Fitting marginal accelerated failure time models to clustered survival data with potentially informative cluster size

Methods for analyzing clustered survival data are gaining popularity in biomedical research. Naive attempts to fitting marginal models to such data may lead to biased estimators and misleading inference when the size of a cluster is statistically correlated with some cluster specific latent factors or one or more cluster level covariates. A simple adjustment to correct for potentially informative cluster size is achieved through inverse cluster size reweighting. We give a methodology that incorporates this technique in fitting an accelerated failure time marginal model to clustered survival data. Furthermore, right censoring is handled by inverse probability of censoring reweighting through the use of a flexible model for the censoring hazard. The resulting methodology is examined through a thorough simulation study. Also an illustrative example using a real dataset is provided that examines the effects of age at enrollment and smoking on tooth survival. (C) 2011 Elsevier B.V. All rights reserved.