Competing Risk of Death: An Important Consideration in Studies of Older Adults
2010/03/22 by Sarah D. Berry, Long Ngo, Elizabeth J. Samelson +1 · 596 citations
Economics, Econometrics and Finance · Medicine · #Cohort #Colorectal Cancer Screening and Detection #Cumulative incidence #Demography #Disease #Environmental health #Framingham Heart Study #Framingham Risk Score #Gerontology #Health Systems, Economic Evaluations, Quality of Life #Hip fracture #Incidence (geometry) #Internal medicine #Liver Disease Diagnosis and Treatment #Medicine #Osteoporosis #Population #Proportional hazards model #Risk assessment #Surgery #Survival analysis
paper · open access · doi:10.1111/j.1532-5415.2010.02767.x
published in Journal of the American Geriatrics Society 58(4), 783-787 (Wiley)
openalex publication_date 2010/03/22 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/01
Abstract
Clinical studies often face the difficult problem of how to account for participants who die without experiencing the study outcome of interest. In a geriatric population with considerable comorbidities, the competing risk of death is especially high. Traditional approaches to describe risk of disease include Kaplan-Meier survival analysis and Cox proportional hazards regression, but these methods can overestimate risk of disease by failing to account for the competing risk of death. This report discusses traditional survival analysis and competing risk analysis as used to estimate risk of disease in geriatric studies. Furthermore, it illustrates a competing risk approach to estimate risk of second hip fracture in the Framingham Osteoporosis Study and compares the results with traditional survival analysis. In this example, survival analysis overestimated the 5-year risk of second hip fracture by 37% and the 10-year risk by 75% compared with competing risk estimates. In studies of older individuals in which a substantial number of participants die during a long follow-up, the cumulative incidence competing risk estimate and competing risk regression should be used to determine incidence and effect estimates. Use of a competing risk approach is critical to accurately determining disease risk for elderly individuals and therefore best inform clinical decision-making.
Cited by
- Introduction to the Analysis of Survival Data in the Presence of Competing Risks
- Low Trauma Fractures in People With HIV: Longitudinal Time Trends in the Swiss HIV Cohort Study, 2009–2022
- 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice
- Gut microbiome composition and functional potential associate with incident type 2 diabetes in 4,685 adults from a Swedish prospective cohort
- Competing Risks: Impact on Risk Estimation and Algorithmic Fairness
- Estimated lifetime risk of venous thromboembolism in men and women in a Danish nationwide cohort: impact of competing risk of death
- Albuminuria is associated with increased risk of dementia, independent of eGFR: The SCREAM project
- Computing Individual Risks based on Family History in Genetic Disease in the Presence of Competing Risks
- Allergic Diseases and Risk of Incident Dementia and Alzheimer's Disease
- Cigarette smoking exposure and heart failure risk in older adults: the Health, Aging, and Body Composition Study. [europepmc]
- Lifetime risk of ESRD. [europepmc]
- A prospective study of thyroid function, bone loss, and fractures in older men: The MrOS study. [europepmc]
- Depression and incident Alzheimer disease: the impact of disease severity. [europepmc]
- Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. [europepmc]
- A Frailty Index predicts 10-year fracture risk in adults age 25 years and older: results from the Canadian Multicentre Osteoporosis Study (CaMos). [europepmc]
- Radical Prostatectomy or External Beam Radiation Therapy vs No Local Therapy for Survival Benefit in Metastatic Prostate Cancer: A SEER-Medicare Analysis. [europepmc]
- Leukocyte telomere length and mortality in the National Health and Nutrition Examination Survey, 1999-2002. [europepmc]
- Introduction to the Analysis of Survival Data in the Presence of Competing Risks. [europepmc]
- Risk Factors for Hip Fracture in Older Men: The Osteoporotic Fractures in Men Study (MrOS). [europepmc]
- Mortality, readmission, and reoperation after hip fracture in nonagenarians. [europepmc]
- Cancer survival disparities worsening by socio-economic disadvantage over the last 3 decades in new South Wales, Australia. [europepmc]
- Functional Impairment and Decline in Middle Age: A Cohort Study. [europepmc]
- Frailty is an independent predictor of incident dementia: Evidence from the English Longitudinal Study of Ageing. [europepmc]
- Long-Term Atherosclerotic Vascular Disease Risk and Prognosis in Elderly Women With Abdominal Aortic Calcification on Lateral Spine Images Captured During Bone Density Testing: A Prospective Study. [europepmc]
- Red cell distribution width and common disease onsets in 240,477 healthy volunteers followed for up to 9 years. [europepmc]
- Incident Hearing Loss and Comorbidity: A Longitudinal Administrative Claims Study. [europepmc]
- Assessing Risk for Adverse Outcomes in Older Adults: The Need to Include Both Physical Frailty and Cognition. [europepmc]
- Health Care Utilization and Cost Outcomes of a Comprehensive Dementia Care Program for Medicare Beneficiaries. [europepmc]
- Association of Patient Priorities-Aligned Decision-Making With Patient Outcomes and Ambulatory Health Care Burden Among Older Adults With Multiple Chronic Conditions: A Nonrandomized Clinical Trial. [europepmc]
- Community engagement and dementia risk: time-to-event analyses from a national cohort study. [europepmc]
- COVID-19 case-fatality rate and demographic and socioeconomic influencers: worldwide spatial regression analysis based on country-level data. [europepmc]
- The impact of fracture liaison services on subsequent fractures and mortality: a systematic literature review and meta-analysis. [europepmc]
- SCORE2-OP risk prediction algorithms: estimating incident cardiovascular event risk in older persons in four geographical risk regions. [europepmc]
- Statin Discontinuation and Cardiovascular Events Among Older People in Denmark. [europepmc]
Related