Longitudinal data subject to irregular observation: A review of methods with a focus on visit processes, assumptions, and study design

Abstract

When data are collected longitudinally, measurement times often vary among patients. This is of particular concern in clinic-based studies, for example retrospective chart reviews. Here, typically no two patients will share the same set of measurement times and moreover, it is likely that the timing of the measurements is associated with disease course; for example, patients may visit more often when unwell. While there are statistical methods that can help overcome the resulting bias, these make assumptions about the nature of the dependence between visit times and outcome processes, and the assumptions differ across methods. The purpose of this paper is to review the methods available with a particular focus on how the assumptions made line up with visit processes encountered in practice. Through this we show that no one method can handle all plausible visit scenarios and suggest that careful analysis of the visit process should inform the choice of analytic method for the outcomes. Moreover, there are some commonly encountered visit scenarios that are not handled well by any method, and we make recommendations with regard to study design that would minimize the chances of these problematic visit scenarios arising.