Setup
knitr::opts_chunk$set(cache = FALSE,
warning = FALSE,
message = FALSE,
cache.lazy = FALSE)
options(scipen = 999,cache.lazy = FALSE)
set.seed(42)
# Set flag to regenerate stored artifacts
reload = F
# set to "glm_propensity" for sensitivity analysis concerning effect of alternate propensity score model
# set to "noqualityexcl" for sensitivity analysis concerning effect without excluding discharges at risk for documentation errors
# set to "first_patient" for sensitivity analysis concering effect of including only the first contact for each patient (instead of excluding repeat patients at the matching stage)
sens_analysis <- "main"
path = paste0(getwd(),"/",sens_analysis)
dir.create(path)
## Warning in dir.create(path): 'C:\Users\dousp651\Projects\SIP -
## Documents\nh_impact\main' already exists
knitr::opts_knit$set(root.dir = path)
suppressPackageStartupMessages({
library(tidycmprsk)
library(ggsurvfit)
library(readxl)
library(lubridate)
library(boot)
library(xgboost)
library(data.table)
library(knitr)
library(tidyverse)
library(MatchIt)
library(marginaleffects)
library(survival)
library(survminer)
library(Matrix)
library(cmprsk)
library(glmnet)
library(effectsize)
library(DT)
})
# Define MDC codes based on NBHW definitions https://www.socialstyrelsen.se/statistik-och-data/klassifikationer-och-koder/drg/drg-koder-och-definitioner/
mdc = c("A" = "Nervous System",
"B" = "Eye",
"C" = "Ear, Nose, Mouth, And Throat",
"D" = "Respiratory System",
"E" = "Circulatory System",
"F" = "Digestive System",
"G" = "Hepatobiliary System and Pancreas",
"H" = "Musculoskeletal System \n and Connective Tissue",
"J" = "Skin, Subcutaneous \nTissue, and Breast",
"K" = "Mammary gland diseases",
"L" = "Endocrine, Nutritional,\n and Metabolic System",
"M" = "Kidney and Urinary Tract",
"N" = "Male Reproductive System",
"O" = "Female Reproductive System",
"P" = "Pregnancy, Childbirth, and Puerperium",
"Q" = "Newborn and Other Neonates (Perinatal Period)",
"R" = "Blood/-Forming and Immun./\nMyeloprolif. Dis. / NS tumors",
"S" = "Infectious and Parasitic\n Diseases and Disorders",
"T" = "Mental Diseases and Disorders",
"U" = "Injuries, Poison, \nand Toxic Effect of Drugs",
"V" = "Burns",
"W" = "Factors Influencing Health Status",
"Z" = "Ungroupable")
mdc_df <- data.frame(mdc = names(mdc),
mdc_name = mdc)
## Set parameters
# Maximum length of stay to include
max_caredays = 90
# Minimum number of observations from a hospital ward to include
min_hosp_mvo_obs = 100
# Time span to search forwards from a contact to identify readmissions
fu_days = 90
# Time span to search backwards from a contact to identify previous admissions
prev_days = 365
# Function for getting bootstrap CIs for mean
mean_fun <- function(data,inds){
return(mean(data[inds]))
}
# Function for calculating number of contacts within a given timeframe
window_dates <- function(d,s,i){
d = unlist(d)
l = length(d[d >= s & d <= i])
return(l)
}
elapsed_months <- function(end_date, start_date) {
sd <- as.POSIXlt(start_date)
ed <- as.POSIXlt(end_date)
return(12 * (ed$year - sd$year) + (ed$mon - sd$mon))
}
# Function for calculating the quantile of a value
get_q <- function(x,q){sum(x>unlist(q))/(length(unlist(q)))}
# Function for generating sparse matrix for propensity xgboost model
generate_sparsm <- function(data){
cats <- data %>%
ungroup() %>%
dplyr::select(id,
mvo,
weekday,
op = interventions,
prevdiag = prev_last_diag,
diagprim = diag_prim_last,
diagsec = diag_sec,
region,
muni,
hosp,
born,
civil,
admit) %>%
mutate(mvo = gsub(" ","|",mvo),
diagprim = gsub(" ","|",diagprim),
diagsec = gsub(" ","|",diagsec),
op = gsub(" ","|",op),
prevdiag = gsub(" ","|",prevdiag),
muni = gsub(" ","|",muni)
) %>%
mutate(across(everything(),function(x) strsplit(as.character(x),"\\|"))) %>%
pivot_longer(-id) %>%
unnest(cols = value,keep_empty = T) %>%
mutate(id = as.numeric(id),
name = make.names(paste(name,value,sep = "_")),
value = 1) %>%
distinct() %>%
ungroup()
ids <- unique(cats$id)
names <- unique(cats$name)
# Map to sparse row/column indices
id_map <- data.frame(sm_id = seq(1,length(ids)),
id = ids)
name_map <- data.frame(sm_d = seq(1,length(names)),
name = names)
# Join to data
cats <- cats %>%
left_join(id_map) %>%
left_join(name_map)
sprsM_cat <- as(sparseMatrix(i = cats$sm_id,
j = cats$sm_d,
x = cats$value,
dimnames = list(unique(cats$id)[order(unique(cats$sm_id))],
unique(cats$name)[order(unique(cats$sm_d))])), "dgCMatrix")
num <- data %>%
transmute(date = as.numeric(out_date),
week,
caredays = caredays,
prevSince = ifelse(is.na(prev_caredays),fu_days+1,prev_caredays),
prevCaredays = ifelse(is.na(days_since_prev),366,days_since_prev),
planned = planned_contact,
age,
countHomecareMonths = n_hc,
countHomeserviceMonths = n_htj,
countAmbPlanned = count_yr_ov_planned,
countAmbUnplanned = count_yr_ov_unplanned,
countDiags = n_diag,
countInterventions = n_op,
female = gender,
countYr = count_yr,
countYrUnplanned = count_yr_unplanned)
sprsM <- num %>%
as.matrix() %>%
Matrix(sparse = T) %>%
cbind(sprsM_cat)
return(sprsM)
}
Load data
Data = hospital data Sol = SOL data
# Load data
if(file.exists("./data_final.rda") &
file.exists("./excl_n.rda") & !reload){
load("data_final.rda")
load("excl_n.rda")
}else{
load("data.rda")
load("sol.rda")
d$disch_sabo <- as.numeric(d$discharge == "Särskilt boende")
#df indicating which months patient has NH or short term stay
sabo <- sol %>%
filter(BOFORM == 2 | KORTTID == 1) %>%
dplyr::select(lopnr, date_month,shortterm = KORTTID) %>%
distinct()
#calculate dates for NH at discharge
sabo_dates <- d %>%
dplyr::select(lopnr,grp, in_date,out_date,admit,discharge) %>%
left_join(sabo) %>%
filter(date_month >= out_date - months(3)) %>%
group_by(lopnr,grp) %>%
filter(date_month == min(date_month)) %>%
ungroup() %>%
distinct() %>%
mutate(sabo_diff = date_month - out_date)
#calculate dates for NH at admission
sabo_dates_in <- d %>%
dplyr::select(lopnr,grp, in_date,out_date,admit,discharge) %>%
left_join(sabo) %>%
filter(date_month >= in_date - months(3)) %>%
group_by(lopnr,grp) %>%
filter(date_month == min(date_month)) %>%
