Sequential Multiple Imputation for Real-World Health-Related Quality of Life Missing Data after Bariatric Surgery

Sun Sun, Nan Luo, Erik Stenberg, Lars Lindholm, Klas-Göran Sahlén, Karl A. Franklin and Yang Cao ()
Additional contact information
Sun Sun: Department of Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
Nan Luo: Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
Erik Stenberg: Department of Surgery, Faculty of Medicine and Health, Örebro University, 701 85 Örebro, Sweden
Lars Lindholm: Department of Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
Klas-Göran Sahlén: Department of Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
Karl A. Franklin: Department of Surgical and Perioperative Sciences, Surgery, Umeå University, 901 87 Umeå, Sweden
Yang Cao: Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, 701 82 Örebro, Sweden

IJERPH, 2022, vol. 19, issue 17, 1-16

Abstract: One of the main challenges for the successful implementation of health-related quality of life (HRQoL) assessments is missing data. The current study examined the feasibility and validity of a sequential multiple imputation (MI) method to deal with missing values in the longitudinal HRQoL data from the Scandinavian Obesity Surgery Registry. All patients in the SOReg who received bariatric surgery between 1 January 2011 and 31 March 2019 ( n = 47,653) were included for the descriptive analysis and missingness pattern exploration. The patients who had completed the short-form 36 (SF-36) at baseline (year 0), and one-, two-, and five-year follow-ups were included ( n = 3957) for the missingness pattern simulation and the sequential MI analysis. Eleven items of the SF-36 were selected to create the six domains of SF-6D, and the SF-6D utility index of each patient was calculated accordingly. The multiply-imputed variables in previous year were used as input to impute the missing values in later years. The performance of the sequential MI was evaluated by comparing the actual values with the imputed values of the selected SF-36 items and index at all four time points. At the baseline and year 1, where missing proportions were about 20% and 40%, respectively, there were no statistically significant discrepancies between the distributions of the actual and imputed responses (all p -values > 0.05). In year 2, where the missing proportion was about 60%, distributions of the actual and imputed responses were consistent in 9 of the 11 SF-36 items. However, in year 5, where the missing proportion was about 80%, no consistency was found between the actual and imputed responses in any of the SF-36 items. Relatively high missing proportions in HRQoL data are common in clinical registries, which brings a challenge to analyzing the HRQoL of longitudinal cohorts. The experimental sequential multiple imputation method adopted in the current study might be an ideal strategy for handling missing data (even though the follow-up survey had a missing proportion of 60%), avoiding significant information waste in the multivariate analysis. However, the imputations for data with higher missing proportions warrant more research.

Keywords: multiple imputations; health-related quality of life; SF-36; health utility; real-world data (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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