Abstract
The Kaplan-Meier (KM) method is commonly used to estimate the incidence of an event
over time. It assumes independence between the event of interest and any competing
event that precludes the event of interest to occur. However, when the competing event
is death without the event of interest, censoring these patients will affect the incidence
of the event of interest by modifying the number of exposed patients, so that KM results
will be misleading. Three prospective cohorts were studied: (1) 657 renal transplant
recipients, (2) 262 children with acute leukemia who received bone marrow transplants,
and (3) 8,353 intensive care patients. The main outcome measures were kidney graft
loss, leukemia relapse, and ICU-acquired infection, respectively, with death before
the main outcome as the competing event. The incidence of each main outcome was overestimated
by the KM method. The magnitude of overestimation ranged from 3% to 30%, and varied
with baseline patient characteristics and follow-up duration, with most of this variation
being related to the rate of the competing event. A competing-risk approach must be
used to analyze the risk of events other than death in cohort studies, particularly
when mortality rates are high.
Keywords
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Article info
Publication history
Accepted:
February 13,
2003
Received in revised form:
January 9,
2003
Received:
July 18,
2002
Identification
Copyright
© 2003 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
