Kaplan–Meier survival analysis overestimates cumulative incidence of health-related events in competing risk settings: a meta-analysis

Lacny, Sarah; Wilson, Todd; Clement, Fiona; Roberts, Derek J.; Faris, Peter; Ghali, William A.; Marshall, Deborah A.

doi:10.1016/j.jclinepi.2017.10.006

Cited by 72 publications

(56 citation statements)

References 50 publications

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“…This is F I G U R E 1 Cumulative incidence of first recurrence of ischemic stroke or TIA considerably lower compared with a meta-analysis from 2011, which estimated a pooled cumulative risk of 11.1% at 1 year and 26.4% at 5 years. 15 Recent studies adjusting for competing risk of death have reported 1-and 5-year incidences of recurrence of 3.6%-7.7% and 10.1%-16.8%. 2,3 Furthermore, optimal use of secondary prevention strategies has shown a significant reduction in the absolute risk of recurrence.…”

Section: Discussion/con Clus Ionmentioning

confidence: 99%

“…The Kaplan-Meier survival analysis may overestimate the cumulative incidence of recurrence since death is not treated as a competing risk. 15 Recent studies adjusting for competing risk of death have reported 1-and 5-year incidences of recurrence of 3.6%-7.7% and 10.1%-16.8%. [16][17][18][19] Our results are thus supporting newer data from several other populations.…”

Section: Discussion/con Clus Ionmentioning

confidence: 99%

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Recurrent ischemic stroke: Incidence, predictors, and impact on mortality

et al. 2019

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Background and purpose Recurrent ischemic stroke (IS) or TIA is frequent with a considerable variation in incidence and mortality across populations. Current data on stroke recurrence and mortality are useful to examine trends, risk factors, and treatment effects. In this study, we calculated the incidence of recurrent IS or TIA in a hospital‐based stroke population in Western Norway, investigated recurrence factors, and estimated the effect of recurrence on all‐cause mortality. Methods This prospective cohort study registered recurrence and mortality among 1872 IS and TIA survivors admitted to the stroke unit at Haukeland University Hospital between July 2007 and December 2013. Recurrence and death until September 1, 2016, were identified by medical chart review. Cumulative incidences of recurrence were estimated with a competing risks Cox model. Multivariate Cox models were used to examine recurrence factors and mortality. Results During follow‐up, 220 patients had 277 recurrent IS or TIAs. The cumulative recurrence rate was 5.4% at 1 year, 11.3% at 5 years, and 14.2% at the end of follow‐up. Hypertension (HR = 1.65, 95% CI 1.21‐2.25), prior symptomatic stroke (HR = 1.63, 95% CI 1.18‐2.24), chronic infarcts on MRI (HR = 1.48, 95% CI 1.10‐1.99), and age (HR 1.02/year, 95% CI 1.00‐1.03) were independently associated with recurrence. A total of 668 (35.7%) patients died during follow‐up. Recurrence significantly increased the all‐cause mortality (HR = 2.55, 95% CI 2.04‐3.18). Conclusions The risk of recurrent IS stroke or TIA was modest in our population and was associated with previously established risk factors. Recurrence more than doubled the all‐cause mortality.

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Section: Discussion/con Clus Ionmentioning

confidence: 99%

Section: Discussion/con Clus Ionmentioning

confidence: 99%

Recurrent ischemic stroke: Incidence, predictors, and impact on mortality

et al. 2019

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“…From other wearable sensors studies in PD populations, we learned that compliance with sensor usage is on average 68% . Fourth, we acknowledge that the Kaplan‐Meier analysis may overestimate the cumulative incidence in the setting of competing risks . For example, when studying falls in PD, the use of medications that induce hypotension (eg, a competing risk) is an event that competes with the event of interest.…”

Section: Discussionmentioning

confidence: 99%

“…38,39 Fourth, we acknowledge that the Kaplan-Meier analysis may overestimate the cumulative incidence in the setting of competing risks. 40 For example, when studying falls in PD, the use of medications that induce hypotension (eg, a competing risk) is an event that competes with the event of interest. Our analyses were performed in a service-generated dataset without information on medication or other competing risks for falls.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Home‐Based Monitoring of Falls Using Wearable Sensors in Parkinson's Disease

et al. 2019

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Introduction Falling is among the most serious clinical problems in Parkinson's disease (PD). We used body‐worn sensors (falls detector worn as a necklace) to quantify the hazard ratio of falls in PD patients in real life. Methods We matched all 2063 elderly individuals with self‐reported PD to 2063 elderly individuals without PD based on age, gender, comorbidity, and living conditions. We analyzed fall events collected at home via a wearable sensor. Fall events were collected either automatically using the wearable falls detector or were registered by a button push on the same device. We extracted fall events from a 2.5‐year window, with an average follow‐up of 1.1 years. All falls included were confirmed immediately by a subsequent telephone call. The outcomes evaluated were (1) incidence rate of any fall, (2) incidence rate of a new fall after enrollment (ie, hazard ratio), and (3) 1‐year cumulative incidence of falling. Results The incidence rate of any fall was higher among self‐reported PD patients than controls (2.1 vs. 0.7 falls/person, respectively; P < .0001). The incidence rate of a new fall after enrollment (ie, hazard ratio) was 1.8 times higher for self‐reported PD patients than controls (95% confidence interval, 1.6–2.0). Conclusion Having PD nearly doubles the incidence of falling in real life. These findings highlight PD as a prime “falling disease.” The results also point to the feasibility of using body‐worn sensors to monitor falls in daily life. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

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“…However, use of these two new indices in other populations will depend on the quality of the available administrative and clinical registry data. Competing Risks: JCE has published several articles on using the correct methods on competing risks [3,4] Competing risk bias has been well known for many years wherever there is comorbidity. Before the Global Burden of Disease project [5] sorted this out, the total deaths claimed were greater than the total number of susceptible individuals; where deaths occur due a combination on malnutrition and a clinical condition such as malaria or diarrhoea both the nutritionists and malariologist/ diarrhoea specialists separately claimed the same death in constructing the burden of disease, so they could each argue for priority in the funding of programs.…”

mentioning

confidence: 99%