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Assessing risk factors of non-fatal outcomes amid a competing risk of mortality: The example of hip fracture

Osteoporosis International Jul 04, 2019

Buzkova P, et al. - Via the Cardiovascular Health Study, an ongoing cohort study of 5,888 older adults, who were assessed for incident hip fractures from their 1992–1993, the researchers intended to determine the risk factors of non-fatal outcomes among a competing risk of mortality. Directionally concordant but quantitatively various strengths of connection were generated by Cox and Fine-Gray (FG) methods for age, current smoking, and sex. A more powerful association of hip fracture with sex was determined by the FG approach. Almost the same results for the race were produced by the two approaches. The estimations were discordant in direction for diabetes and kidney function, however, the FG hazard ratios inferred effects that were in the opposite direction of well-understood and broadly accepted associations. Therefore, for non-fatal outcomes like hip fractures, cause-specific Cox models presented relevant approximations of hazards even in the presence of competitive risk of mortality. Further, in the population of people who have not yet had an event of hip fracture and who are alive, which is typically the group of clinical benefit, the Cox approach assessed the hazard. Also, in a hypothetical population that could generate misleading conclusions about risk factors in populations of clinical interest, the Fine-Gray method estimated hazard.
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