Actual and Actuarial Probabilities of Competing Risks: Apples and Lemons

Grunkemeier, Gary L.; Jin, Ruyun; Eijkemans, Marinus J.C.; Takkenberg, Johanna J.M.

doi:10.1016/j.athoracsur.2006.11.044

Cited by 77 publications

(64 citation statements)

References 27 publications

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“…13 Unlike glycemic control, cholesterol levels were significantly associated with mortality before ESRD as well as the competing outcome of ESRD itself. Although inference with respect to time-varying effects (of cholesterol) is problematic in the Fine-Gray paradigm, 14 this association is consistent with Figure 3. Cumulative incidence of pre-ESRD death increases with increasing age (A), total cholesterol levels (B), and increasing eGFR (C).…”

Section: Clinical Epidemiology Wwwjasnorgsupporting

confidence: 72%

“…2 That is, we limit our analysis to the consideration of two (competing) events: (the development of) ESRD and pre-ESRD deaths; deaths occurring after the development of ESRD are not considered in this analysis. The strength of the association between each predictor variable and the outcome was assessed using the subhazard ratio, 14 which is the ratio of hazards associated with the cumulative incidence function (CIF) in the presence of and in the absence of a prognostic factor. The peculiar advantage of the Fine-Gray approach is that ".…”

Section: Discussionmentioning

confidence: 99%

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Competing-Risk Analysis of ESRD and Death among Patients with Type 1 Diabetes and Macroalbuminuria

Forsblom

Harjutsalo

Thorn

et al. 2011

Journal of the American Society of Nephrology

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Patients with both type 1 diabetes and CKD have an increased risk of adverse outcomes. The competing risks of death and ESRD may confound the estimates of risk for each outcome. Here, we sought to determine the major predictors of the cumulative incidence of ESRD and pre-ESRD mortality in patients with type 1 diabetes and macroalbuminuria while incorporating the competing risk for the alternate outcome into a Fine-Gray competing-risks analysis. We followed 592 patients with macroalbuminuria for a median of 9.9 years. During this time, 56 (9.5%) patients died and 210 (35.5%) patients developed ESRD. Predictors of incident ESRD, taking baseline renal function and the competing risk for death into account, included an elevated HbA 1c , elevated LDL cholesterol, male sex, weight-adjusted insulin dose, and a shorter duration of diabetes. By contrast, predictors of pre-ESRD death, taking baseline renal function and the competing risk for ESRD into account, included only age, the presence of established macrovascular disease, and elevated cholesterol levels. This competing-risks approach has potential to highlight the appropriate targets and strategies for preventing premature mortality in patients with type 1 diabetes. 22: 537-544, 201122: 537-544, . doi: 10.1681 The presence of overt nephropathy in patients with type 1 diabetes from Finland is associated with an increased risk of premature mortality that is over nine times that observed in the age-gender matched general population. 1 A number of different factors potentially contribute to this risk, including poor glycemic control and dyslipidemia. Epidemiologic understanding of the role different factors may play in these adverse outcomes has potentially been limited by cause-specific analyses that fail to take into account competing risks. 2 In particular, in individuals with macroalbuminuria, the outcomes of death and ESRD have important competing effects. For example, analysis of the predictors of ESRD needs to take into account the risk of dying before ESRD. Equally, the consequence of analyzing the predictors of death while taking into account the (proximal) risk of ESRD effectively limits exposure time to the pre-ESRD milieu and "hastens" exposure to the different risks associated with renal replacement therapy. This kind of analysis may be best performed within the paradigm of a formal competing-risks (Fine-Gray) proportional-hazards regression model, which estimates the cumulative incidence of an outcome while accounting for the competing risks of an J Am Soc Nephrol

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Section: Clinical Epidemiology Wwwjasnorgsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Competing-Risk Analysis of ESRD and Death among Patients with Type 1 Diabetes and Macroalbuminuria

Forsblom

Harjutsalo

Thorn

et al. 2011

Journal of the American Society of Nephrology

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“…Because exit from the time at risk is a kind of informative censoring, the competing risks framework provides an unbiased estimate of the actual incidence of thrombosis, which would have otherwise been overestimated by actuarial methods such as Kaplan-Meier. 18 All the statistical analyses were done with Stata Version 10 (www.stata. com).…”

Section: Methodsmentioning

confidence: 99%

Observation versus antiplatelet therapy as primary prophylaxis for thrombosis in low-risk essential thrombocythemia

Alvarez‐Larrán

Cervantes

Pereira³

et al. 2010

Blood

207

154

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“…The predictors of the cumulative incidence of cardiovascular mortality, accounting for the competing event of non-cardiovascular death, were ascertained using a Fine and Gray model [25], which extends the Cox proportional hazards model to competing risks data by considering the subdistribution hazard [26]. The strength of the association between each predictor variable and the outcome was assessed using the subhazard ratio [27], which is the ratio of hazards associated with the cumulative incidence function (CIF) in the presence of and in the absence of a prognostic factor. Model selection from candidate variables was accomplished by minimisation of the Akaike's (AIC) and Bayesian information criteria (BIC).…”

Section: Study Samplementioning

confidence: 99%

Soluble receptor for AGE (RAGE) is a novel independent predictor of all-cause and cardiovascular mortality in type 1 diabetes

et al. 2011

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Aims/hypothesis Activation of the receptor for AGE (RAGE) is implicated in the development and progression of vascular complications of diabetes. In this study, we explore factors and mortality outcomes associated with soluble RAGE (sRAGE) in a multicentre nationwide cohort of Finnish adults with type 1 diabetes. Methods Baseline sRAGE concentrations were estimated in 3,100 adults with type 1 diabetes. Clinical and biological variables independently associated with sRAGE were identified using multivariate regression analysis. Independent predictors of mortality were determined using Cox and FineGray proportional-hazards models. Results The main independent determinants of sRAGE concentrations were estimated glomerular filtration rate, albuminuria, body mass index, age, duration of diabetes, HbA 1c and insulin dose (all p<0.05). During a median of 9.1 years of follow-up there were 202 deaths (7.4 per 1,000 patient years). sRAGE was independently associated with all-cause (Cox model: HR 1.03) and cardiovascular mortality (Fine-Gray competing risks model: HR 1.06) such that patients with the highest sRAGE concentrations had the greatest risk of mortality, after adjusting for age, sex, macrovascular disease, HDL-cholesterol, HbA 1c , triacylglycerol, high-sensitivity C-reactive protein (hsCRP) and the presence and severity of chronic kidney disease. Although polymorphisms in the gene coding for RAGE were significantly associated with sRAGE concentrations, none were associated with mortality outcomes. Conclusions/interpretation Increased concentrations of sRAGE are associated with increased all-cause and cardiovascular mortality in type 1 diabetes, potentially reflecting the activation and production of RAGE in the context of accelerated vascular disease. These novel findings highlight the importance of the RAGE activation in the prevention and management of diabetic complications.

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Actual and Actuarial Probabilities of Competing Risks: Apples and Lemons

Cited by 77 publications

References 27 publications

Competing-Risk Analysis of ESRD and Death among Patients with Type 1 Diabetes and Macroalbuminuria

Competing-Risk Analysis of ESRD and Death among Patients with Type 1 Diabetes and Macroalbuminuria

Observation versus antiplatelet therapy as primary prophylaxis for thrombosis in low-risk essential thrombocythemia

Soluble receptor for AGE (RAGE) is a novel independent predictor of all-cause and cardiovascular mortality in type 1 diabetes

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