Visualizing covariates in proportional hazards model

Abstract

We present a graphical method called the rank-hazard plot that visualizes the relative importance of covariates in a proportional hazards model. The key idea is to rank the covariate values and plot the relative hazard as a function of ranks scaled to interval [0, 1]. The relative hazard is plotted with respect to the reference hazard, which can be, for example, the hazard related to the median of the covariate. Transformation to scaled ranks allows plotting of covariates measured in different units in the same graph, which helps in the interpretation of the epidemiological relevance of the covariates. Rank-hazard plots show the difference of hazards between the extremes of the covariate values present in the data and can be used as a tool to check if the proportional hazards assumption leads to reasonable estimates for individuals with extreme covariate values. Alternative covariate definitions or different transformations applied to covariates can be also compared using rank-hazard plots. We apply rank-hazard plots to the data from the FINRISK study where population-based cohorts have been followed up for events of cardiovascular diseases and compare the relative importance of the covariates cholesterol, smoking, blood pressure and body mass index. The data from the Study to Understand Prognoses Preferences Outcomes and Risks of Treatment (SUPPORT) are used to visualize nonlinear covariate effects. The proposed graphics work in other regression models with different interpretations of the y-axis.