TY - JOUR
T1 - Competing risk adjustment reduces overestimation of opportunistic infection rates in AIDS
AU - Yan, Yan
AU - Moore, Richard D.
AU - Hoover, Donald R.
N1 - Funding Information:
This research was part of dissertation work when Yan was in Johns Hopkins School of Public Health, and Drs. Moore and Yan were supported by R01HS07809 (Agency for Health Care Policy and Research, USA) and by FDU-00097 (Federal Food and Drug Administration). Dr. Hoover was supported by R01DA113622/2 (National Institute of Drug Abuse). Special thanks to Ms. Amy Overbey for her language editing.
PY - 2000/8
Y1 - 2000/8
N2 - To illustrate the importance of adjusting the estimates of cumulative incidence of acquired immunodeficiency syndrome (AIDS) related illnesses for competing risk of other causes of death, we compared unadjusted and adjusted (for competing events) incidence estimates for four AIDS illnesses: pneumocystis cavinii pneumonia (PCP), mycobacterium avium complex (MAC), cytomegalovirus (CMV), and esophageal candidiases. The study population was patients followed by the Johns Hopkins Hospital AIDS Service between 1989 to 1995. Ratios of 4 year unadjusted incidence estimates to 4 year adjusted incidence estimates for the four diseases ranged from 1.38 to 1.86, corresponding to cumulative death rates of 61% to 69%. For CMV, the ratios of 4 year unadjusted to adjusted incidence estimates for five groups of patients ranged from 1.5 to 2.33, corresponding to cumulative death rates of 48% to 78%. We conclude that ignoring the competing risk of death can result in substantial overestimation of disease occurrence, which may give misleading results in estimating and comparing the occurrence of a disease of interest. Copyright (C) 2000 Elsevier Science Inc.
AB - To illustrate the importance of adjusting the estimates of cumulative incidence of acquired immunodeficiency syndrome (AIDS) related illnesses for competing risk of other causes of death, we compared unadjusted and adjusted (for competing events) incidence estimates for four AIDS illnesses: pneumocystis cavinii pneumonia (PCP), mycobacterium avium complex (MAC), cytomegalovirus (CMV), and esophageal candidiases. The study population was patients followed by the Johns Hopkins Hospital AIDS Service between 1989 to 1995. Ratios of 4 year unadjusted incidence estimates to 4 year adjusted incidence estimates for the four diseases ranged from 1.38 to 1.86, corresponding to cumulative death rates of 61% to 69%. For CMV, the ratios of 4 year unadjusted to adjusted incidence estimates for five groups of patients ranged from 1.5 to 2.33, corresponding to cumulative death rates of 48% to 78%. We conclude that ignoring the competing risk of death can result in substantial overestimation of disease occurrence, which may give misleading results in estimating and comparing the occurrence of a disease of interest. Copyright (C) 2000 Elsevier Science Inc.
KW - Competing risks
KW - Cox proportional hazards model
KW - Kaplan-Meier estimates
KW - Multiple decrement model
KW - Natural history of AIDS
UR - http://www.scopus.com/inward/record.url?scp=0033868103&partnerID=8YFLogxK
U2 - 10.1016/S0895-4356(99)00235-8
DO - 10.1016/S0895-4356(99)00235-8
M3 - Article
C2 - 10942864
AN - SCOPUS:0033868103
SN - 0895-4356
VL - 53
SP - 817
EP - 822
JO - Journal of Clinical Epidemiology
JF - Journal of Clinical Epidemiology
IS - 8
ER -