Información de la revista
Vol. 13. Núm. 5.
Páginas 399-406 (Septiembre - Octubre 1999)
Respuestas rápidas
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 13. Núm. 5.
Páginas 399-406 (Septiembre - Octubre 1999)
DOI: 10.1016/S0213-9111(99)71391-9
Open Access
Riesgos competitivos de muerte
Visitas
...
J. Llorca*, M. Delgado-Rodríguez
Cátedra de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Cantabria
Este artículo ha recibido
No disponible
Visitas
(Actualización diaria de datos)

Under a Creative Commons license
Información del artículo
Resumen

La muerte de un individuo no es un hecho repetitivo, de suerte que si una causa de adelanta a otra para ocasionar la muerte del individuo, las tasas de mortalidad de la causa adelantada necesariamente disminuirán. Este fenómeno es conocido como riesgos competitivos de muerte y debe ser tenido en cuenta en cualquier análisis de mortalidad específica por causas. En este trabajo se formaliza el concepto de riesgos competitivos y se apuntan algunos datos sobre su historia; se presentan las principales herramientas para el análisis paramétrico de los riesgos competitivos, con especial atención a las funciones de Gompertz y Weibull. En cuanto a los modelos no paramétricos, se desarrolla especialmente el método de Chiang y se discute su aplicabilidad en causas de muerte dependientes e independientes. Finalmente, se enumeran otros instrumentos útiles especialmente en la epidemiología clínica, incluyendo la regresión de Cox, los métodos de Kaplan-Meier y de los rangos logarítmicos, y las interacciones entre el sesgo de riesgos competitivos y los sesgos de mala clasificación y selección.

Palabras clave:
Mortalidad
riesgos competitivos
métodos epidemiológicos
causas de muerte
Summary

The death of an individual is not a repetitive event, so if a cause of death overtakes another cause in producing death, mortality rates from the overtaken cause decrease. This phenomenon is known as competing risks of death and it must be taken into account in any cause-specific mortality analysis. In this work the competing risks concept is formalized and some historical data are described. The main parametric tools to analyze competing risks are displayed, with a special look at the Gompertz and Weibull functions. Regarding non-parametric models, the Chiang method is shown and its applicability on both dependent and independent causes of death is discussed. Finally, other tools specially useful in clinical epidemiology are enumerated, including Cox regresion, Kaplan-Meier and log-rank methods, as well as the interactions between competing risks and misclassification and selection biases.

