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

被引:70
作者
Lacny, Sarah [1 ]
Wilson, Todd [1 ]
Clement, Fiona [1 ,2 ]
Roberts, Derek J. [1 ,3 ]
Faris, Peter [1 ,4 ,5 ]
Ghali, William A. [1 ,2 ,6 ]
Marshall, Deborah A. [1 ,2 ,5 ,6 ,7 ]
机构
[1] Univ Calgary, Cumming Sch Med, Dept Community Hlth Sci, 3280 Hosp Dr NW, Calgary, AB T2N 4Z6, Canada
[2] Univ Calgary, OBrien Inst Publ Hlth, 3280 Hosp Dr NW, Calgary, AB T2N 4Z6, Canada
[3] Univ Calgary, Dept Surg, Cumming Sch Med, Foothills Med Ctr, 3280 Hosp Dr NW, Calgary, AB T2N 4Z6, Canada
[4] Foothills Med Ctr, Alberta Hlth Serv, 1403-29 St NW, Calgary, AB T2N 2T9, Canada
[5] Alberta Bone & Joint Hlth Inst, 3280 Hosp Dr NW, Calgary, AB T2N 4Z6, Canada
[6] Univ Calgary, Cumming Sch Med, Dept Med, 3280 Hosp Dr NW, Calgary, AB T2N 4Z6, Canada
[7] McCaig Inst Bone & Joint Hlth, 3280 Hosp Dr NW, Calgary, AB T2N 4Z6, Canada
基金
加拿大健康研究院;
关键词
Survival analysis; Competing risks; Kaplan-Meier; Cumulative incidence function; Meta-analysis; Review; TRANSPLANT WAITING-LIST; JOINT REPLACEMENT; TIME; ARTHROPLASTY; PROBABILITY; ASSOCIATION; JOURNALS; OUTCOMES; DISEASE; TRIALS;
D O I
10.1016/j.jclinepi.2017.10.006
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Objectives: Kaplan-Meier survival analysis overestimates cumulative incidence in competing risks (CRs) settings. The extent of overestimation (or its clinical significance) has been questioned, and CRs methods are infrequently used. This meta-analysis compares the Kaplan-Meier method to the cumulative incidence function (CIF), a CRs method. Study Design and Setting: We searched MEDLINE, EMBASE, BIOSIS Previews, Web of Science (1992-2016), and article bibliographies for studies estimating cumulative incidence using the Kaplan Meier method and CIF. For studies with sufficient data, we calculated pooled risk ratios (RRs) comparing Kaplan-Meier and CIF estimates using DerSimonian and Laird random effects models. We performed stratified meta -analyses by clinical area, rate of CRs (CRs/events of interest), and follow-up time. Results: Of 2,192 identified abstracts, we included 77 studies in the systematic review and meta-analyzed 55. The pooled RR demonstrated the Kaplan-Meier estimate was 1.41 [95% confidence interval (CI): 1.36, 1.47] times higher than the CIF. Overestimation was highest among studies with high rates of CRs [RR = 2.36 (95% CI: 1.79, 3.12)], studies related to hepatology [RR = 2.60 (95% CI: 2.12, 3.19)], and obstetrics and gynecology [RR = 1.84 (95% CI: 1.52, 2.23)]. Conclusion: The Kaplan-Meier method overestimated the cumulative incidence across 10 clinical areas. Using CRs methods will ensure accurate results inform clinical and policy decisions. (C) 2017 Elsevier Inc. All rights reserved.
引用
收藏
页码:25 / 35
页数:11
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