ungroup() %>%
distinct() %>%
mutate(sabo_diff_in = date_month - in_date)
# Get home service / home care dates
htj <- sol %>%
filter(BOFORM <= 1 & KORTTID != 1,
HTJ == 1) %>%
dplyr::select(lopnr, date_month) %>%
distinct()
hsl <- sol %>%
filter(BOFORM <= 1 & KORTTID != 1,
HSL == 1) %>%
dplyr::select(lopnr, date_month) %>%
distinct()
htj_dates <- d %>%
dplyr::select(lopnr,grp, in_date,out_date,admit,discharge) %>%
left_join(htj) %>%
filter(date_month >= out_date - months(3)) %>%
group_by(lopnr,grp) %>%
filter(date_month == min(date_month)) %>%
ungroup() %>%
distinct() %>%
mutate(htj_diff = date_month - out_date)
hsl_dates <- d %>%
dplyr::select(lopnr,grp, in_date,out_date,admit,discharge) %>%
left_join(hsl) %>%
filter(date_month >= out_date - months(3)) %>%
group_by(lopnr,grp) %>%
filter(date_month == min(date_month)) %>%
ungroup() %>%
distinct() %>%
mutate(hsl_diff = date_month - out_date)
d <- d %>%
left_join(dplyr::select(sabo_dates,lopnr,grp,
sabo_date = date_month,
sabo_diff,shortterm),
by=c("lopnr","grp")) %>%
left_join(dplyr::select(sabo_dates_in,lopnr,grp,
sabo_date_in = date_month,
sabo_diff_in),
by=c("lopnr","grp")) %>%
left_join(dplyr::select(htj_dates,lopnr,grp,
htj_date = date_month,
htj_diff),
by=c("lopnr","grp")) %>%
left_join(dplyr::select(hsl_dates,lopnr,grp,
hsl_date = date_month,
hsl_diff),
by=c("lopnr","grp"))
d <- d %>%
#Exclude if admitted from home but has had NH care registered for at least 2 months before discharge (these patients are likely living in NH already)
mutate(excl_admit = !(admit == "Ordinärt boende" & sabo_diff_in < -30 ) | is.na(sabo_diff),
#Exclude if discharged to NH but no record of NH care for at least 2 months after discharge
excl_discharge_sabo = !(discharge == "Särskilt boende" & (sabo_diff > 30 | is.na(sabo_diff))),
#Exclude if discharged to home but record of NH care within 2 months
excl_discharge_home = !(discharge == "Ordinärt boende" & (sabo_diff < 30 & !is.na(sabo_diff))),
shortterm = ifelse(is.na(shortterm),0,shortterm)) %>%
ungroup() %>%
select(-dates,-unplanned_dates)
# Apply exclusion criteria, and save the number of included records at each step.
excl_n <- list()
excl_n$orig <- nrow(d)
#Exclude cases prior to 2016 (2015 used to calculate propensity score data)
d <- d %>%
filter(year(out_date) > 2015)
excl_n$year_2015 <- nrow(d)
d <- d %>%
filter(planned_contact == 0)
excl_n$unplanned <- nrow(d)
d <- d %>%
arrange(lopnr,grp) %>%
mutate(days_to_next_unplanned = ifelse(lead(lopnr) == lopnr,lead(in_date) - out_date,NA))
d <- d %>%
filter(!is.na(source_discharge),
!is.na(source_admit),
!is.na(last_hosp))
excl_n$missingdata <- nrow(d)
d <- d %>%
filter(!source_discharge %in% c(4,1))
excl_n$discharge <- nrow(d)
d <- d %>%
filter(caredays > 2)
excl_n$shortstay <- nrow(d)
d <- d %>%
filter(caredays <= max_caredays)
excl_n$longstay <- nrow(d)
d <- d %>%
filter(out_date < ymd("20200101") - days(fu_days))
excl_n$endofstudy <- nrow(d)
d <- d %>%
filter(!is.na(last_hosp_mvo))
excl_n$missingmvo <- nrow(d)
d <- d %>%
filter((days_since_prev >= 0 | is.na(days_since_prev)) &
(out_days_to_next >= 0 | is.na(out_days_to_next)))
excl_n$shortgap <- nrow(d)
d <- d %>%
filter(source_admit == 3)
excl_n$admitfromhome <- nrow(d)
if(sens_analysis != "noqualityexcl"){
d <- d %>%
filter(excl_admit & excl_discharge_sabo & excl_discharge_home)
}
excl_n$uncertain_admit_discharge <- nrow(d)
d <- d %>%
filter((!is.na(htj_diff) & htj_diff < 30) | disch_sabo == 1)
excl_n$admit_home_no_care <- nrow(d)
d <- d %>%
filter(n_diag > 1)
excl_n$multi_diag <- nrow(d)
if(sens_analysis != "noqualityexcl"){
d <- d %>%
group_by(lopnr) %>%
mutate(first_disch_nh = min(out_date[disch_sabo == 1 & shortterm == 0],na.rm = T)) %>%
ungroup() %>%
filter(in_date < first_disch_nh)
}
excl_n$admitfromhome_after_nhdisch <- nrow(d)
if(sens_analysis == "first_patient"){
d <- d %>%
group_by(lopnr) %>%
filter(grp == min(grp))
}
excl_n$final <- nrow(d)
# Append home care volume data
htj_sum <- htj %>%
arrange(lopnr, date_month) %>%
group_by(lopnr) %>%
mutate(n_htj = row_number()-1) %>%
ungroup( )%>%
select(lopnr, discharge_date_month = date_month, n_htj) %>%
filter(lopnr %in% d$lopnr)
hsl_sum <- hsl %>%
arrange(lopnr, date_month) %>%
group_by(lopnr) %>%
mutate(n_hc = row_number()-1) %>%
ungroup() %>%
select(lopnr, discharge_date_month = date_month, n_hc) %>%
filter(lopnr %in% d$lopnr)
muni_sums <- full_join(htj_sum,hsl_sum)
d <- d %>%
left_join(muni_sums,
by = c("lopnr","discharge_date_month")) %>%
ungroup()
d$n_htj[is.na(d$n_htj)] <- 0
d$n_hc[is.na(d$n_hc)] <- 0
save(d, file = "data_final.rda")
save(excl_n, file = "excl_n.rda")
}
length(unique(d$lopnr))
## [1] 230815
excl_n_per_stage <- as.data.frame(t(as.data.frame(excl_n))) %>%
transmute(sum = V1,
excl = lag(sum)-sum,
description = c("Patients over 65 with 2+ ICD codes",
"Year > 2015",
"Unplanned admission",
"Missing discharge/admission/hospital data",
"Discharge to home or NH",
"Care duration < 3 days",
"Care duration > 90 days",
"Year < 2020",
"Missing ward information",
"Same day readmission",
"Patient admitted from home",
"Agreeement re: admission and discharge between data sources",
"Discharged home without care services",
"Single diagnosis only",
"Admission from home discharged to NH following discharge to NH",
"Final"))
kable(excl_n_per_stage,row.names = F)
| 2852592 |
NA |
Patients over 65 with 2+ ICD codes |
| 2289148 |
563444 |
Year > 2015 |
| 1856728 |
432420 |
Unplanned admission |
| 1856278 |
450 |
Missing discharge/admission/hospital data |
| 1704954 |
151324 |
Discharge to home or NH |
| 1376882 |
328072 |
Care duration < 3 days |
| 1375519 |
1363 |
Care duration > 90 days |
| 1288843 |
86676 |
Year < 2020 |
| 1287612 |
1231 |
Missing ward information |
| 1287108 |
504 |
Same day readmission |
| 1188724 |
98384 |
Patient admitted from home |
| 1001640 |
187084 |
Agreeement re: admission and discharge between data
sources |
| 434405 |
567235 |
Discharged home without care services |
| 413657 |
20748 |
Single diagnosis only |
| 413073 |
584 |
Admission from home discharged to NH following