El Texto completo está disponible en PDF
Biblografía
[1.]
J.E. Riggs.
Age-specific mortality rate comparisons: is there a fallacy?.
J Clin Epidemiol, 1 (1994), pp. 463-464
[2.]
R.L. Prentice, J.D. Kalbfleisch, A.V. Peterson Jr., N. Flournoy, V.T. Farewell, N.E. Breslow.
The analysis of failure times in the presence of competing risks.
Biometrics, 34 (1978), pp. 541-554
[3.]
W.D. Hardy, J. Feinberg, D.M. Finkelstein, M.E. Power, W. He, C. Kaczka, et al.
A controlled trial of trimethoprim-sulfamethoxazole or aerosolized pentamidine for secondary prophylaxis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome.
New Eng J Med, 327 (1992), pp. 1842-1848
[4.]
D. Bernoulli.
Essai d'une nouvelle analyse de la mortalité causée par la petite verole et des avantages de l'inoculation pour la prévenir. Historie avec les Memoire.
pp. 1-45
[5.]
N.M. Karn.
An inquiry into various death rates and the comparative influence of certain diseases on the duration of life.
Ann Eugen, 4 (1931), pp. 27-36
[6.]
I. Todhunter.
A History of the Mathematical Theroy of Probability.
Chelsea, (1865),
[7.]
E.F. Spurgeon.
Life Contingencies.
Cambridge Univ Press, (1922),
[8.]
E. Fix, J. Neyman.
A simple stochastic model of recovery, relapse, death and loss of patients.
Hum Biol, 23 (1951), pp. 205-241
[9.]
J. Cornfield.
The estimation of the probabilities of developing a disease in the presence of competing risks.
Am J Public Health, 47 (1957), pp. 601-607
[10.]
J. Benichou, M.H. Gail.
Estimates of absolute cause-specific risks in cohort studies.
Biometrics, 46 (1990), pp. 813-826
[11.]
M.L. Moeschberger, H.A. David.
Life tests under competing causes of failure and the theory of competing risks.
Biometrics, 27 (1971), pp. 909-933
[12.]
J.J. Dirnam, L.A. Weissfeld, S.J. Anderson.
Methods for bounding the marginal survival distribution.
Stat Med, 14 (1995), pp. 1985-1998
[13.]
K.J. Rothman, S. Greenland.
Modern Epidemiology.
Lippincott-Raven, (1998),
[14.]
B. Gompertz.
On nature of the function expressive of the law of human mortality.
Phil Trans R Soc Lond, (1825), pp. 513-585
[15.]
E.T. Lee, O.T. Go.
Survival analysis in public health research.
Annu Rev Public Health, 18 (1997), pp. 105-134
[16.]
A.B. Cantor.
Sample size calculations for the log rank test: a Gompertz model approach.
J Clin Epidemiol, 45 (1992), pp. 1131-1136
[17.]
L.D. Mueller, M.R. Rose, T.J. Nusbaum.
The Gompertz equation as a predictive tool in demography.
Exp Gerontol, 30 (1995), pp. 553-569
[18.]
K. Rygaard, M. Spang-Thomsen.
Quantitation and Gompertzian analysis of tumor growth.
Breast Cancer Res Treat, 46 (1997), pp. 303-312
[19.]
A. Messori, E. Tendi, G. Trallori, M. Costantini, L. Bonistalli.
Costeffectiveness of adjuvant intraportal chemotherapy in patients with colorectal cancer.
J Clin Gastroenterol, 23 (1996), pp. 269-274
[20.]
M. Akahoshi, K. Yano, S. Seto, K. Shimaoka, E. Nakashima, R.L. Carter, et al.
Correlation between systolic blood pressure and physical development in adolescence.
Am J Epidemiol, 144 (1996), pp. 51-58
[21.]
B.L. Strehler, A.S. Mildvan.
General theory of mortality and aging.
Science, 132 (1960), pp. 14-21
[22.]
J.E. Riggs.
The dynamics of aging and mortality in the United States, 1900–1988.
Mech Ageing Dev, 66 (1992), pp. 45-57
[23.]
M.D. Prieto, J. Llorca, M. Delgado-Rodríguez.
Longitudinal Gompertzian and Weibull analyses of adult mortality in Spain (Europe), 1900-1992.
Mech Ageing Dev, 90 (1996), pp. 35-51
[24.]
J. Llorca, M.D. Prieto, M. Delgado-Rodríguez.
Análisis longitudinal gompertziano de la mortalidad por cáncer de pulmón en España.
Gac Sanit (en prensa), (1950–1991),
[25.]
Y. Imaizumi.
Longitudinal analysis of mortality from breast cancer in Japan, 1950–1993: fitting Gompertz and Weibull functions.
Mech Ageing Dev, 88 (1996), pp. 169-183
[26.]
J. Llorca, M.D. Prieto, M. Delgado-Rodríguez.
Increase in cervical cancer mortality in Spain.
J Epidemiol Community Health (en prensa), (1951–1991),
[27.]
J.E. Riggs.
