was for log of monthly income, and its value was .059, which tends to agree with the
covariate’s effect in model 1.
A fourth approach to the dependence problem is similar in spirit to the unob-
served-heterogeneity approach just discussed. However, instead of being fixed, the
heterogeneity term is modeled as a random variable and referred to as a frailty.
Frailty models account for a burgeoning literature within survival analysis (see, e.g.,
Aalen, 1994; Blossfeld and Hamerle, 1990; Blossfeld and Rohwer, 1995; Galler and
Poetter, 1990; Hosmer and Lemeshow, 1999; Klein and Moeschberger, 1997; Land
et al., 2001; McGilchrist and Aisbett, 1991) and are becoming more available in
mainstream software. When the frailty characterizes a group of observations, the
model is referred to as a shared-frailty model. In recurrent-event data, for example,
the shared-frailty model is applicable since each person contributes a group of obser-
vations to the data in the form of multiple episodes. The Cox shared-frailty model
for multiepisode data is (Klein and Moeschberger, 1997)
h
ie
(t) ⫽ h
0
(t ⫺ t
e⫺1
)υ
i
exp(x
ie
⬘
ββ
), (12.7)
where the frailty, υ
i
, is assumed to have some density with a mean of 1 and a vari-
ance of θ. The gamma density is often chosen for its mathematical tractability.
Frailties greater than 1 imply a greater hazard of event occurrence, net of covariates.
That is, these people are more “frail,” or susceptible to the event. Frailties less than
1 indicate greater resistance to the event, or longer survival times. The difference
between equations (12.5) and (12.7) is subtle but important. In equation (12.5), α
i
is
a fixed effect, whereas in equation (12.7), υ
i
is a random variable with some popu-
lation distribution. By “fixed effect” is meant that there is some finite set of α
i
in the
population that are constant values over repeated sampling. That is, each sample of
people is a sample from the same set of limited α
i
values, with the same value of α
characterizing potentially many people in the population. On the other hand, υ in
equation (12.7) is a random variable that is not fixed over repeated sampling, and
may in fact be unique to each person. The set, assumed to be infinite, of all possible
υ
i
in the population is represented by some distribution function.
Model 3 in Table 12.2 is the Cox shared-frailty model for the unemployment data,
assuming a gamma distribution for the frailties. The model was estimated using
STATA. The estimate of the frailty variance is .128 and is significantly different from
zero according to a likelihood-ratio test. It is therefore important to take account of
individual frailties in the model. That said, however, results are, again, not radically
altered compared to model 1, except that in model 3 the number of relatives in North
America no longer has a significant effect on the hazard.
A word of caution is in order regarding unobserved heterogeneity. In the Cox
model, the shape of the hazard function is ignored. However, in parametric models
that specify some form for the hazard, care must be exercised in interpreting the
effect of a hazard that appears to be declining over time. Unobserved heterogeneity,
if unaccounted for, can artificially generate a declining hazard. The reason is that
over time, the frailest people experience the event and drop out of the risk set. This
leaves a risk set that is composed increasingly of the most “resistant” individuals,
428 MULTISTATE, MULTIEPISODE, AND INTERVAL-CENSORED MODELS