Joint inference for competing risks data using multiple endpoints

Biometrics. 2023 Sep;79(3):1635-1645. doi: 10.1111/biom.13752. Epub 2022 Sep 10.

Abstract

Competing risks data are commonly encountered in randomized clinical trials and observational studies. This paper considers the situation where the ending statuses of competing events have different clinical interpretations and/or are of simultaneous interest. In clinical trials, often more than one competing event has meaningful clinical interpretations even though the trial effects of different events could be different or even opposite to each other. In this paper, we develop estimation procedures and inferential properties for the joint use of multiple cumulative incidence functions (CIFs). Additionally, by incorporating longitudinal marker information, we develop estimation and inference procedures for weighted CIFs and related metrics. The proposed methods are applied to a COVID-19 in-patient treatment clinical trial, where the outcomes of COVID-19 hospitalization are either death or discharge from the hospital, two competing events with completely different clinical implications.

Keywords: COVID-19; clinical trial; competing risks; cumulative incidence; restricted mean time; weighted survival time.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • COVID-19*
  • Humans
  • Incidence
  • Risk Factors