Competing risk models to estimate the excess mortality and the first recurrent-event hazards.Report as inadecuate

Competing risk models to estimate the excess mortality and the first recurrent-event hazards. - Download this document for free, or read online. Document in PDF available to download.

* Corresponding author 1 Service de Biostatistiques Lyon 2 LBBE - Laboratoire de Biométrie et Biologie Evolutive 3 Département des maladies chroniques et traumatismes 4 Cancers et Populations : Facteurs de Risque, Depistage, Pratiques Diagnostiques et Therapeutiques 5 LNC - Lipides - Nutrition - Cancer U866 6 LERTIM - Laboratoire d-Enseignement et de Recherche sur le Traitement de l-Information Médicale

Abstract : BACKGROUND: In medical research, one common competing risks situation is the study of different types of events, such as disease recurrence and death. We focused on that situation but considered death under two aspects: -expected death- and -excess death-, the latter could be directly or indirectly associated with the disease. METHODS: The excess hazard method allows estimating an excess mortality hazard using the population expected mortality hazard. We propose models combining the competing risks approach and the excess hazard method. These models are based on a joint modelling of each event-specific hazard, including the event-free excess death hazard. The proposed models are parsimonious, allow time-dependent hazard ratios, and facilitate comparisons between event-specific hazards and between covariate effects on different events. In a simulation study, we assessed the performance of the estimators and showed their good properties with different drop-out censoring rates and different sample sizes. RESULTS: We analyzed a population-based dataset on French colon cancer patients who have undergone curative surgery. Considering three competing events local recurrence, distant metastasis, and death, we showed that the recurrence-free excess mortality hazard reached zero six months after treatment. Covariates sex, age, and cancer stage had the same effects on local recurrence and distant metastasis but a different effect on excess mortality. CONCLUSIONS: The proposed models consider the excess mortality within the framework of competing risks. Moreover, the joint estimation of the parameters allow i direct comparisons between covariate effects, and ii fitting models with common parameters to obtain more parsimonious models and more efficient parameter estimators.

Keywords : Excess hazard Competing risks Time-dependent hazard ratio Regression splines Cancer Population-based study

Author: Aurélien Belot - Laurent Remontet - Guy Launoy - Valérie Jooste - Roch Giorgi -



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