Robustness of Generalized Estimating Equation (GEE) Tests of Significance against Misspecification of the Error Structure Model

Abstract Generalized linear model analyses of repeated measurements typically rely on simplifying mathematical models of the error covariance structure for testing the significance of differences in patterns of change across time. The robustness of the tests of significance depends, not only on the degree of agreement between the specified mathematical model and the actual population data structure, but also on the precision and robustness of the computational criteria for fitting the specified covariance structure to the data. Generalized estimating equation (GEE) solutions utilizing the robust empirical sandwich estimator for modeling of the error structure were compared with general linear mixed model (GLMM) solutions that utilized the commonly employed restricted maximum likelihood (REML) procedure. Under the conditions considered, the GEE and GLMM procedures were identical in assuming that the data are normally distributed and that the variance‐covariance structure of the data is the one specified by the user. The question addressed in this article concerns relative sensitivity of tests of significance for treatment effects to varying degrees of misspecification of the error covariance structure model when fitted by the alternative procedures. Simulated data that were subjected to monte carlo evaluation of actual Type I error and power of tests of the equal slopes hypothesis conformed to assumptions of ordinary linear model ANOVA for repeated measures except for autoregressive covariance structures and missing data due to dropouts. The actual within‐groups correlation structures of the simulated repeated measurements ranged from AR(1) to compound symmetry in graded steps, whereas the GEE and GLMM formulations restricted the respective error structure models to be either AR(1), compound symmetry (CS), or unstructured (UN). The GEE‐based tests utilizing empirical sandwich estimator criteria were documented to be relatively insensitive to misspecification of the covariance structure models, whereas GLMM tests which relied on restricted maximum likelihood (REML) were highly sensitive to relatively modest misspecification of the error correlation structure even though normality, variance homogeneity, and linearity were not an issue in the simulated data.Goodness‐of‐fit statistics were of little utility in identifying cases in which relatively minor misspecification of the GLMM error structure model resulted in inadequate alpha protection for tests of the equal slopes hypothesis. Both GEE and GLMM formulations that relied on unstructured (UN) error model specification produced nonconservative results regardless of the actual correlation structure of the repeated measurements. A random coefficients model produced robust tests with competitive power across all conditions examined. (© 2004 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)