discharge to NH |
| 413073 |
0 |
Final |
# Final n:
nrow(d)
## [1] 413073
# Generate sparse matrix for xgb
if(file.exists("./sm.rda") & !reload){
load("./sm.rda")
}else{
sm <- generate_sparsm(d)
save(sm,file = "./sm.rda")
}
Train propensity models
if(file.exists("./propensity_xgb.rda") & !reload){
load("./propensity_xgb.rda")
load("./propensity_xgb_cv.rda")
load("./propensity_glm.rda")
load("./propensity_glm_cv.rda")
}else{
params <- list(objective = "binary:logistic")
propensity_xgb_cv <- xgb.cv(data = xgb.DMatrix(data = sm,
label = as.logical(d$disch_sabo)),
nfold = 5,
nrounds = 500,
prediction = T,
params = params,
early_stopping_rounds = 10)
propensity_xgb <- xgb.train(data = xgb.DMatrix(data = sm,
label = as.logical(d$disch_sabo)),
params = params,
nrounds = propensity_xgb_cv$early_stop$best_iteration)
propensity_glm_cv <- cv.glmnet(x=sm,
y = as.logical(d$disch_sabo))
propensity_glm <- glmnet(x=sm,
y = as.logical(d$disch_sabo),
lambda = propensity_glm_cv$lambda.min)
save(propensity_xgb_cv,file = "./propensity_xgb_cv.rda")
save(propensity_xgb,file = "./propensity_xgb.rda")
save(propensity_glm_cv,file = "./propensity_glm_cv.rda")
save(propensity_glm,file = "./propensity_glm.rda")
}
d_eval <- d %>%
ungroup() %>%
dplyr::select(id,
lopnr,
out_date,
age,
gender,
region,
muni,
caredays,
planned_contact,
mdc,
mvo_last,
n_op,
n_diag,
disch_sabo,
days_since_prev,
count_yr,
count_yr_unplanned,
count_yr_ov_planned,
count_yr_ov_unplanned,
unplanreadmit30,
mort30,
days_to_next_unplanned,
mort_days,
sabo_diff,
n_hc,
n_htj) %>% #include months of HC before hospitalization
mutate(nh_propensity_xgb = propensity_xgb_cv$cv_predict$pred,
nh_propensity_glm = predict(propensity_glm,newx = sm),
nh_propensity = nh_propensity_xgb,
mortorreadmit30 = pmax(unplanreadmit30,mort30),
days_since_prev_fill = ifelse(is.na(days_since_prev),366,days_since_prev),
prop_weight = disch_sabo/nh_propensity + (1-disch_sabo)/(1-nh_propensity),
prop_strat = cut(nh_propensity,quantile(nh_propensity,probs = seq(0, 1, 0.1)),include.lowest = T),
ts_days_to_next_unplanned = ifelse(days_to_next_unplanned>=0,days_to_next_unplanned,NA),
ts_days_to_sabo = ifelse(sabo_diff>=0 & disch_sabo == 0,sabo_diff,NA),
ts_days_to_mort = ifelse(mort_days>=0,mort_days,NA),
ts_days_to_any = pmin(ts_days_to_next_unplanned,ts_days_to_mort,na.rm = T),
ts_mort_days_pp = pmin(ts_days_to_mort,
ts_days_to_sabo,
fu_days,na.rm = T),
ts_mort_event_pp = ts_days_to_mort == ts_mort_days_pp & !is.na(ts_days_to_mort),
ts_mort_days_itt = pmin(ts_days_to_mort,
fu_days,na.rm = T),
ts_mort_event_itt = ts_days_to_mort == ts_mort_days_itt & !is.na(ts_days_to_mort),
ts_any_days_itt = pmin(ts_days_to_any,
fu_days,na.rm = T),
ts_any_event_itt = ts_days_to_any == ts_any_days_itt & !is.na(ts_days_to_any),
ts_readmit_days_pp = pmin(ts_days_to_next_unplanned,
ts_days_to_mort,
ts_days_to_sabo,
fu_days,na.rm = T),
ts_readmit_event_pp = as.factor(ifelse(ts_readmit_days_pp == ts_days_to_next_unplanned &
!is.na(ts_days_to_next_unplanned), "Readmission",
ifelse(ts_readmit_days_pp == ts_days_to_mort &
!is.na(ts_days_to_mort), "Death","Censored"))),
ts_readmit_days_itt = pmin(ts_days_to_next_unplanned,
ts_days_to_mort,
fu_days,na.rm = T),
ts_readmit_event_itt = factor(ifelse(ts_readmit_days_itt == ts_days_to_next_unplanned &
!is.na(ts_days_to_next_unplanned), "Readmission",
ifelse(ts_readmit_days_itt == ts_days_to_mort &
!is.na(ts_days_to_mort), "Death","Censored")),
levels = c("Censored","Readmission","Death")),
ts_readmit_days_itt_se = pmin(ts_days_to_next_unplanned,
ts_days_to_mort,
fu_days,na.rm = T),
ts_readmit_event_itt_se = ts_readmit_days_itt == ts_days_to_next_unplanned &
!is.na(ts_days_to_next_unplanned),
ts_mort_days_itt_7 = pmin(ts_mort_days_itt, 7),
ts_mort_event_itt_7 = ifelse(ts_mort_days_itt <= 7 & ts_mort_event_itt, T, F),
ts_mort_days_itt_30 = pmin(ts_mort_days_itt, 30),
ts_mort_event_itt_30 = ifelse(ts_mort_days_itt <= 30 & ts_mort_event_itt, T, F),
ts_readmit_days_itt_7 = pmin(ts_readmit_days_itt, 7),
ts_readmit_event_itt_7 = factor(ifelse(ts_readmit_days_itt <= 7,
as.character(ts_readmit_event_itt),
"Censored"),levels = c("Censored",
"Readmission",
"Death")),
ts_readmit_days_itt_30 = pmin(ts_readmit_days_itt, 30),
ts_readmit_event_itt_30 = factor(ifelse(ts_readmit_days_itt <= 30,
as.character(ts_readmit_event_itt),
"Censored"),levels = c("Censored",
"Readmission",
"Death")),
ts_any_days_itt_7 = pmin(ts_any_days_itt, 7),
ts_any_event_itt_7 = ifelse(ts_any_days_itt <= 7 & ts_any_event_itt, T, F),
ts_any_days_itt_30 = pmin(ts_any_days_itt, 30),
ts_any_event_itt_30 = ifelse(ts_any_days_itt <= 30 & ts_any_event_itt, T, F),
)
if(sens_analysis == "glm_propensity") {
d_eval$nh_propensity <- d_eval$nh_propensity_glm
}
Propensity score validation
mean values by percentile
m_data <- m_data %>%
ungroup() %>%
mutate(prop_strat_match = cut(nh_propensity,
quantile(nh_propensity,
probs = seq(0, 1, 0.1)),
include.lowest = T))
d_strat <- m_data %>%
group_by(prop_strat_match,disch_sabo) %>%
summarise(mean_age = mean(age),
pct_female = mean(gender),
mean_caredays = mean(caredays),
mean_n_op = mean(n_op),
mean_n_diag = mean(n_diag),
mean_days_since_prev = mean(days_since_prev,na.rm=T),
mean_count_ov_unplan = mean(count_yr_ov_unplanned),
mean_count_yr = mean(count_yr),
mean_count_yr_unplan = mean(count_yr_unplanned),
pct_unplanreadmit30 = mean(unplanreadmit30),
pct_mort30 = mean(mort30),
mean_hc = mean(n_hc),
mean_htj = mean(n_htj),
n = n()) %>%
pivot_longer(cols = -c(prop_strat_match,disch_sabo))
d_strat_grp <- m_data %>%
group_by(prop_strat_match) %>%
summarise(mean_age = mean(age),
pct_female = mean(gender),
mean_caredays = mean(caredays),
mean_n_op = mean(n_op),
mean_n_diag = mean(n_diag),
mean_days_since_prev = mean(days_since_prev,na.rm=T),
mean_count_ov_unplan = mean(count_yr_ov_unplanned),
mean_count_yr = mean(count_yr),
mean_count_yr_unplan = mean(count_yr_unplanned),
mean_dischsabo = mean(disch_sabo),
n_dischsabo = sum(disch_sabo),
pct_unplanreadmit30 = mean(unplanreadmit30),
pct_mort30 = mean(mort30),
mean_hc = mean(n_hc),
mean_htj = mean(n_htj),
