Use an irreversible continuous-time multi-state model , with state 3 absorbing. Let and , and define log-linear age effects byFor a closed-form panel-observed multi-state likelihood, freeze the age covariate at the start of each observation interval. The transition intensities are then over the first interval and over the second. Conditional on the initial state, the likelihood contribution isIndeed, and . In this irreversible continuous-time Markov chain, the intermediate state has probabilityThe second expression is the continuous limit of the first and handles equal rates. The observed two-state jump across an interval is compatible with adjacent instantaneous transitions: an unobserved visit to state 2 occurs between the examinations.
The four-parameter panel-observed multi-state likelihood requires the following additional assumptions.
- Irreversibility: the chronic disease can progress but cannot improve, so and state 3 is absorbing. Merely permitting transitions between adjacent states does not impose this; allowing regression would require additional transition intensities.
- Piecewise-constant age: the current age is held at 50 and 55 over the respective observation intervals. Actual age changes continuously, and a five-year interval can be too long for this approximation when the age effect is substantial.
- Log-linear age effects and common rates: the specified age functions apply to the patient, without unmodelled heterogeneity or other changing covariates.
- Observation mechanism: disease states are recorded without misclassification, and examination times or dropout carry no additional information about the underlying process once the modelled history is given. A new visit only one year after a five-year gap might have been prompted by worsening symptoms, making the observation schedule informative.
If age is instead updated continuously, the model is time-inhomogeneous and the displayed homogeneous transition formula is not exact. For example, setThen the exact irreversible likelihood contribution isThus the simple closed form uses an explicit frozen-age approximation; adjacency alone and continuously evolving age do not determine that form.
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