Cavenague de Souza Hayala Cristina, Louzada Francisco, de Oliveira Mauro Ribeiro, Fawole Bukola, Akintan Adesina, Oyeneyin Lawal, Sanni Wilfred, da Silva Castro Perdoná Gleici
Department of Social Medicine, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo Brazil.
Institute of Mathematical Science and Computing, University of São Paulo, São Carlos, Brazil.
J Appl Stat. 2021 Mar 9;49(9):2416-2429. doi: 10.1080/02664763.2021.1896684. eCollection 2022.
In obstetrics and gynecology, knowledge about how women's features are associated with childbirth is important. This leads to establishing guidelines and can help managers to describe the dynamics of pregnant women's hospital stays. Then, time is a variable of great importance and can be described by survival models. An issue that should be considered in the modeling is the inclusion of women for whom the duration of labor cannot be observed due to fetal death, generating a proportion of times equal to zero. Additionally, another proportion of women's time may be censored due to some intervention. The aim of this paper was to present the Log-Normal zero-inflated cure regression model and to evaluate likelihood-based parameter estimation by a simulation study. In general, the inference procedures showed a better performance for larger samples and low proportions of zero inflation and cure. To exemplify how this model can be an important tool for investigating the course of the childbirth process, we considered the Better Outcomes in Labor Difficulty project dataset and showed that parity and educational level are associated with the main outcomes. We acknowledge the World Health Organization for granting us permission to use the dataset.
在妇产科领域，了解女性特征与分娩之间的关联至关重要。这有助于制定指导方针，并能帮助管理人员描述孕妇住院时间的动态变化。那么，时间是一个非常重要的变量，可以用生存模型来描述。建模时应考虑的一个问题是，由于胎儿死亡而无法观察到产程持续时间的女性的纳入，这会产生一部分时间等于零的情况。此外，由于某些干预，女性时间的另一部分可能会被截尾。本文的目的是介绍对数正态零膨胀治愈回归模型，并通过模拟研究评估基于似然的参数估计。一般来说，对于较大的样本以及零膨胀和治愈比例较低的情况，推断程序表现出更好的性能。为了举例说明该模型如何成为研究分娩过程的重要工具，我们考虑了“分娩困难更好结局”项目数据集，并表明产次和教育水平与主要结局相关。我们感谢世界卫生组织允许我们使用该数据集。