n = n()) %>%
pivot_longer(cols = -c(prop_strat_match))
d_props <- m_data %>%
group_by(disch_sabo) %>%
summarise(mean_age = mean(age),
pct_female = mean(gender),
mean_caredays = mean(caredays),
mean_n_op = mean(n_op),
mean_n_diag = mean(n_diag),
mean_days_since_prev = mean(days_since_prev,na.rm=T),
mean_count_ov_unplan = mean(count_yr_ov_unplanned),
mean_count_yr = mean(count_yr),
mean_count_yr_unplan = mean(count_yr_unplanned),
pct_unplanreadmit30 = mean(unplanreadmit30),
pct_mort30 = mean(mort30),
mean_hc = mean(n_hc),
mean_htj = mean(n_htj),
n = n()) %>%
pivot_longer(cols = -disch_sabo) %>%
mutate(prop_strat = "Overall") %>%
bind_rows(d_strat) %>%
mutate(prop_strat = factor(prop_strat_match,levels = c("Overall",levels(d_strat$prop_strat_match))),
prop_strat_n = as.numeric(prop_strat_match)-1,
discharge = ifelse(disch_sabo == 1,"NH","Home"))
d_props %>%
#filter(!name %in% c("pct_mort30","pct_unplanreadmit30")) %>%
ggplot(aes(x = prop_strat_n,y=value,color=discharge))+
geom_point() +
scale_x_continuous(breaks = seq(0,10,1)) +
facet_wrap(~name,scales = "free",ncol = 2) +
theme(axis.text.x = element_text(angle = 90))
Pseudo r-squared
Pseudo.R2=function(object){
stopifnot(object$family$family == "binomial")
object0 = update(object, ~ 1)
wt <- object$prior.weights # length(wt)
y = object$y # weighted
ones = round(y*wt)
zeros = wt-ones
fv <- object$fitted.values # length(fv)
if (is.null(object$na.action)) fv0 <- object0$fitted.values else
fv0 <- object0$fitted.values[-object$na.action] # object may have missing values
resp <- cbind(ones, zeros)
Y <- apply(resp, 1, function(x) {c(rep(1, x[1]), rep(0, x[2]))} )
if (is.list(Y)) Y <- unlist(Y) else Y <- c(Y)
# length(Y); sum(Y)
fv.exp <- c(apply(cbind(fv, wt), 1, function(x) rep(x[1], x[2])))
if (is.list(fv.exp)) fv.exp <- unlist(fv.exp) else fv.exp <- c(fv.exp)
# length(fv.exp)
fv0.exp <- c(apply(cbind(fv0, wt), 1, function(x) rep(x[1], x[2])))
if (is.list(fv0.exp)) fv0.exp <- unlist(fv0.exp) else fv0.exp <- c(fv0.exp)
(ll = sum(log(dbinom(x=Y,size=1,prob=fv.exp))))
(ll0 = sum(log(dbinom(x=Y,size=1,prob=fv0.exp))))
n <- length(Y)
G2 <- -2 * (ll0 - ll)
McFadden.R2 <- 1 - ll/ll0
CoxSnell.R2 <- 1 - exp((2 * (ll0 - ll))/n) # Cox & Snell / Maximum likelihood pseudo r-squared
r2ML.max <- 1 - exp(ll0 * 2/n)
Nagelkerke.R2 <- CoxSnell.R2/r2ML.max # Nagelkerke / Cragg & Uhler's pseudo r-squared
out <- c(llh = ll, llhNull = ll0, G2 = G2, McFadden = McFadden.R2,
r2ML = CoxSnell.R2, r2CU = Nagelkerke.R2)
out
}
disch_test <- glm(disch_sabo ~ nh_propensity, family = "binomial",
data = d_eval)
Pseudo.R2(disch_test)
## llh llhNull G2 McFadden r2ML
## -103439.2201207 -187786.2582188 168694.0761963 0.4491651 0.3352791
## r2CU
## 0.5614561
Generate outcome predictions
m_d_risk <- m_data %>%
left_join(select(d,-names(d)[names(d) %in% names(m_data)],id))
if(file.exists("./m_sm.rda") & !reload){
load("./m_sm.rda")
}else{
m_sm <- generate_sparsm(m_d_risk)
save(m_sm,file = "./m_sm.rda")
}
if(file.exists("./outcome_mod.rda") & !reload){
load("./outcome_mod.rda")
}else{
outcome_mod <- list()
params = list(objective = "binary:logistic")
outcome_mod$mort7_xgb_cv <- xgb.cv(data = xgb.DMatrix(data = m_sm,
label = m_d_risk$ts_mort_event_itt_7),
nrounds = 500,
nfold = 5,
prediction = T,
early_stopping_rounds = 10,
params = params)
outcome_mod$mort30_xgb_cv <- xgb.cv(data = xgb.DMatrix(data = m_sm,
label = m_d_risk$ts_mort_event_itt_30),
nrounds = 500,
nfold = 5,
prediction = T,
early_stopping_rounds = 10,
params = params)
outcome_mod$mort90_xgb_cv <- xgb.cv(data = xgb.DMatrix(data = m_sm,
label = m_d_risk$ts_mort_event_itt),
nrounds = 500,
nfold = 5,
prediction = T,
early_stopping_rounds = 10,
params = params)
outcome_mod$readmit7_xgb_cv <- xgb.cv(data = xgb.DMatrix(data = m_sm,
label = m_d_risk$ts_readmit_event_itt_7 == "Readmission"),
nrounds = 500,
nfold = 5,
prediction = T,
early_stopping_rounds = 10,
params = params)
outcome_mod$readmit30_xgb_cv <- xgb.cv(data = xgb.DMatrix(data = m_sm,
label = m_d_risk$ts_readmit_event_itt_30 == "Readmission"),
nrounds = 500,
nfold = 5,
prediction = T,
early_stopping_rounds = 10,
params = params)
outcome_mod$readmit90_xgb_cv <- xgb.cv(data = xgb.DMatrix(data = m_sm,
label = m_d_risk$ts_readmit_event_itt == "Readmission"),
nrounds = 500,
nfold = 5,
prediction = T,
early_stopping_rounds = 10,
params = params)
outcome_mod$any7_xgb_cv <- xgb.cv(data = xgb.DMatrix(data = m_sm,
label = m_d_risk$ts_any_event_itt_7),
nrounds = 500,
nfold = 5,
prediction = T,
early_stopping_rounds = 10,
params = params)
outcome_mod$any30_xgb_cv <- xgb.cv(data = xgb.DMatrix(data = m_sm,
label = m_d_risk$ts_any_event_itt_30),
nrounds = 500,
nfold = 5,
prediction = T,
early_stopping_rounds = 10,
params = params)
outcome_mod$any90_xgb_cv <- xgb.cv(data = xgb.DMatrix(data = m_sm,
label = m_d_risk$ts_any_event_itt),
nrounds = 500,
nfold = 5,
prediction = T,
early_stopping_rounds = 10,
params = params)
save(outcome_mod,file = "./outcome_mod.rda")
}
preds <- data.frame(mort7_pred = unlist(outcome_mod$mort7_xgb_cv$cv_predict),
mort30_pred = unlist(outcome_mod$mort30_xgb_cv$cv_predict),
mort90_pred = unlist(outcome_mod$mort90_xgb_cv$cv_predict),
readmit7_pred = unlist(outcome_mod$readmit7_xgb_cv$cv_predict),
readmit30_pred = unlist(outcome_mod$readmit30_xgb_cv$cv_predict),
readmit90_pred = unlist(outcome_mod$readmit90_xgb_cv$cv_predict),
any7_pred = unlist(outcome_mod$any7_xgb_cv$cv_predict),
any30_pred = unlist(outcome_mod$any30_xgb_cv$cv_predict),
any90_pred = unlist(outcome_mod$any90_xgb_cv$cv_predict))
m_data <- m_data %>%
as_tibble() %>%
ungroup() %>%
bind_cols(preds)
Matching table
meanfun <- function(data, i){
d <- data[i]
return(mean(d,na.rm=T))
}
boot_cis <- function(d, s = meanfun, r=100,rd = 2,paste = T){
bo <- boot(d, statistic=s, R=r)
bci <- boot.ci(bo, conf=0.95,type = "perc")
if(paste){
o <- paste0(round(bci$t0,rd)," (",
round(bci$percent[4],rd),"-",
round(bci$percent[5],rd),")")
} else{
o <- list(bci$t0,
bci$percent[4],
bci$percent[5])
}
return(o)
}
m_strat <- m_data %>%
group_by(disch_sabo) %>%
summarise(n = as.character(n()),