Longitudinal Gompertzian analysis of prostate cancer mortality in the U.S., 1962–1987: a method of demonstrating relative environmental, genetic and competitive influences upon mortality.
Mech Ageing Dev, 60 (1991), pp. 243-253
[28.]
J.E. Riggs.
The decline of mortality due to stroke: A competitive and deterministic perspective.
Neurology, 41 (1991), pp. 1335-1338
[29.]
J. Llorca, M.D. Prieto, M. Delgado-Rodríguez.
Análisis gompertziano de la mortalidad por cardiopatía isquémica en España, 1951-1992.
Rev Esp Cardiol, 51 (1998), pp. 467-472
[30.]
J.E. Riggs.
The nonenvironmental basis for rising mortality from Parkinson's disease.
Arch Neurol, 50 (1993), pp. 653-656
[31.]
H. Gilbert Welch, P.C. Albertsen, R.F. Nease, T.A. Bubolz, J.H. Wasson.
Estimating treatment benefits for the elderly: the effect of competing risks.
Ann Intern Med, 124 (1996), pp. 577-584
[32.]
D.A. Juckett, B. Rosenberg.
Comparison of the Gompertz and Weibull functions as descriptors for human mortality distributions and their intersections.
Mech Ageing Dev, 69 (1993), pp. 1-31
[33.]
S. Matsushita, K. Hagiwara, T. Shiota, H. Shimada, K. Kuramoto, Y. Toyokura.
Lifetime data analysis of disease and aging by the Weibull probability distribution.
J Clin Epidemiol, 45 (1992), pp. 1165-1175
[34.]
W.K. Cavenee, R.L. White.
Genetic bases of cancer.
Sci Am, 224 (1995), pp. 44-51
[35.]
M.D. Prieto.
Análisis gompertziano y de Weibull de la mortalidad en España 1900–1992.
Universidad de Cantabria, (1996),
[36.]
M.L. Moeschberger, H.A. David.
Life tests under competing cuases of failure and the theory of competing risks.
Biometrics, 27 (1971), pp. 909-933
[37.]
D.A. Juckett, B. Rosenberg.
Comparison of the Gompertz and Weibull functions as descriptors for human mortality distributions and their intersections.
Mech Ageing Dev, 69 (1993), pp. 1-31
[38.]
M. Lunn, D. McNeil.
Applying Cox regression to competing risks.
Biometrics, 51 (1995), pp. 524-532
[39.]
V. Mor, O. Intrator, B.E. Fries, C. Phillips, J. Teno, J. Hiris, C. Hawes, et al.
Changes in hospitalization associated with introducing the Resident Assessment Instrument.
J Am Geriatr Soc, 45 (1997), pp. 1002-1010
[40.]
A. Krongrad, H. Lai, S. Lai.
Competing risks of mortality in prostate cancer.
J Urol, 158 (1997), pp. 865-868
[41.]
C.L. Chiang.
Competing risks in mortality analysis.
Annu Rev Publ Health, 12 (1991), pp. 281-307
[42.]
S.J. Olshansky.
Pursuing longevity: delay vs elimination of degenerative diseases.
Am J Public Health, 75 (1985), pp. 754-757
[43.]
R.B. Rothenberg.
Competing mortality and progress against cancer.
Epidemiology, 5 (1994), pp. 197-203
[44.]
K.J. Rothman.
Causes.
Am J Epidemiol, 104 (1976), pp. 587-592
[45.]
J.E. Riggs.
Competing mortality riks and differential survival.
J Clin Epidemiol, 48 (1995), pp. 1087-1088
[46.]
D.C. Mcgiffin, D.C. Naftel, J.K. Kirklin, W.R. Morrow, J. Towbin, R. Shaddy, et al.
Predicting outcome after listing for heart transplantation in children: comparison of Kaplan-Meier and parametric competing risk analysis. Pediatric Heart Trasplant Study Group.
J Heart Lung Transplant, 16 (1997), pp. 713-722
[47.]
D.Y. Lin.
Non-parametric inference for cumulative incidence functions in competing risks studies.
Stat Med, (1997), pp. 901-910
[48.]
N. Ebrahimi.
The effects of misclassification of the actual cause of death in competing risks analysis.
[49.]
A. Schatzkin, E. Slud.
Competing risks bias arising from an omitted risk factor.
Am J Epidemiol, 129 (1989), pp. 850-856
[50.]
Q. Yi, L.T. Glickman.
Computer simulation analysis of Sartwell's incubation period model for diseases with uncertain etiology.
Am J Epidemiol, 142 (1995), pp. 363-368
[51.]
R.E. Fusaro, P. Bacchetti, N.P. Jewell.
A competing risks analysis of presenting AIDS diagnoses trends.
Biometrics, 52 (1996), pp. 211-225
Copyright © 1999. Sociedad Española de Salud Pública y Administración Sanitaria
Idiomas
Gaceta Sanitaria

Suscríbase a la newsletter

Opciones de artículo
Herramientas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.