The analysis of COVID-19 in-hospital mortality: A competing risk approach or a cure model?
Stat Methods Med Res
; 31(10): 1976-1991, 2022 10.
Article
in English
| MEDLINE | ID: covidwho-1896268
ABSTRACT
Competing risk analyses have been widely used for the analysis of in-hospital mortality in which hospital discharge is considered as a competing event. The competing risk model assumes that more than one cause of failure is possible, but there is only one outcome of interest and all others serve as competing events. However, hospital discharge and in-hospital death are two outcomes resulting from the same disease process and patients whose disease conditions were stabilized so that inpatient care was no longer needed were discharged. We therefore propose to use cure models, in which hospital discharge is treated as an observed "cure" of the disease. We consider both the mixture cure model and the promotion time cure model and extend the models to allow cure status to be known for those who were discharged from the hospital. An EM algorithm is developed for the mixture cure model. We also show that the competing risk model, which treats hospital discharge as a competing event, is equivalent to a promotion time cure model. Both cure models were examined in simulation studies and were applied to a recent cohort of COVID-19 in-hospital patients with diabetes. The promotion time model shows that statin use improved the overall survival; the mixture cure model shows that while statin use reduced the in-hospital mortality rate among the susceptible, it improved the cure probability only for older but not younger patients. Both cure models show that treatment was more beneficial among older patients.
Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Hydroxymethylglutaryl-CoA Reductase Inhibitors
/
COVID-19
Type of study:
Cohort study
/
Observational study
/
Prognostic study
Limits:
Humans
Language:
English
Journal:
Stat Methods Med Res
Year:
2022
Document Type:
Article
Affiliation country:
09622802221106300
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