现代方法的反思：竞争风险与多状态模型
Reflection on modern methods: competing risks versus multi-state models
摘要：
生存竞争风险模型对于研究与其他可能的疾病或健康状况竞争的疾病的发病率非常有用。这些模型在处理终端事件（如死亡）时表现良好，这意味着相应研究的结论。但它们不允许处理可能顺序发生的非终端竞争事件的场景。多状态模型是复杂的生存模型。它们专注于由众多感兴趣的事件的时间和顺序发生定义的途径，因此它们适合于连接竞争性非终端事件以及管理具有更高复杂性的其他生存场景。我们讨论的多状态模型的框架内的竞争风险，并澄清这两个模型的有用性分析流行病学数据。我们通过贝叶斯推理方法对复发性髋部骨折的真实研究，突出了多状态模型的作用。
英文摘要：
Survival competing risks models are very useful for studying the incidence of diseases whose occurrence competes with other possible diseases or health conditions. These models perform properly when working with terminal events, such as death, that imply the conclusion of the corresponding study. But they do not allow the treatment of scenarios with non-terminal competing events that may occur sequentially. Multi-state models are complex survival models. They focus on pathways defined by the temporal and sequential occurrence of numerous events of interest and thus they are suitable for connecting competing non-terminal events as well as to manage other survival scenarios with higher complexity. We discuss competing risks within the framework of multi-state models and clarify the usefulness of both models for analysing epidemiological data. We highlight the power of multi-state models through a real-world study of recurrent hip fracture from Bayesian inferential methodology.
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