scholarly journals Competing Risks Models for an Enterprises Duration on the Market

2020 ◽  
Vol 20 (1) ◽  
pp. 456-473
Author(s):  
Dominika M. Urbańczyk

AbstractResearch background: Enterprises are an important element of the economy, which explains that the analysis of their duration on the market is an important and willingly undertaken research topic. In the case of complex problems like this, considering only one type of event, which ends the duration, is often insufficient for full understanding.Purpose: In this paper there is an analysis of the duration of enterprises on the market, taking into account various reasons for the termination of their business activity as well as their characteristics.Research methodology: A survival analysis can be used to study duration on the market. However, the possibility of considering the waiting time for only one type of event is its important limitation. One solution is to use competing risks. Various competing risks models (naive Kaplan-Meier estimator, subdistribution model, subhazard and cause-specific hazard) are presented and compared with an indication of their advantages and weakness.Results: The competing risks models are estimated to investigate the impact of the causes of an enterprises liquidation on duration distribution. The greatest risk concerns enterprises with a natural person as the owner (regardless of the reason of failure). For each of the competing risks, it is also indicated that there is a section of activity which adversely affects the ability of firms to survive on the market.Novelty: A valuable result is considering the reasons for activity termination in the duration analysis for enterprises from the Mazowieckie Voivodeship.

2021 ◽  
pp. 003288552110481
Author(s):  
Thomas Wojciechowski

Past research has indicated that Major Depressive Disorder and exposure to violence are risk factors for offending. However, researchers have yet to examine how this disorder may predict recidivism risk among juvenile offenders and how the disorder moderates the effect of exposure to violence. Kaplan-Meier survival analysis was used to determine the impact of Major Depressive Disorder on time to recidivism. Cox proportional hazard modeling was applied to examine Major Depressive Disorder as a moderator of exposure to violence. Results indicated that participants with Major Depressive Disorder demonstrate greater risk for recidivism post-adjudication. The proposed moderation effect was not supported.


2020 ◽  
pp. 181-218
Author(s):  
Bendix Carstensen

This chapter describes survival analysis. Survival analysis concerns data where the outcome is a length of time, namely the time from inclusion in the study (such as diagnosis of some disease) till death or some other event — hence the term 'time to event analysis', which is also used. There are two primary targets normally addressed in survival analysis: survival probabilities and event rates. The chapter then looks at the life table estimator of survival function and the Kaplan–Meier estimator of survival. It also considers the Cox model and its relationship with Poisson models, as well as the Fine–Gray approach to competing risks.


2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8511-8511 ◽  
Author(s):  
J. S. Temel ◽  
V. A. Jackson ◽  
A. Billings ◽  
H. G. Prigerson ◽  
P. Fidias ◽  
...  

8511 Background: The impact of emotional distress on cancer-related mortality is unclear. Divergent results in studies are due, in part, from heterogeneous populations in terms of type of cancer, stage of disease, and time of emotional assessment. This study examined the effect of depression and anxiety on a well-defined cohort of patients with newly diagnosed advanced NSCLC. Methods: 46 patients with advanced NSCLC were recruited within eight weeks of diagnosis to participate in a feasibility study of early palliative care. Participants completed the Hospital Anxiety and Depression Scale (HADS) at baseline and were followed for six months. The primary study endpoint was survival at six months. The effects of depression and anxiety were evaluated first by Kaplan-Meier survival analysis and then by Cox regression to control for other variables. Results: Three patients (6%) had stage IIIB with effusions and the remaining 43 (93%) had stage IV disease. The median age of patients was 65.5 years and 28 of the 46 (61%) were women. 34 patients had a PS 1 (74%), 11 (24%) had PS 0 and one (2%) had PS 2. 96% of the patients completed the baseline HADS. 23% met HADS criteria for probable cases of depression (8 or greater) at baseline and 34% met HADS criteria for probable cases of anxiety (8 or greater). Using Kaplan-Meier survival analysis, patients with depression were less likely to have survived at 6 months than non-depressed patients (50% versus 80%, log rank p=0.01). Baseline anxiety did not appear to impact survival. Using Cox proportional hazard regression analyses to control for stage, ECOG performance status, age, and gender, the effect of depression remained significant at p=0.03. Conclusion: Depression in newly diagnosed advanced NSCLC patients was associated with inferior survival in this well-defined patient population. Conversely, anxiety did not appear to be associated with mortality. These findings strengthen the argument that emotional distress influences survival. Larger prospective studies are needed to confirm this conclusion, explore possible mediators, and investigate the effects of treatment for depression. No significant financial relationships to disclose.


