Joint modelling of longitudinal ordinal and multi-state data.

Joint modeling of longitudinal and survival data is increasingly used in biomedical studies. However, existing joint models are not applicable to model the longitudinal ordinal responses with non-ignorable missing values caused by the occurrence of events in a multi-state process. In this article, we introduce a joint model for longitudinal ordinal measurements and multi-state data. Our proposed joint model consists of two sub-models: a proportional odds sub-model for longitudinal ordinal measurements and a multi-state sub-model with transition-specific proportional hazards for times of transitions between different health states, both linked by shared random effects. The model parameters were estimated employing the maximum likelihood method for a piecewise constant baseline hazard function. The proposed joint model is evaluated in a simulation study and, as an illustration, it is fitted to real data from people with human immunodeficiency virus.