title: Survival Analysis in the Presence of Competing Risks: The Example of Waitlisted Kidney Transplant Candidates.
abstract: Competing events (or risks) preclude the observation of an event of interest or alter the probability of the event's occurrence and are commonly encountered in transplant outcomes research. Transplantation, for example, is a competing event for death on the waiting list because receiving a transplant may significantly decrease the risk of long-term mortality. In a typical analysis of time-to-event data, competing events may be censored or incorporated into composite end points; however, the presence of competing events violates the assumption of "independent censoring," which is the basis of standard survival analysis techniques. The use of composite end points disregards the possibility that competing events may be related to the exposure in a way that is different from the other components of the composite. Using data from the Scientific Registry of Transplant Recipients, this paper reviews the principles of competing risks analysis; outlines approaches for analyzing data with competing events (cause-specific and subdistribution hazards models); compares the estimates obtained from standard survival analysis, which handle competing events as censoring events; discusses the appropriate settings in which each of the two approaches could be used; and contrasts their interpretation.
authors.affiliation: Division of Nephrology and the Multi Organ Transplant Program, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada.|Centre for Outcomes Research and Evaluation (CORE), McGill University Health Centre, Montreal, Quebec, Canada.|Division of Nephrology, Department of Medicine, McGill University, Montreal, Quebec, Canada.|Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Sapir-Pichhadze
authors.affiliation: Division of Biostatistics, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Pintilie
authors.affiliation: Division of Nephrology and the Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.|Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.|Departments of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: K J
authors.identifier: 0000-0002-6638-2887
authors.initials: KJ
authors.lastname: Tinckam
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Departments of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.|Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Laupacis
authors.affiliation: Division of Nephrology and the Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: A G
authors.initials: AG
authors.lastname: Logan
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Population Health Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.|Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Beyene
authors.affiliation: Division of Nephrology and the Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.|Division of Nephrology and the Renal Transplant Program, St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: S J
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D015233:Models, Statistical; D018570:Risk Assessment / Q000379:methods*; D016019:Survival Analysis; D014850:Waiting Lists
keywords: Scientific Registry for Transplant Recipients (SRTR); clinical research/practice; epidemiology; health services and outcomes research; kidney transplantation/nephrology; statistics