2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 4037-4037
Author(s):  
Maithili A Shethia ◽  
Aparna Hegde ◽  
Xiao Zhou ◽  
Michael J. Overman ◽  
Saroj Vadhan-Raj

4037 Background: Patients (pts) with pancreatic cancer are at high risk for VTE, and the occurrence of VTE can affect pts’ prognosis. The purpose of this study was to evaluate the incidence of VTE and the impact of timing of VTE (early vs. late) on survival. Methods: Medical record of 260 pts with pancreatic cancer, newly referred to UT MDACC during one year period from 1/1/2006 to 12/31/2006, were reviewed for the incidence of VTE during a 2-year follow-up period from the date of diagnosis. All VTE episodes were confirmed by radiologic studies. Survival analysis was conducted using Kaplan-Meier analysis and Cox proportional hazard models. Results: Of the 260 pts, 47 pts (18%) had 51 episodes of VTE during the 2-year follow-up. The median age of the pts with VTE was 61 years (range: 28-86) and 53% were males. Of the 47 pts with VTE, 27 (57%) had PE, 19 (40%) had DVT and 1 had concurrent PE/DVT. Three pts had recurrent VTE during the study period. Median follow-up time for OS was 192 days (range: 1-1652 days). Kaplan-Meier Survival analysis showed that those who developed VTE earlier (within 30 or 90 days) had shorter median overall survival (OS) compared with those who had VTE beyond these time points. The hazard ratios, 95% CI, and median OS at 1 year are summarized in the table below. Conclusions: The incidence of VTE is high in pts with pancreatic cancer. The timing of VTE had a significant impact on OS; pts who had an early development of VTE had a shorter overall survival. [Table: see text]


