Volume 40, Issue 17 pp. 3937-3952
RESEARCH ARTICLE

Multilevel modeling of spatially nested functional data: Spatiotemporal patterns of hospitalization rates in the US dialysis population

Yihao Li

Yihao Li

Department of Biostatistics, University of California, Los Angeles, California

Search for more papers by this author
Danh V. Nguyen

Danh V. Nguyen

Department of Medicine, UC Irvine School of Medicine, Orange, California

Search for more papers by this author
Sudipto Banerjee

Sudipto Banerjee

Department of Biostatistics, University of California, Los Angeles, California

Search for more papers by this author
Connie M. Rhee

Connie M. Rhee

Department of Medicine, UC Irvine School of Medicine, Orange, California

Search for more papers by this author
Kamyar Kalantar-Zadeh

Kamyar Kalantar-Zadeh

Department of Medicine, UC Irvine School of Medicine, Orange, California

Search for more papers by this author
Esra Kürüm

Esra Kürüm

Department of Statistics, University of California, Riverside, California

Search for more papers by this author
Damla Şentürk

Corresponding Author

Damla Şentürk

Department of Biostatistics, University of California, Los Angeles, California

Correspondence Damla Şentürk, Department of Biostatistics, University of California, Los Angeles, CA 90095, USA.

Email: [email protected]

Search for more papers by this author
First published: 26 April 2021
Citations: 4

Funding information: National Institute of Diabetes and Digestive and Kidney Diseases, K23 DK102903; R01 DK092232

Abstract

End-stage renal disease patients on dialysis experience frequent hospitalizations. In addition to known temporal patterns of hospitalizations over the life span on dialysis, where poor outcomes are typically exacerbated during the first year on dialysis, variations in hospitalizations among dialysis facilities across the US contribute to spatial variation. Utilizing national data from the United States Renal Data System (USRDS), we propose a novel multilevel spatiotemporal functional model to study spatiotemporal patterns of hospitalization rates among dialysis facilities. Hospitalization rates of dialysis facilities are considered as spatially nested functional data (FD) with longitudinal hospitalizations nested in dialysis facilities and dialysis facilities nested in geographic regions. A multilevel Karhunen-Loéve expansion is utilized to model the two-level (facility and region) FD, where spatial correlations are induced among region-specific principal component scores accounting for regional variation. A new efficient algorithm based on functional principal component analysis and Markov Chain Monte Carlo is proposed for estimation and inference. We report a novel application using USRDS data to characterize spatiotemporal patterns of hospitalization rates for over 400 health service areas across the US and over the posttransition time on dialysis. Finite sample performance of the proposed method is studied through simulations.

DATA AVAILABILITY STATEMENT

The release of the data used in this article is governed by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) through the USRDS Coordinating Center. The data can be requested from the USRDS through a data use agreement.

The full text of this article hosted at iucr.org is unavailable due to technical difficulties.