Estimation with Cox models: cause-specific survival analysis with misclassified cause of failure

Epidemiology. 2012 Mar;23(2):194-202. doi: 10.1097/EDE.0b013e3182454cad.

Abstract

While epidemiologic and clinical research often aims to analyze predictors of specific endpoints, time-to-the-specific-event analysis can be hampered by problems with cause ascertainment. Under typical assumptions of competing risks analysis (and missing-data settings), we correct the cause-specific proportional hazards analysis when information on the reliability of diagnosis is available. Our method avoids bias in effect estimates at low cost in variance, thus offering a perspective for better-informed decision making. The ratio of different cause-specific hazards can be estimated flexibly for this purpose. It thus complements an all-cause analysis. In a sensitivity analysis, this approach can reveal the likely extent and direction of the bias of a standard cause-specific analysis when the diagnosis is suspect. These 2 uses are illustrated in a randomized vaccine trial and an epidemiologic cohort study, respectively.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bias
  • Cause of Death
  • Data Interpretation, Statistical
  • Epidemiologic Methods
  • Humans
  • Models, Statistical
  • Mortality
  • Proportional Hazards Models*
  • Survival Analysis