2006 ◽  
Author(s):  
Θεοδώρα Δημητρακοπούλου

The study of events involving an element of time has a long and important history in statistical research and practice. Survival analysis is a collection of statistical procedures for the analysis of data, where the response of interest is the time until an event occurs. Though such events may refer to any designated experience of interest, they are generally referred to as ‘failures’, whereas the time to their occurrences is referred to as ‘lifetime’ or ‘failure time’. Examples of failure times include the lifetimes of machine components in industrial reliability, the durations of strikes or periods of unemployment in economics, the times taken by subjects to complete specified tasks in psychological experimentation and the survival or remission times of patients in clinical trials.Generally speaking, the estimation, prediction or otimization of survival probabilities or life expectancies has become an issue of considerable interest in many different fields of human life and activity. Therefore, survival analysis has developed into an important tool for researchers in many areas, particularly, those involving biomedical studies and industrial life testing. This dissertation is occupied with continuous lifetime models. In this context, the first chapter, provides a short overview on the basic concepts o f survival analysis. Distribution representations of the time to failure are given when the life lengths are measured by a continuous nonnegative random variable and special emphasis is placed on the hazard function due to its intuitive appeal. In the sequel, several univariate popular lifetime distributions are presented and two specialized models designed to describe more complicated failure patterns (competing risks and frailty models) are briefly examined. The basic concepts of survival analysis for bivariate populations are considered next and the most popular bivariate lifetime distributions are reported. In the second chapter, various statistical properties and reliability aspects of a two parameter distribution with decreasing and increasing failure rates are explored. The model includes the Exponential-Geometric distribution (Adamidis and Loukas, 1988) as a special case. Characterizations are given and the estimation of parameters is studied by the method of maximum likelihood. An EM algorithm (Dempster et al., 1977) is proposed for computing the estimates and expressions for their asymptotic variances and covariances are derived. Numerical examples based on real data are shown, to illustrate the applicability of the new model. The results of this chapter are included in Adamidis et al. (2005).Though the most popular lifetime models are those with monotone hazard rates, when the entire life span of a biological entity or a manufactured item is under consideration, high initial and eventual failure rates are frequently observed, indicating a bathtub shaped failure rate (Gaver and Acar, 1979). Also, situations involving a high occurrence of early ‘failures’ are best modeled by distributions with upturned bathtub shaped hazard rates (Chhikara and Folks, 1977). In the third chapter, a three parameter lifetime distribution with increasing, decreasing, bathtub and upside down bathtub shaped failure rates is introduced. The new model includes the Weibull distribution as a special case. A motivation for its derivation is given using a competing risks interpretation when restricting its parametric space. Several of its statistical properties and reliability aspects are explored and the estimation of the parameters is studied using the standard maximum likelihood procedures. Applications of the model to real data are also included. The results of this chapter are included in Dimitrakopoulou et al. (2006 b). In the forth chapter, bivariate extensions of the model introduced in the second chapter are presented, along with the physical considerations leading to their derivation. Marginal and conditional distributions are obtained and their corresponding survival and hazard functions are calculated. The dependence in the proposed bivariate distributions is evaluated by means of the Pearson correlation coefficient. The models presented so far, implicitly assume that the population under study is homogeneous, an assumption which is often unrealistic in practice. However, heterogeneity is not only of interest in its own right but actually distorts what is observed. One o f the ways of assessing the impact of heterogeneity in mortality studies is via the concept of frailty introduced by Vaupel et al. (1979). When the multiplicative frailty model is underconsideration (e.g. Hougaard, 1984), the assumption of a gamma distributed frailty leads to the so called gamma frailty model. Chapter five, is devoted to exploiting some aspects of its relevant distribution theory. Failure rate characterizations are obtained and bounds on the survival function are constructed. Moreover, it is shown that the model can serve as a method of constructing lifetime models or extending existing ones (by adding a parameter in the sense of Marsall and Olkin, (1997)). Therefore, the investigation of its reliability aspects, provides a unified approach in studying lifetime distributions in a reliability context and a way of assessing the impact of the ‘average’ individual survival capacity - in the presence of heterogeneity - on what is actually observed. The results of this chapter are included in Dimitrakopoulou et al. (2006 a).


Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1151-1151
Author(s):  
Vivek Kesari ◽  
Maithili Shethia ◽  
Xiao Zhou ◽  
Michael Overman ◽  
Saroj Vadhan-Raj

Abstract Abstract 1151 Background: Patients (pts) with pancreatic cancer are at high risk for venous thromboembolic events (VTE) and the occurrence of VTE can adversely affect prognosis. However, it is unclear if the type of VTE such as symptomatic vs incidental, deep vein thrombosis (DVT) vs pulmonary embolism (PE), the location of VTE [DVT of extremities vs visceral veins (abdominal/pelvic veins)] or the timing of VTE from diagnosis can influence the survival. The purpose of this study was to evaluate the incidence of different types of VTE, the impact of types and timing of VTE (early vs late) on survival. Methods: Medical records of 260 pts with pancreatic cancer, newly referred to MDACC in 2006, were reviewed for cancer diagnosis, patient demographics (age, gender), presence of metastasis, the date of diagnosis of VTE, timing of VTE, type of VTE, the site of VTE, the incidence of VTE during 2 years of follow up from the date of diagnosis. Clinical and laboratory parameters predictive for survival were also reviewed. All VTE episodes, including symptomatic as well as incidental VTEs were confirmed by the radiological studies using CT ANGIO, CT scan, Doppler compression ultrasound or V/Q perfusion scans. The survival time was calculated from the date of cancer diagnosis to the date of last follow up. Survival analysis was conducted using Kaplan-Meier method and Cox proportional hazard models. The stepwise selection method was employed to build a multivariate model using variables with p<0.15 in univariate analysis. Results: Of the 260 pts referred, 235 were confirmed to have the diagnosis of pancreatic carcinoma. During the 2-year follow-up, 80 pts (34%) had 109 episodes of VTE, including symptomatic and incidental episodes. The median age of the pts with VTE was 59 years (range: 28–86) and 51% were males. Of the 80 pts with VTE, 21 (26%) had PE, 18 (23%) had DVT of extremities, 28 (35%) had DVT of visceral veins and 13 (16%) had concurrent PE/DVT (diagnosed on the same day). Of the 80 pts, 25 (31%) had 29 recurrent episodes. Kaplan-Meier survival analysis, as shown in the table below, indicated that the pts who had early VTE (defined as VTE diagnosed within 30 days from the date of diagnosis of pancreatic cancer) vs late VTE (> 30 days) and pts with metastasis vs no metastasis had statistically poor 1 year survival (log-rank test). Conclusions: These findings suggest that timing of VTE is an important indicator of prognosis, regardless of whether symptomatic or incidental. Patients with VTE within 30 days of diagnosis have shorter survival. Disclosures: No relevant conflicts of interest to declare.