mean_age = boot_cis(age),
pct_female = boot_cis(gender),
mean_caredays = boot_cis(caredays),
mean_n_op = boot_cis(n_op),
mean_n_diag = boot_cis(n_diag),
mean_days_since_prev = boot_cis(days_since_prev),
mean_count_yr = boot_cis(count_yr),
mean_count_yr_unplan = boot_cis(count_yr_unplanned),
mean_hc_prev = boot_cis(n_hc),
mean_htj_prev = boot_cis(n_htj),
mean_amb_unplanned = boot_cis(count_yr_ov_unplanned),
mean_amb_planned = boot_cis(count_yr_ov_planned),
pct_unplanreadmit30 = boot_cis(unplanreadmit30),
pct_mort30 = boot_cis(mort30)) %>%
pivot_longer(cols = -c(disch_sabo)) %>%
mutate(discharge = ifelse(disch_sabo == 1,"NH","Home"))
d_strat <- d %>%
group_by(disch_sabo) %>%
summarise(n = as.character(n()),
mean_age = boot_cis(age),
pct_female = boot_cis(gender),
mean_caredays = boot_cis(caredays),
mean_n_op = boot_cis(n_op),
mean_n_diag = boot_cis(n_diag),
mean_days_since_prev = boot_cis(days_since_prev),
mean_count_yr = boot_cis(count_yr),
mean_count_yr_unplan = boot_cis(count_yr_unplanned),
mean_hc_prev = boot_cis(n_hc),
mean_htj_prev = boot_cis(n_htj),
mean_amb_unplanned = boot_cis(count_yr_ov_unplanned),
mean_amb_planned = boot_cis(count_yr_ov_planned),
pct_unplanreadmit30 = boot_cis(unplanreadmit30),
pct_mort30 = boot_cis(mort30)) %>%
pivot_longer(cols = -c(disch_sabo)) %>%
mutate(discharge = ifelse(disch_sabo == 1,"NH","Home"))
smd <- m_data %>%
as_tibble() %>%
select(disch_sabo,
mean_age = age,
mean_caredays = caredays,
mean_n_op = n_op,
mean_n_diag = n_diag,
mean_days_since_prev = days_since_prev,
mean_count_yr = count_yr,
mean_count_yr_unplan = count_yr_unplanned,
mean_hc_prev = n_hc,
mean_htj_prev = n_htj,
mean_amb_unplanned = count_yr_ov_unplanned,
mean_amb_planned = count_yr_ov_planned) %>%
pivot_longer(-disch_sabo, names_to = "variable", values_to = "value") %>%
group_by(variable) %>%
summarise(effectsize::cohens_d(value ~ disch_sabo, ci = 0.95)) %>%
mutate(pasted = paste0(round(Cohens_d,3)," (",round(CI_low,3),"-",round(CI_high,3),")"))
#Balance in original data
d_strat_wide <- d_strat %>%
select(-disch_sabo) %>%
pivot_wider(names_from = discharge,
values_from = value,
names_prefix = "raw ")
#Balance in matched data
m_strat_wide <- m_strat %>%
select(-disch_sabo) %>%
pivot_wider(names_from = discharge,
values_from = value,
names_prefix = "matched ")
match_table <- bind_cols(d_strat_wide,select(m_strat_wide,-name)) %>%
left_join(select(smd,name = variable,smd_ci = pasted))
kable(match_table)
| n |
343183 |
69890 |
36111 |
36111 |
NA |
| mean_age |
82.02 (82-82.05) |
83.97 (83.91-84.03) |
82.54 (82.46-82.63) |
82.82 (82.72-82.9) |
-0.035 (-0.049–0.02) |
| pct_female |
0.59 (0.59-0.59) |
0.59 (0.59-0.59) |
0.58 (0.57-0.58) |
0.58 (0.57-0.58) |
NA |
| mean_caredays |
10.07 (10.04-10.09) |
15.97 (15.85-16.06) |
14.36 (14.24-14.49) |
14.35 (14.24-14.47) |
0.002 (-0.013-0.016) |
| mean_n_op |
2.56 (2.55-2.57) |
3.09 (3.06-3.11) |
3.09 (3.06-3.12) |
3.06 (3.02-3.1) |
0.009 (-0.005-0.024) |
| mean_n_diag |
5.74 (5.73-5.75) |
6.03 (6-6.05) |
5.67 (5.64-5.7) |
5.74 (5.71-5.77) |
-0.025 (-0.039–0.01) |
| mean_days_since_prev |
90.85 (90.44-91.31) |
83.86 (82.9-85.25) |
79.11 (77.02-80.73) |
78.69 (76.76-80.37) |
0.004 (-0.02-0.028) |
| mean_count_yr |
1.65 (1.64-1.66) |
1.05 (1.04-1.06) |
0.76 (0.74-0.77) |
0.82 (0.81-0.84) |
-0.045 (-0.06–0.031) |
| mean_count_yr_unplan |
1.48 (1.47-1.48) |
0.95 (0.94-0.96) |
0.66 (0.65-0.67) |
0.72 (0.71-0.74) |
-0.047 (-0.062–0.033) |
| mean_hc_prev |
3.96 (3.93-3.99) |
0.28 (0.26-0.3) |
0.48 (0.45-0.52) |
0.48 (0.45-0.51) |
0.001 (-0.014-0.015) |
| mean_htj_prev |
8.58 (8.54-8.62) |
0.68 (0.65-0.71) |
1.06 (1-1.11) |
1.18 (1.12-1.25) |
-0.024 (-0.038–0.009) |
| mean_amb_unplanned |
2.53 (2.52-2.54) |
1.63 (1.61-1.65) |
1.16 (1.14-1.18) |
1.24 (1.22-1.27) |
-0.035 (-0.05–0.021) |
| mean_amb_planned |
2.9 (2.87-2.92) |
1.53 (1.48-1.59) |
1.39 (1.33-1.44) |
1.44 (1.39-1.51) |
-0.01 (-0.025-0.005) |
| pct_unplanreadmit30 |
0.25 (0.24-0.25) |
0.15 (0.15-0.15) |
0.19 (0.18-0.19) |
0.15 (0.15-0.15) |
NA |
| pct_mort30 |
0.05 (0.04-0.05) |
0.08 (0.08-0.08) |
0.06 (0.06-0.06) |
0.08 (0.07-0.08) |
NA |
Categorical predictor distributions
Major Diagnostic Group
d_eval %>%
left_join(mdc_df) %>%
group_by(disch_sabo,mdc_name) %>%
summarise(n = n()) %>%
group_by(discharge = ifelse(disch_sabo == 1,"NH","Home")) %>%
mutate(pct = n/sum(n)) %>%
ggplot(aes(y=pct,x= mdc_name,fill = discharge)) +
geom_bar(stat="identity", position = position_dodge()) +
labs(y= "% of patients with MDC (raw)") +
theme(axis.text.x = element_text(angle = 90,hjust = 1,vjust = 0.3))
m_data %>%
left_join(mdc_df) %>%
group_by(disch_sabo,mdc_name) %>%
summarise(n = n()) %>%
group_by(discharge = ifelse(disch_sabo == 1,"NH","Home")) %>%
mutate(pct = n/sum(n)) %>%
ggplot(aes(y=pct,x= mdc_name,fill = discharge)) +
geom_bar(stat="identity", position = position_dodge()) +
labs(y= "% of patients with MDC (raw)") +
theme(axis.text.x = element_text(angle = 90,hjust = 1,vjust = 0.3))
Hospital Ward
d_eval %>%
group_by(disch_sabo,mvo_last) %>%
summarise(n = n()) %>%
group_by(discharge = ifelse(disch_sabo == 1,"NH","Home")) %>%
mutate(pct = n/sum(n)) %>%
ggplot(aes(y=pct,x= as.factor(mvo_last),fill = discharge)) +
geom_bar(stat="identity", position = position_dodge()) +
labs(y= "Percent of patients with ward code (raw)") +
theme(axis.text.x = element_text(angle = 90,hjust = 1,vjust = 0.3))
labs(x = "Hospital ward code")
## <ggplot2::labels> List of 1
## $ x: chr "Hospital ward code"
m_data %>%
group_by(disch_sabo,mvo_last) %>%
summarise(n = n()) %>%
group_by(discharge = ifelse(disch_sabo == 1,"NH","Home")) %>%
mutate(pct = n/sum(n)) %>%
ggplot(aes(y=pct,x= as.factor(mvo_last),fill = discharge)) +
geom_bar(stat="identity", position = position_dodge()) +
labs(y= "Percent of patients with ward code (raw)") +
theme(axis.text.x = element_text(angle = 90,hjust = 1,vjust = 0.3))
labs(x = "Hospital ward code")
## <ggplot2::labels> List of 1
## $ x: chr "Hospital ward code"
These codes are a bit difficult to translate and likely have limited
