Tsai S P, Wen C P
Ann Acad Med Singap. 1984 Apr;13(2 Suppl):321-6.
Mortality risk is competing because each individual is subject to several competing causes of death but can only die from one. Adjustment for competing risks will allow more meaningful comparisons of cause-specific mortality of two populations, especially if dying from all other causes is significantly different between the two populations. In this paper, a method has been developed for adjustment of competing causes of death in the calculation of relative risk. It identifies three factors as determining the significance of competing risks: (1) magnitude of the overall mortality risk of the study population; (2) differential risk or adjustment factor for all other causes between two populations; and (3) age interval used in mortality calculation. Thus, the impact of competing risks is increased if the mortality risk of the study population is high, if the differential risk for all other causes is large or if wide age intervals are used in the mortality calculation. An example from refinery cohort data shows that in certain age groups unadjusted for competing risks the relative risk is overestimated by 9%. The impact of competing risks in this particular example is relatively small.
死亡风险具有竞争性，因为每个人都面临多种相互竞争的死亡原因，但只能死于其中一种。对竞争风险进行调整将使对两个人群特定病因死亡率的比较更有意义，特别是当两个人群死于所有其他原因的情况存在显著差异时。本文开发了一种在计算相对风险时调整竞争死亡原因的方法。该方法确定了三个决定竞争风险显著性的因素：（1）研究人群的总体死亡风险大小；（2）两个人群中所有其他原因的差异风险或调整因子；（3）死亡率计算中使用的年龄区间。因此，如果研究人群的死亡风险高、所有其他原因的差异风险大，或者在死亡率计算中使用了较宽的年龄区间，竞争风险的影响就会增加。炼油厂队列数据的一个例子表明，在某些未对竞争风险进行调整的年龄组中，相对风险被高估了9%。在这个特定例子中，竞争风险的影响相对较小。
