In clinical and observational studies, recurrent event data (e.g. hospitalization) with a terminal event (e.g. death) are often encountered. In many instances, the terminal event is strongly correlated with the recurrent event process. In this article, we propose a semiparametric method to jointly model the recurrent and terminal event processes. The dependence is modeled by a shared gamma frailty that is included in both the recurrent event rate and terminal event hazard function. Marginal models are used to estimate the regression effects on the terminal and recurrent event processes and a Poisson model is used to estimate the dispersion of the frailty variable. A sandwich estimator is used to achieve additional robustness. An analysis of hospitalization data for patients in the peritoneal dialysis study is presented to illustrate the proposed method.
Ye, Yining; Kalbfleisch, Jack; and Schaubel, Doug E., "Semiparametric Analysis for Correlated Recurrent and Terminal Events" (March 2006). The University of Michigan Department of Biostatistics Working Paper Series. Working Paper 57.