Varadhan Ravi, Xue Qian-Li, Bandeen-Roche Karen
Division of Geriatric Medicine and Gerontology, The Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA,
Lifetime Data Anal. 2014 Oct;20(4):538-62. doi: 10.1007/s10985-014-9295-7. Epub 2014 Apr 12.
A semicompeting risks problem involves two-types of events: a nonterminal and a terminal event (death). Typically, the nonterminal event is the focus of the study, but the terminal event can preclude the occurrence of the nonterminal event. Semicompeting risks are ubiquitous in studies of aging. Examples of semicompeting risk dyads include: dementia and death, frailty syndrome and death, disability and death, and nursing home placement and death. Semicompeting risk models can be divided into two broad classes: models based only on observables quantities (class [Formula: see text]) and those based on potential (latent) failure times (class [Formula: see text]). The classical illness-death model belongs to class [Formula: see text]. This model is a special case of the multistate models, which has been an active area of methodology development. During the past decade and a half, there has also been a flurry of methodological activity on semicompeting risks based on latent failure times ([Formula: see text] models). These advances notwithstanding, the semicompeting risks methodology has not penetrated biomedical research, in general, and gerontological research, in particular. Some possible reasons for this lack of uptake are: the methods are relatively new and sophisticated, conceptual problems associated with potential failure time models are difficult to overcome, paucity of expository articles aimed at educating practitioners, and non-availability of readily usable software. The main goals of this review article are: (i) to describe the major types of semicompeting risks problems arising in aging research, (ii) to provide a brief survey of the semicompeting risks methods, (iii) to suggest appropriate methods for addressing the problems in aging research, (iv) to highlight areas where more work is needed, and (v) to suggest ways to facilitate the uptake of the semicompeting risks methodology by the broader biomedical research community.
非终末事件和终末事件（死亡）。通常，非终末事件是研究的重点，但终末事件可能会阻止非终末事件的发生。半竞争风险在衰老研究中无处不在。半竞争风险二元组的例子包括：痴呆与死亡、衰弱综合征与死亡、残疾与死亡以及入住养老院与死亡。半竞争风险模型可分为两大类：仅基于可观测数量的模型（类别[公式：见原文]）和基于潜在（潜伏）失效时间的模型（类别[公式：见原文]）。经典的疾病 - 死亡模型属于类别[公式：见原文]。该模型是多状态模型的一个特例，多状态模型一直是方法学发展的活跃领域。在过去十五年中，基于潜伏失效时间的半竞争风险（[公式：见原文]模型）也有一系列方法学活动。尽管有这些进展，但半竞争风险方法总体上尚未渗透到生物医学研究中，尤其是老年学研究中。这种缺乏应用的一些可能原因是：这些方法相对较新且复杂，与潜在失效时间模型相关的概念问题难以克服，旨在教育从业者的阐述性文章匮乏，以及缺乏易于使用的软件。这篇综述文章的主要目标是：（i）描述衰老研究中出现的主要类型的半竞争风险问题，（ii）对半竞争风险方法进行简要概述，（iii）提出解决衰老研究中问题的适当方法，（iv）突出需要更多工作的领域，以及（v）提出促进更广泛的生物医学研究界采用半竞争风险方法的途径。
