Abstract
BACKGROUND: The Fine-Gray subdistribution hazard model is frequently used in the cardiovascular literature to estimate subject-specific probabilities of the occurrence of an event of interest over time in the presence of competing risks. A little-known limitation of this approach is that, for some subjects and for some time points, the sum of the subject-specific probabilities for the different event types (eg, cardiovascular and noncardiovascular death) can exceed one. METHODS: We used data on 8238 patients hospitalized with congestive heart failure in Ontario, Canada. We fit 2 Fine-Gray subdistribution hazards models, one for cardiovascular death and one for noncardiovascular death and estimated the probability of death due to each cause within 5 years of hospital admission. We also fit 2 cause-specific hazard models for the 2 event types and combined the estimated cause-specific hazard functions to obtain subject-specific estimates of the probabilities of each of the 2 event types occurring within 5 years. RESULTS: When adding the probabilities of 5-year cardiovascular death and 5-year noncardiovascular death obtained from the Fine-Gray subdistribution hazard models, 8.6% of subjects had an estimated probability of 5-year all-cause mortality that exceeded 1 (100%). This problem was avoided by fitting 2 cause-specific hazard models, one for each outcome type, and combining the estimated cause-specific hazard functions to obtain subject-specific estimates of the risk of cardiovascular and noncardiovascular death. CONCLUSIONS: The Fine-Gray subdistribution hazard model may be problematic to use for a comprehensive assessment of absolute risks of multiple outcomes, while the combination of 2 cause-specific hazard models shows better statistical behaviour. Cause-specific modeling should not be discarded in competing risk situations.
| Original language | English |
|---|---|
| Article number | e008368 |
| Pages (from-to) | e008368 |
| Journal | Circulation: Cardiovascular Quality and Outcomes |
| Volume | 15 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - 1 Feb 2022 |
Bibliographical note
Funding Information:This research was supported by operating grant from the Canadian Institutes of Health Research (CIHR; PJT 166161). Dr Austin is supported in part by a Mid-Career Investigator award from the Heart and Stroke Foundation of Ontario.
Funding Information:
ICES is an independent, nonprofit research institute funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). As a prescribed entity under Ontario’s privacy legislation, ICES is authorized to collect and use health care data for the purposes of health system analysis, evaluation, and decision support. Secure access to these data is governed by policies and procedures that are approved by the Information and Privacy Commissioner of Ontario. The opinions, results, and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOH or MLTC is intended or should be inferred. Parts of this report are based on Ontario Registrar General (ORG) information on deaths, the original source of which is ServiceOntario. The views expressed therein are those of the author and do not necessarily reflect those of ORG or the Ministry of Government and Consumer Services. The data set from this study is held securely in coded form at ICES. While legal data sharing agreements between ICES and data providers (eg, health care organizations and government) prohibit ICES from making the dataset publicly available, access may be granted to those who meet prespecified criteria for confidential access, available at www.ices.on.ca/DAS (email: [email protected] ). The use of data in this project was authorized under section 45 of Ontario’s Personal Health Information Protection Act, which does not require review by a research ethics board.
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