Abstract
Life expectancy has dramatically increased in industrialized nations over the last 200 hundred years. The aging of populations carries over to clinical research and leads to an increasing representation of elderly and multimorbid individuals in study populations. Clinical research in these populations is complicated by the fact that individuals are likely to experience several potential disease endpoints that prevent some disease-specific endpoint of interest from occurrence. Large developments in competing risks methodology have been achieved over the last decades, but we assume that recognition of competing risks in the clinical community is still marginal. It is the aim of this article to address translational aspects of competing risks to the clinical community. We describe clinical populations where competing risks issues may arise. We then discuss the importance of agreement between the competing risks methodology and the study aim, in particular the distinction between etiologic and prognostic research questions. In a review of 50 clinical studies performed in individuals susceptible to competing risks published in high-impact clinical journals, we found competing risks issues in 70% of all articles. Better recognition of issues related to competing risks and of statistical methods that deal with competing risks in accordance with the aim of the study is needed. Copyright © 2011 John Wiley & Sons, Ltd.
Highlights
Competing risks are an extension of classical survival analysis
We assess the popularity of the topic of competing risks in biostatistical and clinical journals based on a literature search
We critically appraise the quality of reporting competing risks in studies performed in populations susceptible to competing risks that were published in high-ranked clinical journals
Summary
Competing risks are an extension of classical survival analysis. In competing risks, we observe different event types in addition to the time to the first event occurring, possibly subject to censoring or left truncation. In medical research, competing risks occur when the time to a disease-specific endpoint of interest may be precluded by death or a major health event from another cause. The aim of this work is to address translational aspects of competing risks to the clinical community. We first describe study populations susceptible to competing risks. These rapidly growing populations highlight the increasing need for competing risks approaches in clinical research. We assess the popularity of the topic of competing risks in biostatistical and clinical journals based on a literature search. We critically appraise the quality of reporting competing risks in studies performed in populations susceptible to competing risks that were published in high-ranked clinical journals
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