interpretability outside of Sweden anyway… Ward code lists may be found
with the National Board of Health and Welfare: https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/dokument-webb/klassifikationer-och-koder/sjukhuskoder-kodlista-verksamhetsomraden-2006.pdf
Region
d_eval %>%
group_by(disch_sabo,region) %>%
summarise(n = n()) %>%
group_by(discharge = ifelse(disch_sabo == 1,"NH","Home")) %>%
mutate(pct = n/sum(n)) %>%
ggplot(aes(y=pct,x= as.factor(region),fill = discharge)) +
geom_bar(stat="identity", position = position_dodge()) +
labs(y= "Percent of patients in region (raw)") +
theme(axis.text.x = element_text(angle = 90,hjust = 1,vjust = 0.3)) +
labs(x = "Region")
m_data %>%
group_by(disch_sabo,region) %>%
summarise(n = n()) %>%
group_by(discharge = ifelse(disch_sabo == 1,"NH","Home")) %>%
mutate(pct = n/sum(n)) %>%
ggplot(aes(y=pct,x= as.factor(region),fill = discharge)) +
geom_bar(stat="identity", position = position_dodge()) +
labs(y= "Percent of patients in region (raw)") +
theme(axis.text.x = element_text(angle = 90,hjust = 1,vjust = 0.3)) +
labs(x = "Region")
Propensity score distribution in raw and matched samples
ggplot(d_eval, aes(x = nh_propensity,
fill = as.factor(disch_sabo))) +
geom_density(alpha = 0.5, colour = "grey50") +
#geom_point(aes(y= 0,x=nh_propensity,)) +
geom_rug(aes(color = prop_strat)) +
scale_color_brewer(palette = "Spectral")
d_eval %>%
group_by(prop_strat,disch_sabo) %>%
summarise(n = n()) %>%
pivot_wider(names_from = disch_sabo,
values_from = n)
ggplot(m_data, aes(x = nh_propensity,
fill = as.factor(disch_sabo))) +
geom_density(alpha = 0.5, colour = "grey50") +
#geom_point(aes(y= 0,x=nh_propensity,)) +
geom_rug(aes(color = prop_strat)) +
scale_color_brewer(palette = "Spectral")
m_data %>%
group_by(prop_strat,disch_sabo) %>%
summarise(n = n()) %>%
pivot_wider(names_from = disch_sabo,
values_from = n)
Propensity score variable description
description <- c("caredays" = "Duration of hospital stay",
"diagsec" = "Secondary diagnosis",
"age" = "Patient age",
"region" = "Region",
"muni" = "Municipality",
"mvo" = "Hospital ward",
"date" = "Date of discharge",
"prevSince" = "Days since previous hospital stay",
"countYrUnplanned" = "Number of unplanned hospital stays in the last year",
"countHomecareMonths" = "Number of months of home health care prior to discharge",
"countHomeserviceMonths" = "Number of months of home services prior to discharge",
"countAmbPlanned" = "Number of planned contacts with ambulatory care in the previous year",
"countAmbUnplanned" = "Number of unplanned contacts with ambulatory care in the previous year",
"countDiags" = "Number of diagnosis codes recorded during hospital stay",
"countInterventions" = "Number of intervention codes recorded during hospital stay",
"prevCaredays" = "Duration of previous hostial stay",
"week" = "Week of discharge",
"hosp" = "Discharging hospital",
"civil" = "Patient civil status",
"diagprim" = "Patient primary diagnosis",
"op" = "Operation (KVÃ…) code",
"countYr" = "Number of hospital stays in the last year",
"female" = "Sex of patient",
"weekday" = "Weekday of discharge",
"born" = "Patient region of birth",
"prevdiag" = "Primary diagnosis during previous hospital stay")
importance_matrix <- xgb.importance(propensity_xgb) %>%
mutate(type = str_split_i(Feature,"_",1)) %>%
left_join(as_tibble(list(type = names(description),
description = description)))
t <- xgb.plot.shap.summary(data = sm, model = propensity_xgb,top_n = 100)
mean_shap <- t$data %>%
mutate(valshap = feature_value*shap_value) %>%
group_by(Feature = feature) %>%
summarise(mean_shap = mean(valshap))
importance_matrix <- importance_matrix %>%
left_join(mean_shap) %>%
select(description,Feature,Gain,Cover,mean_shap)
smd_matched <- m_sm[,importance_matrix$Feature] %>%
as.matrix() %>%
as_tibble() %>%
bind_cols(select(m_data,disch_sabo)) %>%
pivot_longer(-disch_sabo, names_to = "variable", values_to = "value") %>%
group_by(variable) %>%
summarise(effectsize::cohens_d(value ~ disch_sabo)) %>%
left_join(importance_matrix,by = c("variable"="Feature")) %>%
mutate(smd_95ci = paste0(round(Cohens_d,3)," (",round(CI_low,3),":",round(CI_high,3),")")) %>%
transmute(variable,
description,
smd_95ci,
Gain = round(Gain,5),
Cover = round(Cover,5),
mean_shap = round(mean_shap,5),
Cohens_d) %>%
arrange(desc(Gain))
Variable summary
importance_matrix %>%
group_by(description) %>%
summarise(n_values = n(),
sum_gain = sum(Gain)) %>%
arrange(desc(sum_gain)) %>%
kable()
| Number of months of home services prior to
discharge |
1 |
0.3641464 |
| Secondary diagnosis |
603 |
0.1256795 |
| Duration of hospital stay |
1 |
0.1109751 |
| Number of months of home health care prior to
discharge |
1 |
0.0596538 |
| Municipality |
203 |
0.0474117 |
| Number of unplanned contacts with ambulatory care in
the previous year |
1 |
0.0449320 |
| Patient age |
1 |
0.0387139 |
| Region |
20 |
0.0373902 |
| Operation (KVÃ…) code |
286 |
0.0298589 |
| Hospital ward |
36 |
0.0293212 |
| Discharging hospital |
73 |
0.0156222 |
| Date of discharge |
1 |
0.0148339 |
| Days since previous hospital stay |
1 |
0.0111590 |
| Number of unplanned hospital stays in the last
year |
1 |
0.0096172 |
| Patient primary diagnosis |
187 |
0.0088950 |
| Duration of previous hostial stay |
1 |
0.0082234 |
| Week of discharge |
1 |
0.0073195 |
| Number of intervention codes recorded during hospital
stay |
1 |
0.0068706 |
| Number of planned contacts with ambulatory care in the
previous year |
1 |
0.0058187 |
| Patient civil status |
4 |
0.0055297 |
| Number of diagnosis codes recorded during hospital
stay |
1 |
0.0048772 |
| Primary diagnosis during previous hospital stay |
128 |
0.0041403 |
| Weekday of discharge |
7 |
0.0039231 |
| Sex of patient |
1 |
0.0019593 |
| Number of hospital stays in the last year |
1 |
0.0018019 |
| Patient region of birth |
4 |
0.0013262 |
Detailed variable table
Note: Higher SHAP values indicate a marginal, linear association with
a higher likelihood of discharge to NH. Note that many ICD codes were
masked by the providers of the registry data to maintain patient
anonymity.
