Comparing estimation approaches for the illness-death model under left truncation and right censoring

Bella Vakulenko-Lagun, Micha Mandel

Research output: Contribution to journalArticlepeer-review


Left-truncated data arise when lifetimes are observed only if they are larger than independent truncation times. For example, in a cross-sectional sampling, only individuals who live long enough to be present on the sampling day are observed. There are several ways to perform statistical inference under this setting. One can do the following: (i) use an unconditional approach, (ii) condition on the value of the truncation variable, or (iii) condition on all the history up to the time of truncation. The latter two approaches are equivalent when analyzing univariate survival outcomes but differ under the multi-state framework. In this paper, we consider the illness-death model and compare between the three estimation approaches in a parametric regression framework. We show that approach (ii) is more efficient than the standard approach (iii), although it requires more computational effort. Approach (i) is the most efficient approach, but it requires knowledge on the distribution of the truncation variable and hence is less robust. The methods are compared using a theoretical example and simulations and are applied to intensive care units data collected in a cross-sectional design, where the illness state corresponds to a bloodstream infection.

Original languageEnglish
Pages (from-to)1533-1548
Number of pages16
JournalStatistics in Medicine
Issue number9
StatePublished - 30 Apr 2016
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2016 John Wiley & Sons, Ltd.


  • Conditional likelihood
  • Cross-sectional sampling
  • Length bias
  • Uniform truncation

ASJC Scopus subject areas

  • Epidemiology
  • Statistics and Probability


Dive into the research topics of 'Comparing estimation approaches for the illness-death model under left truncation and right censoring'. Together they form a unique fingerprint.

Cite this