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流行病学研究中复发事件的分析策略:背景及在老年人住院风险中的应用

Analytic strategies for recurrent events in epidemiologic studies: background and application to hospitalization risk in the elderly.

作者信息

Stürmer T, Glynn R J, Kliebsch U, Brenner H

机构信息

Department of Epidemiology, University of Ulm, Germany.

出版信息

J Clin Epidemiol. 2000 Jan;53(1):57-64. doi: 10.1016/s0895-4356(99)00137-7.

Abstract

Due to the intraindividual dependence, specific analytic strategies are needed to assess risk factors for recurrent events. Although well established in the biostatistics literature, applications of these techniques are almost nonexistent in the field of epidemiology. The authors applied four different regression approaches for recurrent events (logistic, Poisson, and two different Cox proportional hazards regressions) to derive rate ratios of hospitalizations for various prognostic factors in a cohort of 2424 frail elderly. Over a median follow-up of 670 days, 3299 hospitalizations were observed in 1564 persons. Estimated rate ratios were similar in all four approaches and virtually identical in three. With all methods, confidence intervals of the rate ratios were considerably wider than with naive Poisson regression neglecting intraindividual dependence of events. Appropriate analysis of recurrent events is feasible with minor modifications of multivariable models familiar to epidemiologists and should no longer be neglected in epidemiologic research. In our setting, Poisson regression was the most convenient approach.

摘要

由于个体内部的依赖性,需要特定的分析策略来评估复发事件的风险因素。尽管这些技术在生物统计学文献中已得到充分确立,但在流行病学领域几乎没有应用。作者应用了四种不同的复发事件回归方法(逻辑回归、泊松回归和两种不同的Cox比例风险回归),以得出2424名体弱老年人队列中各种预后因素的住院率比。在中位随访670天期间,1564人中有3299次住院。在所有四种方法中,估计的率比相似,其中三种方法几乎相同。使用所有方法时,率比的置信区间比忽略事件个体内部依赖性的朴素泊松回归要宽得多。对复发事件进行适当分析,只需对流行病学家熟悉的多变量模型进行微小修改即可实现,在流行病学研究中不应再被忽视。在我们的研究中,泊松回归是最方便的方法。

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