Prepare an NHANES-LMF dataset for survival analysis

Takes a linked NHANES-mortality data frame (from nhanes_mortality_link()) and returns a dataset ready for use with survival::Surv(), with:

Usage

nhanes_survival_prep(
  data,
  origin = c("exam", "interview"),
  time_unit = c("months", "years"),
  cause = NULL,
  weight_var = NULL,
  seqn_col = "SEQN",
  cycle_col = "cycle"
)

Arguments

data: A data frame from nhanes_mortality_link().
origin: Character. Follow-up origin: "interview" (uses PERMTH_INT) or "exam" (uses PERMTH_EXM). For analyses involving lab or examination data, use "exam".
time_unit: Character. "months" (default, as stored in LMF) or "years" (divides by 12).
cause: Character or NULL. If supplied, creates a cause-specific event indicator event_cause that is 1 only when UCOD_LEADING matches this code and MORTSTAT == 1. See nhanes_ucod_labels() for valid codes. For all-cause mortality, leave NULL.
weight_var: Character. Name of the survey weight column to carry through. The column is renamed to survey_weight in the output. If NULL, no weight is attached.
seqn_col: Character. Name of the participant sequence-number column. Default "SEQN". Use "seqn" for nhanesdata output.
cycle_col: Character. Name of the cycle column. Default "cycle". Use "year" for nhanesdata output.

Value

A data frame with additional columns:

time: Follow-up time in specified units.
event: All-cause mortality indicator (0/1).
event_cause: Cause-specific indicator, if cause supplied.
survey_weight: Survey weight, renamed from weight_var.
.eligstat_dropped: Attribute recording how many rows were removed.

Details

Ineligible participants (ELIGSTAT != 1) removed with a warning
A time column (in months or years) from the specified follow-up origin
An event column (0/1) from MORTSTAT
Optional cause-specific event indicator based on UCOD_LEADING
Survey weight column renamed and validated

Eligibility filtering

Participants with ELIGSTAT != 1 are automatically removed with a warning. This includes those under 18 at time of survey (ELIGSTAT == 2) and those with insufficient identifying data for linkage (ELIGSTAT == 3). The number dropped is reported and attached as an attribute.

Asymmetric follow-up across cycles

All public-use LMF files censor at December 31, 2019. Participants enrolled in later cycles (e.g. 2017-2018) have substantially shorter maximum follow-up than those enrolled in 1999-2000. This function warns when multiple cycles are detected, as this asymmetry must be accounted for in any pooled analysis.

Survey weights

NHANES provides three families of survey weight, each correcting for a different sampling stage. Choosing the wrong weight produces biased point estimates and incorrect standard errors.

Weight	When to use
`WTINT2YR`	Interview-only data (questionnaires, no lab/exam)
`WTMEC2YR`	Any examination or laboratory component
`WTSAF2YR`	Analytes from the fasting subsample (triglycerides, glucose, insulin, calculated LDL)

The fasting subsample weight (WTSAF2YR) is a statistical probability weight – not a body-weight measurement – that accounts for the additional random subsampling of participants asked to fast before their blood draw. Fasting participants are a minority of all MEC attendees; using WTMEC2YR for fasting analytes ignores this extra subsampling step and will give incorrect population estimates.

For pooled multi-cycle analyses divide the 2-year weight by the number of cycles pooled, or use the pre-computed 4-year weight WTMEC4YR where available. See the NHANES analytic guidelines for details.

Perturbed variables

PERMTH_INT, PERMTH_EXM, and UCOD_LEADING contain synthetic values for select records (CDC data perturbation to reduce re-identification risk). MORTSTAT is not perturbed. Cause-specific analyses using UCOD_LEADING should be interpreted with this in mind.

Examples

# \donttest{
demo_list <- nhanes_download("DEMO", c("2013-2014", "2015-2016"))
demo <- nhanes_stack(demo_list)
demo_mort <- nhanes_mortality_link(demo)

# All-cause mortality, exam origin, MEC 2-year weight
surv_data <- nhanes_survival_prep(
  demo_mort,
  origin     = "exam",
  time_unit  = "years",
  weight_var = "WTMEC2YR"
)
#> Warning: ! Removed 8072 ineligible participants (8041 under 18; 31 insufficient
#>   identifying data).
#> ℹ These records cannot be used in survival analyses with the public-use LMF.
#>   12074 eligible participants remain.
#> ℹ See the LMF documentation for eligibility criteria:
#>   <https://www.cdc.gov/nchs/data/datalinkage/public-use-linked-mortality-file-description.pdf>
#> Warning: ! Data contains 2 NHANES cycles: "2013-2014" and "2015-2016".
#> ℹ All cycles censor at December 31, 2019. Participants enrolled in later cycles
#>   have shorter maximum follow-up. Consider this asymmetry in any pooled or
#>   stacked analysis.
#> 2 records have follow-up time < 0.5 months (same-month exam and death). Time
#> floored at 0.5 months.
#> Warning: 441 records have non-missing MORTSTAT but missing PERMTH_EXM. These will
#> produce NA in the "time" column.
#> Warning: ! Using 2-year weight "WTMEC2YR" with 2 pooled cycles.
#> ℹ Divide 2-year weights by the number of cycles pooled, or use a pre-computed
#>   4-year weight where available.
#> ℹ See NHANES analytic guidelines:
#>   <https://wwwn.cdc.gov/nchs/nhanes/analyticguidelines.aspx>

# Cause-specific: cardiovascular (code "001")
surv_data_cvd <- nhanes_survival_prep(
  demo_mort,
  origin = "exam",
  cause  = "001",
  weight_var = "WTMEC2YR"
)
#> Warning: ! Removed 8072 ineligible participants (8041 under 18; 31 insufficient
#>   identifying data).
#> ℹ These records cannot be used in survival analyses with the public-use LMF.
#>   12074 eligible participants remain.
#> ℹ See the LMF documentation for eligibility criteria:
#>   <https://www.cdc.gov/nchs/data/datalinkage/public-use-linked-mortality-file-description.pdf>
#> Warning: ! Data contains 2 NHANES cycles: "2013-2014" and "2015-2016".
#> ℹ All cycles censor at December 31, 2019. Participants enrolled in later cycles
#>   have shorter maximum follow-up. Consider this asymmetry in any pooled or
#>   stacked analysis.
#> 2 records have follow-up time < 0.5 months (same-month exam and death). Time
#> floored at 0.5 months.
#> Warning: 441 records have non-missing MORTSTAT but missing PERMTH_EXM. These will
#> produce NA in the "time" column.
#> Cause-specific event "event_cause": Diseases of heart (UCOD 001). 199 events
#> among eligible participants.
#> Warning: ! Using 2-year weight "WTMEC2YR" with 2 pooled cycles.
#> ℹ Divide 2-year weights by the number of cycles pooled, or use a pre-computed
#>   4-year weight where available.
#> ℹ See NHANES analytic guidelines:
#>   <https://wwwn.cdc.gov/nchs/nhanes/analyticguidelines.aspx>

# Use with survival package
library(survival)
library(survey)
#> Loading required package: grid
#> Loading required package: Matrix
#> 
#> Attaching package: ‘survey’
#> The following object is masked from ‘package:graphics’:
#> 
#>     dotchart
design <- svydesign(
  id      = ~SDMVPSU,
  strata  = ~SDMVSTRA,
  weights = ~survey_weight,
  nest    = TRUE,
  data    = surv_data
)
# }