Modeling perinatal mortality in twins via generalized additive mixed models: a comparison of estimation approaches

BACKGROUND: The analysis of twin data presents a unique challenge. Second-born twins on average weigh less than first-born twins and have an elevated risk of perinatal mortality. It is not clear whether the risk difference depends on birth order or their relative birth weight. This study evaluates the association between birth order and perinatal mortality by birth order-specific weight difference in twin pregnancies. METHODS: We adopt generalized additive mixed models (GAMMs) which are a flexible version of generalized linear mixed models (GLMMs), to model the association. Estimation of such models for correlated binary data is challenging. We compare both Bayesian and likelihood-based approaches for estimating GAMMs via simulation. We apply the methods to the US matched multiple birth data to evaluate the association between twins’ birth order and perinatal mortality. RESULTS: Perinatal mortality depends on both birth order and relative birthweight. Simulation results suggest that the Bayesian method with half-Cauchy priors for variance components performs well in estimating all components of the GAMM. The Bayesian results were sensitive to prior specifications. CONCLUSION: We adopted a flexible statistical model, GAMM, to precisely estimate the perinatal mortality risk differences between first- and second-born twins whereby birthweight and gestational age are nonparametrically modelled to explicitly adjust for their effects. The risk of perinatal mortality in twins was found to depend on both birth order and relative birthweight. We demonstrated that the Bayesian method estimated the GAMM model components more reliably than the frequentist approaches.