Roustaei Narges, Jamali Jamshid, Taghi Ayatollahi Seyyed Mohammad, Zare Najaf
Department of Epidemiology and Biostatistics, School of Health and Nutrition Sciences, Social Determinants of Health Research Center, Yasuj University of Medical Sciences, Yasuj, Iran.
Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Iran J Public Health. 2020 Sep;49(9):1776-1786. doi: 10.18502/ijph.v49i9.4099.
The prevalence of HIV/AIDS has been increasing in Iran, especially amongst the young population, recently. The joint model (JM) is a statistical method that represents an effective strategy to incorporate all information of repeated measurements and survival outcomes simultaneously. In many theoretical studies, the population under the study were heterogeneous. This study aimed at comparing three approaches by considering heterogeneity in the patients.
This study was conducted on 750 archived files of patients infected with HIV in Fars Province, southern Iran, from 1994 to 2017. Proposed Approach (PA), Joint Latent Class Models (JLCM), and Separated Approach (SA) were compared to evaluate the influence covariates on the longitudinal and time-to-event outcomes in the heterogeneous HIV/AIDS patients.
Gender (<0.001) and HCV (<0.01) were two significant covariates in the classification of HIV/AIDS patients. Time had a significant effect on CD4 (<0.001) in both classes in the three approaches. In PA and SA, females had higher CD4 than males (<0.001) in the first class. In JLCM, females had higher CD4 than males (<0.01) in both classes. The patients with higher Hgb had also higher CD4 (<0.001) in both classes in the three approaches. HCV reduced the CD4 significantly in both classes in PA (<0.05) and SA (<0.001). Within the survival sub-model, HCV reduced survival rate significantly in the second class in PA (<0.05), JLCM (<0.01) and SA (<0.001).
PA was an appropriate approach for joint modeling longitudinal and survival outcomes for this heterogeneous population.
近年来，伊朗的艾滋病毒/艾滋病患病率一直在上升，尤其是在年轻人群体中。联合模型（JM）是一种统计方法，是一种将重复测量和生存结果的所有信息同时纳入的有效策略。在许多理论研究中，研究对象的总体是异质性的。本研究旨在通过考虑患者的异质性来比较三种方法。
本研究对1994年至2017年伊朗南部法尔斯省750份艾滋病毒感染患者的存档文件进行了研究。比较了提议方法（PA）、联合潜在类别模型（JLCM）和分离方法（SA），以评估协变量对异质性艾滋病毒/艾滋病患者纵向和事件发生时间结果的影响。
性别（<0.001）和丙型肝炎病毒（<0.01）是艾滋病毒/艾滋病患者分类中的两个显著协变量。在三种方法的两个类别中，时间对CD4有显著影响（<0.001）。在PA和SA中，第一类中女性的CD4高于男性（<0.001）。在JLCM中，两个类别中女性 的CD4均高于男性（<0.01）。在三种方法的两个类别中，血红蛋白水平较高的患者CD4也较高（<0.001）。在PA（<0.05）和SA（<0.001）中，丙型肝炎病毒在两个类别中均显著降低了CD4。在生存子模型中，PA（<0.05）、JLCM（<0.01）和SA（<0.001）中，丙型肝炎病毒在第二类中显著降低了生存率。
PA是对这一异质性人群的纵向和生存结果进行联合建模的合适方法。
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