A comparison of the Cox model to the Fine-Gray model for survival analyses of re-fracture rates
| Autor: | Huei-Yang Chen, Erin K Nolan |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
Male Osteoporosis 030209 endocrinology & metabolism Kaplan-Meier Estimate Risk Assessment 03 medical and health sciences 0302 clinical medicine Recurrence Risk Factors Covariate Medicine Humans Orthopedics and Sports Medicine Cumulative incidence Survival analysis Proportional Hazards Models Aged 80 and over business.industry Proportional hazards model Incidence (epidemiology) Incidence Hazard ratio medicine.disease Survival Analysis Cohort Female 030101 anatomy & morphology business Osteoporotic Fractures Demography |
| Zdroj: | Archives of osteoporosis. 15(1) |
| ISSN: | 1862-3514 |
| Popis: | We compared the Cox model with the Fine-Gray model when assessing the risk of low-trauma re-fractures. The risk of re-fracture was consistently higher when using the Cox model compared with the Fine-Gray model. The Fine-Gray model more accurately assesses the risk of re-fracture when a competing risk is present. Compared with the Kaplan-Meier and Cox model, the Fine-Gray competing risk model was developed to take competing risks into account, which provides a better estimation for the risk of the main outcome of interest when one or more competing risks are presented. To date, it remains underused. This study aims to use a case study to illustrate why and how the Fine-Gray model should be used and interpreted, especially when a competing risk is present. Using a cohort of patients who presented to a NSW hospital with a non-trauma-related fracture between 2013/2014 and 2017/2018, the cumulative incidence and rate of re-fracture were estimated by the Kaplan-Meier and the Cox model, and by the Fine-Gray model when deaths present as competing events. The cumulative incidence of re-fracture at day 1825 (5 years) was 20.7% when using the Kaplan-Meier model and was 17.7% when using the Fine-Gray model. The estimations of cumulative incidence or rate of re-fracture were consistently higher by traditional survival analyses (Kaplan-Meier or Cox) compared with the Fine-Gray model. For patients aged 90 years and older, the re-fracture incidence at year 5 was estimated to be 66% vs. 28% whereas patients with a history of osteoporosis were 44% vs. 31%. Similarly, compared with patients without osteoporosis history, the estimated re-fracture rate for those with osteoporosis was 9.2 times higher by the Cox model but only 2.6 times higher by the Fine-Gray model. The Fine-Gray model more accurately estimates the cumulative incidence of re-fracture and the effect of covariates on the hazard rate than the Kaplan-Meier and Cox models in the presence of a competing risk. This accuracy improves the larger the rate of a competing event. |
| Databáze: | OpenAIRE |
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