Competing risks in epidemiology: possibilities and pitfalls

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ID: 301763
2012
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Abstract
Background In studies of all-cause mortality, the fundamental epidemiological concepts of rate and risk are connected through a well-defined one-to-one relation.An important consequence of this relation is that regression models such as the proportional hazards model that are defined through the hazard (the rate) immediately dictate how the covariates relate to the survival function (the risk). MethodsThis introductory paper reviews the concepts of rate and risk and their one-to-one relation in all-cause mortality studies and introduces the analogous concepts of rate and risk in the context of competing risks, the cause-specific hazard and the cause-specific cumulative incidence function. ResultsThe key feature of competing risks is that the one-to-one correspondence between cause-specific hazard and cumulative incidence, between rate and risk, is lost.This fact has two important implications.First, the naı ¨ve Kaplan-Meier that takes the competing events as censored observations, is biased.Secondly, the way in which covariates are associated with the cause-specific hazards may not coincide with the way these covariates are associated with the cumulative incidence.An example with relapse and non-relapse mortality as competing risks in a stem cell transplantation study is used for illustration.Conclusion The two implications of the loss of one-to-one correspondence between cause-specific hazard and cumulative incidence should be kept in mind when deciding on how to make inference in a competing risks situation.
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openalex_W2154117702 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Per Kragh Andersen, Ronald B. Geskus, Théo de Witte, Hein Putter
Journal International Journal of Epidemiology
Year 2012
DOI
10.1093/ije/dyr213
URL
https://academic.oup.com/ije/article-pdf/41/3/861/18481551/dyr213.pdf
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