Simulation shows undesirable results for competing risks analysis with time-dependent covariates for clinical outcomes

BMC Medical Research Methodology
Inga PoguntkeMartin Wolkewitz

Abstract

We evaluate three methods for competing risks analysis with time-dependent covariates in comparison with the corresponding methods with time-independent covariates. We used cause-specific hazard analysis and two summary approaches for in-hospital death: logistic regression and regression of the subdistribution hazard. We analysed real hospital data (n=1864) and considered pneumonia on admission / hospital-acquired pneumonia as time-independent / time-dependent covariates for the competing events 'discharge alive' and 'in-hospital death'. Several simulation studies with time-constant hazards were conducted. All approaches capture the effect of time-independent covariates, whereas the approaches perform differently with time-dependent covariates. The subdistribution approach for time-dependent covariates detected effects in a simulated no-effects setting and provided counter-intuitive effects in other settings. The extension of the Fine and Gray model to time-dependent covariates is in general not a helpful synthesis of the cause-specific hazards. Cause-specific hazard analysis and, for uncensored data, the odds ratio are capable of handling competing risks data with time-dependent covariates but the use of the subdistribution ap...Continue Reading

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Citations

Mar 7, 2020·The American Journal of Gastroenterology·Robert B HinesShunpu Zhang
Nov 5, 2019·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Hrishikesh S KulkarniRamsey R Hachem
Aug 22, 2020·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·X J LeeT M Wozniak
Apr 24, 2021·Frontiers in Cardiovascular Medicine·Sucharitha ChadalavadaSteffen E Petersen
Jul 16, 2021·BMC Medical Research Methodology·Hamid Reza MaratebMartin Wolkewitz
Feb 11, 2021·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Maddalena GiannellaUNKNOWN CRECOOLT study group

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