Multiple imputation for analysis of incomplete data in distributed health data networks

Distributed health data networks (DHDNs) leverage data from multiple sources or sites such as electronic health records (EHRs) from multiple healthcare systems and have drawn increasing interests in recent years, as they do not require sharing of subject-level data and hence lower the hurdles for collaboration between institutions considerably. However, DHDNs face a number of challenges in data analysis, particularly in the presence of missing data. The current state-of-the-art methods for handling incomplete data require pooling data into a central repository before analysis, which is not feasible in DHDNs. In this paper, we address the missing data problem in distributed environments such as DHDNs that has not been investigated previously. We develop communication-efficient distributed multiple imputation methods for incomplete data that are horizontally partitioned. Since subject-level data are not shared or transferred outside of each site in the proposed methods, they enhance protection of patient privacy and have the potential to strengthen public trust in analysis of sensitive health data. We investigate, through extensive simulation studies, the performance of these methods. Our methods are applied to the analysis of an acute stroke dataset collected from multiple hospitals, mimicking a DHDN where health data are horizontally partitioned across hospitals and subject-level data cannot be shared or sent to a central data repository.