MS, University of Cincinnati, 2022, Medicine: Biostatistics (Environmental Health)
BACKGROUND: Environmental exposures and community characteristics have been linked to rapid lung function decline and other adverse pulmonary outcomes in people with cystic fibrosis (CF). Geomarkers, the measurements of these exposures, have been linked to patient outcomes in other respiratory diseases, though broad-based geomarker studies are lacking and it is unknown which geomarkers will have the greatest predictive potential for rapid decline and pulmonary exacerbation (PEx) in CF.
OBJECTIVE: A retrospective longitudinal cohort study was performed to determine whether and which geomarkers would be chosen via novel Bayesian joint covariate selection approaches and to compare the predictive performance of the resultant models for onset of PEx.
METHODS: Non-stationary Gaussian linear mixed effects models were fitted to data from 151 cystic fibrosis patients aged 6 – 20 receiving care at the Cincinnati Children's Hospital Cystic Fibrosis Center (2007-2017). The outcome of interest was forced expiratory volume in 1 second of percent predicted (FEV1pp). Target functions were used to predict PEx onset according to an established definition based on drops in FEV1pp. Covariates included 11 clinical/demographic characteristics (age, sex, number of PEx-defined events within previous year, F508del mutation, pancreatic insufficiency, MEDICAID insurance use, BMI percentile, PA infection, MRSA infection, CF-related diabetes mellitus, and the number of hospital visits within the previous year), and 45 geomarkers comprising 8 categories (socioeconomic status, access to care, roadway proximity, crime, land cover, impervious descriptors, weather, and air pollution). Joint selection of covariates for predictive models was achieved using four Bayesian penalized regression models (elastic-net, adaptive lasso, ridge, and lasso). Unique covariate selections at both the 95% and 90% credible intervals (CIs) were fit to a linear mixed effects model with non-stationary stocha (open full item for complete abstract)
Committee: Marepalli Rao Ph.D. (Committee Member); Rhonda Szczesniak Ph.D. (Committee Member)
Subjects: Statistics