A sensitivity analysis for nonrandomly missing categorical data arising from a national health disability survey

• Published in: Biostatistics (Oxford, England) Vol. 4; no. 1; pp. 41 - 56
• Main Author: Baker, S. G.
• Format: Journal Article
• Language: English
• Published: England Oxford Publishing Limited (England) 01.01.2003
• Subjects: Adult; Depression - epidemiology; Depression - etiology; Female; Health Surveys; Humans; Male; Models, Statistical; National Center for Health Statistics (U.S.); Postural Balance - physiology; Surveys and Questionnaires; United States; United States
• ISSN: 1465-4644; 1468-4357
• DOI: 10.1093/biostatistics/4.1.41

Using data from 145,007 adults in the Disability Supplement to the National Health Interview Survey, we investigated the effect of balance difficulties on frequent depression after controlling for age, gender, race, and other baseline health status information. There were two major complications: (i) 80% of subjects were missing data on depression and the missing-data mechanism was likely related to depression, and (ii) the data arose from a complex sample survey. To adjust for (i) we investigated three classes of models: missingness in depression, missingness in depression and balance, and missingness in depression with an auxiliary variable. To adjust for (ii) we developed the first linearization variance formula for nonignorable missing-data models. Our sensitivity analysis was based on fitting a range of ignorable missing-data models along with nonignorable missing-data models that added one or two parameters. All nonignorable missing-data models that we considered fit the data substantially better than their ignorable missing-data counterparts. Under an ignorable missing-data mechanism, the odds ratio for the association between balance and depression was 2.0 with a 95% CI of (1.8, 2.2). Under 29 of the 30 selected nonignorable missing-data models, the odds ratios ranged from 2.7 with 95% CI of (2.3, 3.1) to 4.2 with 95% CI of (3.9, 4.6). Under one nonignorable missing-data model, the odds ratio was 7.4 with 95% CI of (6.3, 8.6). This is the first analysis to find a strong association between balance difficulties and frequent depression.