate the detrimental relationship
between the changing haemoglobin levels of haemodialysis patients and their survival. As outliers within the
NI renal data were found to have significantly worse survival, identification of outlying individuals through
robust joint modelling may aid nephrologists to improve patient's survival.
A simulation study was also undertaken to explore the difference between robust and standard joint models in
the presence of increasing proportions and extremity of longitudinal outliers. More efficient and reliable
estimates were obtained by robust joint models with increasing contrast between the robust and standard joint
models when a greater proportion of more extreme outliers are present.
Through illustration of the gains in efficiency and reliability of parameters when outliers exist, the potential of
robust joint modelling is evident. The research presented in this thesis highlights the benefits and stresses the
need to utilise a more robust approach to joint modelling in the presence of longitudinal outliers.
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