2019 ◽  
Vol 18 (2) ◽  
pp. 215-222 ◽  
Author(s):  
A. B. Zulkarnaev

Survival analysis is one of the most common methods of statistical analysis in medicine. The statistical analysis of the transplantation (or death) probability dependent on the waiting time on the "waiting list" is a rare case when the survival analysis is used to estimate the time before the event rather than to indirectly assess the risks. However, for an assessment to be adequate, the reason for censoringmust be independent of the outcome of interest. Patients on the waiting list are not only at risk of dying, they can be excluded from the waiting list due to deterioration of the comorbid background or as a result of kidney transplantation. Kaplan – Meier, Nelson – Aalen estimates, as well as a cause-specific Cox proportional hazards regression model, are consciously biased estimates of survival in the presence of competing risks. Since competing events are censored, it is impossible to directly assess the impact of covariates on their frequency, because there is no direct relationship between the regression coefficients and the intensity of these events. The determination of the median waiting time on the basis of such analysis generates a selection bias, which inevitably leads to a biased assessment. Thus, in presence of competing risks, these methods allow us to investigate the features of cause-and-effect relationships, but do not allow us to make a prediction of the individual probability of a particular event based on the value of its covariates. In the regression model of competing risks, the regression coefficients are monotonically related to the cumulative incidence function and the competing events have a direct impact on the regression coefficients. Its significant advantage is the additive nature of the cumulative incidence functions of all possible events. In the study of etiological associations, it is better to use Cox regression model, which allows to estimate the size of the effect of various factors. The regression model of competing risks, in turn, has a greater prognostic value and allows to estimate the probability of a specific outcome within a certain time in a single patient.


2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e20016-e20016
Author(s):  
Laura Evans ◽  
Shaji Kumar ◽  
David Dingli ◽  
Angela Dispenzieri ◽  
Martha Lacy ◽  
...  

e20016 Background: An elevated serum LDH level is an adverse prognostic factor in NDMM. However, this category includes quantitative serum LDH levels that range from just over the upper limit of normal (ULN) to levels that may be 2 or more-fold higher than the ULN. This binary classification of serum LDH level of “normal versus elevated” fails to discriminate between the different disease biology that exists among NDMM patients with elevated serum LDH levels. Thus, we attempted to further stratify NDMM patients by the level of their serum LDH and determine its impact on OS. Methods: The cohort included patients diagnosed with NDMM from the Mayo Clinic, Rochester from 2003 - 2017 who were treated with novel agent induction therapy and had serum LDH levels measured at the time of diagnosis. The serum LDH levels were stratified into three levels: Normal (LDH < 222 U/L), Elevated (LDH 223-444 U/L), and Very Elevated (LDH >444 U/L or >2x upper limit of normal). Survival analysis was performed using the Kaplan-Meier survival analysis and compared via the log-rank method. Results: The cohort consists of 1,196 NDMM patients with a median age of 65 (22 – 95). R-ISS classification and cytogenetic risk were available for 968 and 970 patients respectively. The median serum LDH level was (162 U/L (3- 1260)) and an elevated LDH was present in 199 patients (17%). The median OS for patients with normal (N = 997; 83%), elevated (N = 170; 13%) and very elevated (N = 29; 3%) LDH levels were 76 months, 57 months and 23 months respectively (P < 0.001). The impact of these different levels of LDH on OS by R-ISS stage and cytogenetic risk is shown in the Table. Conclusions: A very small subset of NDMM patients has very elevated LDH levels that confer an exceptionally poor OS irrespective of R-ISS stage and cytogenetic risk. Future studies elucidating their disease biology responsible for such poor OS outcomes are warranted.[Table: see text]