datatable(select(smd_matched,-Cohens_d))
Partial dependence plot
xgb.plot.shap(sm, model = propensity_xgb,top_n = 5)
SMD for all predictors
smd_matched %>%
ggplot(aes(x=Cohens_d,y=reorder(variable,Gain))) +
geom_point() +
theme(
axis.text.y = element_blank(),
axis.ticks.y = element_blank() )+
labs(y = "Parameter in propensity score model",
x = "Standardized Mean Difference")
Main analysis
Estimate models
if(file.exists("./cif.rda") & !reload){
load("./cif.rda")
load("./hr.rda")
}else{
cif <- list()
hr <- list()
cif$mort <- tidycmprsk::cuminc(Surv(ts_mort_days_itt,
as.factor(ts_mort_event_itt)) ~ disch_sabo,
cluster = lopnr,
d_eval)
cif$mort_prop <- tidycmprsk::cuminc(Surv(ts_mort_days_itt,
as.factor(ts_mort_event_itt)) ~ disch_sabo,
cluster = subclass,
m_data)
hr$mort7 <- coxph(Surv(ts_mort_days_itt_7,
ts_mort_event_itt_7) ~ disch_sabo,
cluster = lopnr,
data = d_eval)
hr$mort30 <- coxph(Surv(ts_mort_days_itt_30,
ts_mort_event_itt_30) ~ disch_sabo,
cluster = lopnr,
data = d_eval)
hr$mort90 <- coxph(Surv(ts_mort_days_itt,
ts_mort_event_itt) ~ disch_sabo,
cluster = lopnr,
data = d_eval)
hr$mort7_prop <- coxph(Surv(ts_mort_days_itt_7,
ts_mort_event_itt_7) ~ disch_sabo,
cluster = subclass,
data = m_data)
hr$mort30_prop <- coxph(Surv(ts_mort_days_itt_30,
ts_mort_event_itt_30) ~ disch_sabo,
cluster = subclass,
data = m_data)
hr$mort90_prop <- coxph(Surv(ts_mort_days_itt,
ts_mort_event_itt) ~ disch_sabo,
cluster = subclass,
data = m_data)
hr$mort7_dr <- coxph(Surv(ts_mort_days_itt_7,
ts_mort_event_itt_7) ~ disch_sabo +
mort7_pred,
cluster = subclass,
data = m_data)
hr$mort30_dr <- coxph(Surv(ts_mort_days_itt_30,
ts_mort_event_itt_30) ~ disch_sabo + mort30_pred,
cluster = subclass,
data = m_data)
hr$mort90_dr <- coxph(Surv(ts_mort_days_itt,
ts_mort_event_itt) ~ disch_sabo + mort90_pred,
cluster = subclass,
data = m_data)
## Readmission
cif$readmit <- tidycmprsk::cuminc(Surv(ts_readmit_days_itt,
ts_readmit_event_itt) ~ disch_sabo,
cluster = lopnr,
d_eval)
cif$readmit_prop <- tidycmprsk::cuminc(Surv(ts_readmit_days_itt,
ts_readmit_event_itt) ~ disch_sabo,
cluster = subclass,
m_data)
# cif$readmit_prop_dr <- tidycmprsk::cuminc(Surv(ts_readmit_days_itt,
# as.numeric(ts_readmit_event_itt)) ~ disch_sabo + readmit30_pred,
# cluster = subclass,
# m_data)
library(fastcmprsk)
hr$readmit7 <- fastCrr(Crisk(ts_readmit_days_itt_7,ts_readmit_event_itt_7,
failcode = "Readmission",
cencode = "Censored") ~ disch_sabo,
data = d_eval)
hr$readmit30 <- fastCrr(Crisk(ts_readmit_days_itt_30,ts_readmit_event_itt_30,
failcode = "Readmission",
cencode = "Censored") ~ disch_sabo,
data = d_eval)
hr$readmit90 <- fastCrr(Crisk(ts_readmit_days_itt,ts_readmit_event_itt,
failcode = "Readmission",
cencode = "Censored") ~ disch_sabo,
data = d_eval)
hr$readmit7_prop <- fastCrr(Crisk(ts_readmit_days_itt_7,ts_readmit_event_itt_7,
failcode = "Readmission",
cencode = "Censored") ~ disch_sabo,
data = m_data)
hr$readmit30_prop <- fastCrr(Crisk(ts_readmit_days_itt_30,ts_readmit_event_itt_30,
failcode = "Readmission",
cencode = "Censored") ~ disch_sabo,
data = m_data)
hr$readmit90_prop <- fastCrr(Crisk(ts_readmit_days_itt,ts_readmit_event_itt,
failcode = "Readmission",
cencode = "Censored") ~ disch_sabo,
data = m_data)
hr$readmit7_dr <- fastCrr(Crisk(ts_readmit_days_itt_7,ts_readmit_event_itt_7,
failcode = "Readmission",
cencode = "Censored") ~ disch_sabo + readmit7_pred,
data = m_data)
hr$readmit30_dr <- fastCrr(Crisk(ts_readmit_days_itt_30,ts_readmit_event_itt_30,
failcode = "Readmission",
cencode = "Censored") ~ disch_sabo + readmit30_pred,
data = m_data)
hr$readmit90_dr <- fastCrr(Crisk(ts_readmit_days_itt,ts_readmit_event_itt,
failcode = "Readmission",
cencode = "Censored") ~ disch_sabo + readmit90_pred,
data = m_data)
# Composite outcome
cif$any <- tidycmprsk::cuminc(Surv(ts_any_days_itt,
as.factor(ts_any_event_itt)) ~ disch_sabo,
cluster = lopnr,
d_eval)
cif$any_prop <- tidycmprsk::cuminc(Surv(ts_any_days_itt,
as.factor(ts_any_event_itt)) ~ disch_sabo,
cluster = subclass,
m_data)
hr$any7 <- coxph(Surv(ts_any_days_itt_7,
ts_any_event_itt_7) ~ disch_sabo,
cluster = lopnr,
data = d_eval)
hr$any30 <- coxph(Surv(ts_any_days_itt_30,
ts_any_event_itt_30) ~ disch_sabo,
cluster = lopnr,
data = d_eval)
hr$any90 <- coxph(Surv(ts_any_days_itt,
ts_any_event_itt) ~ disch_sabo,
cluster = lopnr,
data = d_eval)
hr$any7_prop <- coxph(Surv(ts_any_days_itt_7,
ts_any_event_itt_7) ~ disch_sabo,
cluster = subclass,
data = m_data)
hr$any30_prop <- coxph(Surv(ts_any_days_itt_30,
ts_any_event_itt_30) ~ disch_sabo,
cluster = subclass,
data = m_data)
hr$any90_prop <- coxph(Surv(ts_any_days_itt,
ts_any_event_itt) ~ disch_sabo,
