Sensitivity analysis method in the presence of a missing not at random ordinal independent variable

TL;DR

This paper introduces a flexible sensitivity analysis method for handling missing not at random (MNAR) ordinal variables, demonstrated on trauma data, improving bias and precision over traditional methods.

Contribution

It extends existing sensitivity analysis techniques to MNAR ordinal variables, providing a practical approach for more accurate data analysis in medical research.

Findings

MNAR estimates are less biased than MAR estimates.

MNAR estimates have more precise confidence intervals.

Glasgow Coma Scale significance varies with missing data assumptions.

Abstract

Data analysis often encounters missing data, which can result in inaccurate conclusions, especially when it comes to ordinal variables. In trauma data, the Glasgow Coma Scale is useful for assessing the level of consciousness. This score is often missing in patients who are intubated or under sedation upon arrival at the hospital, and those with normal reactivity without head injury, suggesting a Missing Not At Random (MNAR) mechanism. The problem with MNAR is the absence of a definitive analysis. While sensitivity analysis is often recommended, practical limitations sometimes restrict the analysis to a basic comparison between results under Missing Completely At Random (MCAR) and Missing At Random (MAR) assumptions, disregarding MNAR plausibility. Our objective is to propose a flexible and accessible sensitivity analysis method in the presence of a MNAR ordinal independent variable. The method is inspired by the sensitivity analysis approach proposed by Leurent et al. (2018) for a continuous response variable. We propose an extension for an independent ordinal variable. The method is evaluated on simulated data before being applied to Pan-Canadian trauma data from April 2013 to March 2018. The simulation shows that MNAR estimates are less biased than MAR estimates and more precise than complete case analysis (CC) estimates. The confidence intervals coverage rates are relatively better for MNAR estimates than CC and MAR estimates. In the application, it is observed that the Glasgow Coma Scale is significant under MNAR, unlike MCAR and MAR assumptions.