Past exam of the mathematics course of the University of Cambridge / 2014 / iii / Paper 32 / 2 / c

Let $p_{rs}(t)=P(X(u+t)=s\mid X(u)=r)$ and $P(t)=e^{Qt}$, where time homogeneity removes dependence on $u$. A recorded state at the next clinic visit contributes a transition probability; an exactly observed death contributes a statistical probability density, not the probability of being dead at that time. If the last recorded living state is $r$, the mixed panel and exact-death likelihood factor after an interval $t$ isThis sums over the unobserved living state immediately before death.

Conditioning on the recorded initial states, the contribution of the three displayed patient histories isIn this irreversible illness-death model, $p_{21}=0$, $p_{11}(t)=e^{-(a+b)t}$ and $p_{22}(t)=e^{-ct}$, simplifying it toThe factor $c$ is essential: the death time is known exactly. Replacing the final statistical probability density by $p_{23}(34.6)$ would instead model interval observation of death and give a different likelihood.

The assumptions are independent patient histories with common rates; the Markov property; constant rates over calendar/follow-up time in this model; the stated absence of recovery and absorption at death; accurate state labels and death times; and an observation/follow-up mechanism that is noninformative for the latent process given the observed history. Clinic dates are conditioned on. The displayed living endpoints contribute only the shown observations, with noninformative right censoring if they are follow-up endpoints. Initial state probabilities are omitted by conditioning on them. Progression between visits can be unobserved, which is precisely why panel-observed multi-state likelihood uses the matrix exponential rather than assuming a transition occurs at a visit.