2017 ◽  
Vol 62 (8) ◽  
pp. 5-18
Author(s):  
Beata Bieszk-Stolorz

The purpose of this article is to present selected methods of the survival analysis to evaluate the probability of leaving unemployment for the various types of competing risks. Complement to the unity of the Kaplan-Meier estimator, cumulative incidence function and cumulative conditional probability were used in the study. With these three estimators, the probability of deregistering caused by undertaking work, refusal and other causes were compared. The analysis was based on data from the Powiat Labour Office in Szczecin.


2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Anabela Malho Guedes ◽  
Roberto Calças ◽  
Ana Domingos ◽  
Teresa Jerónimo ◽  
Pedro Neves ◽  
...  

Abstract Background and Aims Survival analysis is a cornerstone in medical research. For this purpose Kaplan-Meier is the most widely used statistical test, but the presence of competing risks violates the fundamental assumption that the censoring mechanism is independent of survival time. This leads to overestimation of the cumulative probability of cause-specific failure. Cumulative incidence estimate and competing risks analysis are preferred. The purpose of this study was to compare different survival analysis methods: Kaplan-Meier and cumulative incidence function estimates in a cohort of Peritoneal Dialysis (PD) patients. Method The survival of 115 incident patients on PD in a university hospital was evaluated after establishing 2 cohorts: patients starting renal replacement therapy with PD (PD first; n=85) and patients switching to PD on the first 6 months of dialysis (PD transfer; n=30). Kaplan-Meier, cumulative incidence function, cause-specific and subdistribution hazards were performed. The event of interest was death and the competing risk events were transfer to hemodialysis and renal transplantation. Results Besides higher residual renal function (RRF) and kt/V in the PD first group, there were no other significant differences between groups. There were 22 deaths. PD first group had a better survival with both Kaplan-Meier (log-rank test, p=0.013) and cumulative incidence function (p=0.021) approaches. The Cox regression model showed, as protecting variables, higher albumin (HR=0.174; CI95% 0.054-0.562), higher RRF (HR=0.785; CI95% 0.666-0.925) and PD first (HR=0.350; CI95% 0.132-0.927). Higher Charlson Index predicted worse outcome (HR=1.459; CI95% 1.159-1.835). PD as first dialysis therapy was associated with 65.0 % lower risk of death comparing with PD transfer. The subdistribution multivariable model found higher Charlson Index (HR=1.389; CI95% 1.118-1.725) and lower RRF (HR=0.798; CI95% 0.680-0.936) were statistically associated with death, but not PD transfer or albumin. This result differs from the obtained using the cause-specific hazard model. Analyzing the competing events, patients submitted to renal transplantation had a lower Charlson Index. Conclusion The probability of death was overestimated by the Kaplan-Meier method. The bias of Kaplan-Meier is especially great when the hazard of the competing risks is large. This study consisted on a statistical critical analysis of a real medical example, broader clinical conclusions related with “PD first initiative” should be cautious in this context. It is primordial to recognize the presence of competing risks in studies with multiple outcomes, as in Peritoneal Dialysis studies, to estimate cumulative incidence and yield more accurate results. This study shows how different conclusions are attained with different statistical methodology and its relevance in clinical context.


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