Modeling cumulative incidence function for competing risks data

Abstract

A frequent occurrence in medical research is that a patient is subject to different causes of failure, where each cause is known as a competing risk. The cumulative incidence curve is a proper summary curve, showing the cumulative failure rates over time due to a particular cause. A common question in medical research is to assess the covariate effects on a cumulative incidence function. The standard approach is to construct regression models for all cause-specific hazard rate functions and then model a covariate-adjusted cumulative incidence curve as a function of all cause-specific hazards for a given set of covariates. New methods have been proposed in recent years, emphasizing direct assessment of covariate effects on cumulative incidence function. Fine and Gray proposed modeling the effects of covariates on a subdistribution hazard function. A different approach is to directly model a covariate-adjusted cumulative incidence function, including a pseudovalue approach by Andersen and Klein and a direct binomial regression by Scheike, Zhang and Gerds. In this paper, we review the standard and new regression methods for modeling a cumulative incidence function, and give the sources of computer packages/programs that implement these regression models. A real bone marrow transplant data set is analyzed to illustrate various regression methods.