Methodologic Issues When Estimating Risks in Pharmacoepidemiology

Curr Epidemiol Rep. 2016 Dec;3(4):285-296. doi: 10.1007/s40471-016-0089-1. Epub 2016 Sep 13.

Abstract

Risk is an important parameter to describe the occurrence of health outcomes over time. However, many outcomes of interest in healthcare settings, such as disease incidence, treatment initiation, and cause-specific mortality, may be precluded from occurring by other events, often referred to as competing events. Here, we review straightforward approaches to estimate risk in the presence of competing events. We illustrate the application of these methods using timely examples in pharmacoepidemiologic research and compare results to those obtained using analytic simplifications commonly used to handle competing events. These examples demonstrate how the analytic methods used to account for competing events affect the interpretation of results from pharmacoepidemiologic studies.

Keywords: Bias (Epidemiology); Epidemiologic Methods; Pharmacoepidemiology; Survival Analysis.