A dynamic trajectory class model for intensive longitudinal categorical outcome

This paper presents a novel dynamic latent class model for a longitudinal response that is frequently measured as in our prospective study of older adults with monthly data on activities of daily living for more than 10 years. The proposed method is especially useful when the longitudinal response is measured much more frequently than other relevant covariates. The trajectory classes are latent classes that represent distinct temporal patterns of the longitudinal response wherein an individual may remain in a trajectory class or switch to another as the class membership predictors are updated periodically over time. The identification of a common set of trajectory classes allows changes among the temporal patterns to be distinguished from local fluctuations in the response. Within a trajectory class, the longitudinal response is modeled by a class-specific generalized linear mixed model. An informative event such as death is jointly modeled by class-specific probability of the event through shared random effects with that for the longitudinal response. We do not impose the conditional independence assumption given the classes. We illustrate the method by analyzing the change over time in activities of daily living trajectory class among 754 older adults with 70,500 person-months of follow-up in the Precipitating Events Project. We also investigate the impact of jointly modeling the class-specific probability of the event on the parameter estimates in a simulation study. The primary contribution of our paper is the periodic updating of trajectory classes for a longitudinal categorical response without assuming conditional independence.