Estimation and modeling of the restricted mean time lost in the presence of competing risks.

Estimation and modeling of the restricted mean time lost in the presence of competing risks.
复制标题

存在竞争风险时有限平均时间损失的估计和建模。

DOI:
10.1002/sim.8896
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发表时间:
2021-04
影响因子:
2
通讯作者:
Trinquart L
Trinquart L
中科院分区:
医学3区
文献类型:
--
作者:
Conner SC;Trinquart L

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具有竞争性或半竞争性风险的生存数据在观察性研究中很常见。作为原因特异性和亚分布风险比的替代方法,原因特异性限制性平均损失时间(RMTL)的组间差异给出了在预先指定的时间段内因特定死亡原因而损失的预期寿命或非致死性结局情况下的无病时间损失的平均差异。为了调整协变量,我们引入了一个逆概率加权估计及其方差的边际差RMTL。我们还介绍了一个逆概率截尾加权回归模型的RMTL。在模拟研究中,我们研究了比例和非比例子分布风险的情况下,所提出的方法的有限样本性能。我们用来自心脏病研究的竞争风险数据说明了这两种方法。我们估计了40年内无房颤(AF)时间损失的性别差异。我们还估计了AF患者10年内因心血管疾病(CVD)和非CVD死亡的平均寿命损失的性别差异。
Survival data with competing or semi-competing risks are common in observational studies. As an alternative to cause-specific and subdistribution hazard ratios, the between-group difference in cause-specific restricted mean times lost (RMTL) gives the mean difference in life expectancy lost to a specific cause of death or in disease-free time lost, in the case of a nonfatal outcome, over a pre-specified period. To adjust for covariates, we introduce an inverse probability weighted estimator and its variance for the marginal difference in RMTL. We also introduce an inverse probability of censoring weighted regression model for the RMTL. In simulation studies, we examined the finite sample performance of the proposed methods under proportional and nonproportional subdistribution hazards scenarios. We illustrated both methods with competing risks data from the Framingham Heart Study. We estimated sex differences in atrial fibrillation (AF)-free times lost over 40 years. We also estimated sex differences in mean lifetime lost to cardiovascular disease (CVD) and non-CVD death over 10 years among individuals with AF.
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