Diagnostic Plots for Assessing the Frailty Distribution in Multivariate Survival Data

In biomedical studies, frailty models arecommonly used in analyzing multivariate survival data, wherethe objective of the study is to estimate both the covariateeffect and the dependence between the multivariate survival times.However, inference based on these models are dependent on thedistributional assumption of frailty. We propose a diagnosticplot for assessing the frailty assumption. The proposed methodis based on the cross-ratio function and the diagnostic plotsuggested by Oakes (1989). We use kernel regression smoothingwith bandwidth choice by cross-validation, to obtain the proposedplot. The resulting plot is capable of differentiating betweenthe gamma and positive stable frailty models when strong associationis present. We illustrate the feasibility of our method usingsimulation studies under known frailty distributions. The approachis applied to data on blindness for each eye of diabetic patientswith adult onset diabetes and a reasonable fit to the gamma frailtymodel is found.