Fay Michael P, Pfeiffer Ruth, Cronin Kathleen A, Le Chenxiong, Feuer Eric J
National Cancer Institute, 6116 Executive Blvd, Suite 504, MSC 8317, Bethesda, Maryland 20892-8317, USA.
Stat Med. 2003 Jun 15;22(11):1837-48. doi: 10.1002/sim.1428.
We propose an estimator of the probability of developing a disease in a given age range, conditional on never having developed the disease prior to the beginning of the age range. Our estimator improves the one described by Wun, Merrill and Feuer ( Lifetime Data Analysis 1998; 4, 169-186) that is currently used by the U.S. National Cancer Institute for the SEER Cancer Statistics Review. Both estimators use cross-sectional disease rates and provide an interpretation of these rates in terms of the age-conditional probability of developing disease in a hypothetical cohort. The difficulty of this problem is that rates are not available per person-years alive and disease free, but only per person-years alive. Wun et al. used ad hoc methods to handle this problem which did not properly account for competing risks, did not provide a measure of variability, and only allowed age ranges using prespecified 5-year age intervals. Here we solve the problem under a unified competing risks framework, which allows the calculation of the age-conditional probabilities for any age range. We generalize gamma confidence intervals to apply to our new statistic. Although our new method provides estimates which are numerically similar to that of Wun et al., this paper provides a comprehensive theoretical basis for estimation and inference about the age-conditional probability of developing a disease.
我们提出了一种估计在给定年龄范围内患某种疾病概率的方法,该概率以在该年龄范围开始之前从未患过该疾病为条件。我们的估计方法改进了Wun、Merrill和Feuer(《寿命数据分析》1998年;4卷,第169 - 186页)所描述的方法,美国国家癌症研究所目前在其监测、流行病学和最终结果(SEER)癌症统计回顾中使用的就是后者的方法。这两种估计方法都使用横断面疾病发病率,并根据假设队列中患疾病的年龄条件概率对这些发病率做出解释。该问题的难点在于无法获得按存活且无病的人年计算的发病率,而只能获得按存活人年计算的发病率。Wun等人采用了临时方法来处理这个问题,这些方法没有妥善考虑竞争风险,没有提供变异度量,并且只允许使用预先指定的5年年龄间隔的年龄范围。在此,我们在一个统一的竞争风险框架下解决了该问题,这使得能够计算任何年龄范围内的年龄条件概率。我们将伽马置信区间进行了推广,使其适用于我们的新统计量。尽管我们的新方法提供的估计值在数值上与Wun等人的方法类似,但本文为关于患疾病年龄条件概率的估计和推断提供了全面的理论基础。