cluster = subclass,
data = m_data)
hr$any7_dr <- coxph(Surv(ts_any_days_itt_7,
ts_any_event_itt_7) ~ disch_sabo +
any7_pred,
cluster = subclass,
data = m_data)
hr$any30_dr <- coxph(Surv(ts_any_days_itt_30,
ts_any_event_itt_30) ~ disch_sabo + any30_pred,
cluster = subclass,
data = m_data)
hr$any90_dr <- coxph(Surv(ts_any_days_itt,
ts_any_event_itt) ~ disch_sabo + any90_pred,
cluster = subclass,
data = m_data)
save(cif,file = "./cif.rda")
save(hr,file = "./hr.rda")
}
Plot cumulative incidence curves
cif$mort %>%
ggcuminc(outcome = "TRUE") +
add_confidence_interval() +
labs(y = "Mortality cumulative incidence (raw)",
x = "Days since discharge") +
scale_color_manual(values = c("red", "blue")) +
scale_fill_manual(values = c("red", "blue")) +
geom_vline(xintercept = c(7,30,90))
cif$mort_prop %>%
ggcuminc(outcome = "TRUE") +
add_confidence_interval() +
labs(y = "Mortality cumulative incidence (matched)",
x = "Days since discharge") +
scale_color_manual(values = c("red", "blue")) +
scale_fill_manual(values = c("red", "blue")) +
geom_vline(xintercept = c(7,30,90))
cif$readmit %>%
ggcuminc(outcome = "Readmission") +
add_confidence_interval() +
labs(y = "Readmission cumulative incidence (raw)",
x = "Days since discharge") +
scale_color_manual(values = c("red", "blue")) +
scale_fill_manual(values = c("red", "blue")) +
geom_vline(xintercept = c(7,30,90))
cif$readmit_prop %>%
ggcuminc(outcome = "Readmission") +
add_confidence_interval() +
labs(y = "Readmission cumulative incidence (matched)",
x = "Days since discharge") +
scale_color_manual(values = c("red", "blue")) +
scale_fill_manual(values = c("red", "blue")) +
geom_vline(xintercept = c(7,30,90))
cif$any %>%
ggcuminc(outcome = "TRUE") +
add_confidence_interval() +
labs(y = "Composite cumulative incidence (raw)",
x = "Days since discharge") +
scale_color_manual(values = c("red", "blue")) +
scale_fill_manual(values = c("red", "blue")) +
geom_vline(xintercept = c(7,30,90))
cif$any_prop %>%
ggcuminc(outcome = "TRUE") +
add_confidence_interval() +
labs(y = "Composite cumulative incidence (matched)",
x = "Days since discharge") +
scale_color_manual(values = c("red", "blue")) +
scale_fill_manual(values = c("red", "blue")) +
geom_vline(xintercept = c(7,30,90))
Hazard ratio table
paste_cox_ci <- function(mod,r=3){
paste0(round(exp(coef(mod)["disch_sabo"]),r), " (",
round(exp(confint(mod)["disch_sabo",1]),r),"-",
round(exp(confint(mod)["disch_sabo",2]),r),")")
}
paste_crr_ci <- function(mod,r=3){
ci <- confint(mod)
if(first(class(ci)) == "matrix"){
ci <- ci[1,]
}
paste0(round(exp(coef(mod)[1]),r), " (",
round(exp(ci[1]),r),"-",
round(exp(ci[2]),r),")")
}
if(file.exists("./outcome_table.rda") & !reload){
load("./outcome_table.rda")
}else{
raw <- data.frame("raw" = c(paste_cox_ci(hr$mort7),
paste_cox_ci(hr$mort30),
paste_cox_ci(hr$mort90),
paste_crr_ci(hr$readmit7),
paste_crr_ci(hr$readmit30),
paste_crr_ci(hr$readmit90),
paste_crr_ci(hr$any7),
paste_crr_ci(hr$any30),
paste_crr_ci(hr$any90)))
matched <- data.frame("matched" = c(paste_cox_ci(hr$mort7_prop),
paste_cox_ci(hr$mort30_prop),
paste_cox_ci(hr$mort90_prop),
paste_crr_ci(hr$readmit7_prop),
paste_crr_ci(hr$readmit30_prop),
paste_crr_ci(hr$readmit90_prop),
paste_crr_ci(hr$any7_prop),
paste_crr_ci(hr$any30_prop),
paste_crr_ci(hr$any90_prop)))
doublerobust <- data.frame("doublerobust" = c(paste_cox_ci(hr$mort7_dr),
paste_cox_ci(hr$mort30_dr),
paste_cox_ci(hr$mort90_dr),
paste_crr_ci(hr$readmit7_dr),
paste_crr_ci(hr$readmit30_dr),
paste_crr_ci(hr$readmit90_dr),
paste_crr_ci(hr$any7_dr),
paste_crr_ci(hr$any30_dr),
paste_crr_ci(hr$any90_dr)))
outcome_table <- data.frame("outcome" = c(rep("Mortality",3),
rep("Readmission",3),
rep("Composite",3)),
"Time" = c(rep(c("7","30","90"),3))) %>%
bind_cols(raw) %>%
bind_cols(matched) %>%
bind_cols(doublerobust)
save(outcome_table,file = "./outcome_table.rda")
}
kable(outcome_table)
| Mortality |
7 |
1.423 (1.321-1.533) |
0.928 (0.817-1.053) |
0.917 (0.806-1.044) |
| Mortality |
30 |
1.806 (1.75-1.864) |
1.336 (1.263-1.413) |
1.319 (1.244-1.398) |
| Mortality |
90 |
1.794 (1.756-1.832) |
1.542 (1.487-1.599) |
1.538 (1.481-1.598) |
| Readmission |
7 |
0.509 (0.493-0.526) |
0.649 (0.612-0.689) |
0.643 (0.605-0.682) |
| Readmission |
30 |
0.585 (0.574-0.596) |
0.784 (0.754-0.816) |
0.765 (0.736-0.796) |
| Readmission |
90 |
0.628 (0.618-0.638) |
0.871 (0.847-0.896) |
0.846 (0.823-0.868) |
| Composite |
7 |
0.587 (0.569-0.607) |
0.703 (0.665-0.743) |
0.694 (0.657-0.735) |
| Composite |
30 |
0.758 (0.744-0.771) |
0.94 (0.911-0.97) |
0.916 (0.887-0.945) |
| Composite |
90 |
0.853 (0.841-0.864) |
1.09 (1.065-1.116) |
1.05 (1.025-1.075) |