Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Division of Health Sciences, Populations, Evidence and Technologies Group, University of Warwick, Coventry, United Kingdom.
PLoS One. 2021 Jan 7;16(1):e0245111. doi: 10.1371/journal.pone.0245111. eCollection 2021.
The use of inappropriate methods for estimating the effects of covariates in survival data with frailty leads to erroneous conclusions in medical research. This study evaluated the performance of 13 survival regression models in assessing the factors associated with the timing of complications in implant-supported dental restorations in a Swedish cohort. Data were obtained from randomly selected cohort (n = 596) of Swedish patients provided with dental restorations supported in 2003. Patients were evaluated over 9 years of implant loss, peri-implantitis or technical complications. Best Model was identified using goodness, AIC and BIC. The loglikelihood, the AIC and BIC were consistently lower in flexible parametric model with frailty (df = 2) than other models. Adjusted hazard of implant complications was 45% (adjusted Hazard Ratio (aHR) = 1.449; 95% Confidence Interval (CI): 1.153-1.821, p = 0.001) higher among patients with periodontitis. While controlling for other variables, the hazard of implant complications was about 5 times (aHR = 4.641; 95% CI: 2.911-7.401, p<0.001) and 2 times (aHR = 2.338; 95% CI: 1.553-3.519, p<0.001) higher among patients with full- and partial-jaw restorations than those with single crowns. Flexible parametric survival model with frailty are the most suitable for modelling implant complications among the studied patients.
在包含脆弱性的生存数据中使用不当的方法来估计协变量的效果会导致医学研究中的错误结论。本研究评估了 13 种生存回归模型在评估与瑞典队列中种植体支持的牙科修复体并发症时间相关因素的表现。数据来自于 2003 年接受种植体支持的牙科修复体的瑞典患者随机选择的队列（n = 596）。患者在 9 年内接受了种植体丢失、种植体周围炎或技术并发症的评估。使用 goodness、AIC 和 BIC 来识别最佳模型。具有脆弱性（df = 2）的灵活参数模型的对数似然、AIC 和 BIC 始终低于其他模型。患有牙周炎的患者发生种植体并发症的调整危险比（adjusted Hazard Ratio，aHR）为 45%（aHR = 1.449；95%置信区间，95% Confidence Interval，CI：1.153-1.821，p = 0.001）。在控制其他变量的情况下，种植体并发症的危险比约为 5 倍（aHR = 4.641；95% CI：2.911-7.401，p < 0.001）和 2 倍（aHR = 2.338；95% CI：1.553-3.519，p < 0.001），全颌和部分颌修复体患者高于单冠患者。在研究患者中，具有脆弱性的灵活参数生存模型是最适合建模种植体并发症的模型。
