Estimating disease incidence rates and transition probabilities in elderly patients using multi-state models: a case study in fragility fracture using a Bayesian approach
Abstract Background Multi-state models are complex stochastic models which focus on pathways defined by the temporal and sequential occurrence of numerous events of interest. In particular, the so-called illness-death models are especially useful for studying probabilities associated to diseases who...
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| Format: | Article |
| Language: | English |
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BMC
2023-02-01
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| Series: | BMC Medical Research Methodology |
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| Online Access: | https://doi.org/10.1186/s12874-023-01859-y |
| _version_ | 1797864353092861952 |
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| author | Fran Llopis-Cardona Carmen Armero Gabriel Sanfélix-Gimeno |
| author_facet | Fran Llopis-Cardona Carmen Armero Gabriel Sanfélix-Gimeno |
| author_sort | Fran Llopis-Cardona |
| collection | DOAJ |
| description | Abstract Background Multi-state models are complex stochastic models which focus on pathways defined by the temporal and sequential occurrence of numerous events of interest. In particular, the so-called illness-death models are especially useful for studying probabilities associated to diseases whose occurrence competes with other possible diseases, health conditions or death. They can be seen as a generalization of the competing risks models, which are widely used to estimate disease-incidences among populations with a high risk of death, such as elderly or cancer patients. The main advantage of the aforementioned illness-death models is that they allow the treatment of scenarios with non-terminal competing events that may occur sequentially, which competing risks models fail to do. Methods We propose an illness-death model using Cox proportional hazards models with Weibull baseline hazard functions, and applied the model to a study of recurrent hip fracture. Data came from the PREV2FO cohort and included 34491 patients aged 65 years and older who were discharged alive after a hospitalization due to an osteoporotic hip fracture between 2008-2015. We used a Bayesian approach to approximate the posterior distribution of each parameter of the model, and thus cumulative incidences and transition probabilities. We also compared these results with a competing risks specification. Results Posterior transition probabilities showed higher probabilities of death for men and increasing with age. Women were more likely to refracture as well as less likely to die after it. Free-event time was shown to reduce the probability of death. Estimations from the illness-death and the competing risks models were identical for those common transitions although the illness-death model provided additional information from the transition from refracture to death. Conclusions We illustrated how multi-state models, in particular illness-death models, may be especially useful when dealing with survival scenarios which include multiple events, with competing diseases or when death is an unavoidable event to consider. Illness-death models via transition probabilities provide additional information of transitions from non-terminal health conditions to absorbing states such as death, what implies a deeper understanding of the real-world problem involved compared to competing risks models. |
| first_indexed | 2024-04-09T22:51:33Z |
| format | Article |
| id | doaj.art-63c044a69b30426e8d0dd24c8e9f8165 |
| institution | Directory Open Access Journal |
| issn | 1471-2288 |
| language | English |
| last_indexed | 2024-04-09T22:51:33Z |
| publishDate | 2023-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Research Methodology |
| spelling | doaj.art-63c044a69b30426e8d0dd24c8e9f81652023-03-22T11:38:39ZengBMCBMC Medical Research Methodology1471-22882023-02-0123111110.1186/s12874-023-01859-yEstimating disease incidence rates and transition probabilities in elderly patients using multi-state models: a case study in fragility fracture using a Bayesian approachFran Llopis-Cardona0Carmen Armero1Gabriel Sanfélix-Gimeno2Health Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO)Department of Statistics and Operations Research. Universitat de ValènciaHealth Services Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO)Abstract Background Multi-state models are complex stochastic models which focus on pathways defined by the temporal and sequential occurrence of numerous events of interest. In particular, the so-called illness-death models are especially useful for studying probabilities associated to diseases whose occurrence competes with other possible diseases, health conditions or death. They can be seen as a generalization of the competing risks models, which are widely used to estimate disease-incidences among populations with a high risk of death, such as elderly or cancer patients. The main advantage of the aforementioned illness-death models is that they allow the treatment of scenarios with non-terminal competing events that may occur sequentially, which competing risks models fail to do. Methods We propose an illness-death model using Cox proportional hazards models with Weibull baseline hazard functions, and applied the model to a study of recurrent hip fracture. Data came from the PREV2FO cohort and included 34491 patients aged 65 years and older who were discharged alive after a hospitalization due to an osteoporotic hip fracture between 2008-2015. We used a Bayesian approach to approximate the posterior distribution of each parameter of the model, and thus cumulative incidences and transition probabilities. We also compared these results with a competing risks specification. Results Posterior transition probabilities showed higher probabilities of death for men and increasing with age. Women were more likely to refracture as well as less likely to die after it. Free-event time was shown to reduce the probability of death. Estimations from the illness-death and the competing risks models were identical for those common transitions although the illness-death model provided additional information from the transition from refracture to death. Conclusions We illustrated how multi-state models, in particular illness-death models, may be especially useful when dealing with survival scenarios which include multiple events, with competing diseases or when death is an unavoidable event to consider. Illness-death models via transition probabilities provide additional information of transitions from non-terminal health conditions to absorbing states such as death, what implies a deeper understanding of the real-world problem involved compared to competing risks models.https://doi.org/10.1186/s12874-023-01859-yBayesian inferenceCause-specific hazard modelsCumulative incidence functionEpidemiological dataIllness-death modelsTransition probabilities |
| spellingShingle | Fran Llopis-Cardona Carmen Armero Gabriel Sanfélix-Gimeno Estimating disease incidence rates and transition probabilities in elderly patients using multi-state models: a case study in fragility fracture using a Bayesian approach BMC Medical Research Methodology Bayesian inference Cause-specific hazard models Cumulative incidence function Epidemiological data Illness-death models Transition probabilities |
| title | Estimating disease incidence rates and transition probabilities in elderly patients using multi-state models: a case study in fragility fracture using a Bayesian approach |
| title_full | Estimating disease incidence rates and transition probabilities in elderly patients using multi-state models: a case study in fragility fracture using a Bayesian approach |
| title_fullStr | Estimating disease incidence rates and transition probabilities in elderly patients using multi-state models: a case study in fragility fracture using a Bayesian approach |
| title_full_unstemmed | Estimating disease incidence rates and transition probabilities in elderly patients using multi-state models: a case study in fragility fracture using a Bayesian approach |
| title_short | Estimating disease incidence rates and transition probabilities in elderly patients using multi-state models: a case study in fragility fracture using a Bayesian approach |
| title_sort | estimating disease incidence rates and transition probabilities in elderly patients using multi state models a case study in fragility fracture using a bayesian approach |
| topic | Bayesian inference Cause-specific hazard models Cumulative incidence function Epidemiological data Illness-death models Transition probabilities |
| url | https://doi.org/10.1186/s12874-023-01859-y |
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