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Semicompeting risks in aging research: methods, issues and needs.

Ravi Varadhan1, Qian-Li Xue, Karen Bandeen-Roche

  • 1Division of Geriatric Medicine and Gerontology, The Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA, ravi.varadhan@jhu.edu.

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Semicompeting risks, common in aging studies, involve nonterminal and terminal events like dementia and death. This review surveys methods to improve their use in aging research.

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Area of Science:

  • Biostatistics
  • Gerontology
  • Epidemiology

Background:

  • Semicompeting risks, involving nonterminal and terminal events (e.g., dementia and death), are prevalent in aging research.
  • These risks can preclude the occurrence of the primary nonterminal event of interest.
  • Examples include frailty, disability, and nursing home placement, all potentially followed by death.

Purpose of the Study:

  • To describe semicompeting risks problems in aging research.
  • To survey existing semicompeting risks methodologies.
  • To suggest methods and facilitate broader adoption in biomedical and gerontological research.

Main Methods:

  • Review of semicompeting risks models, categorized into observable quantities (class [Formula: see text]) and latent failure times (class [Formula: see text]).
  • Discussion of the classical illness-death model as a multistate model.
  • Examination of recent methodological developments in latent failure time models.

Main Results:

  • Despite methodological advances, semicompeting risks methods are underutilized in biomedical and gerontological research.
  • Identified barriers include method sophistication, conceptual challenges, lack of practitioner-focused articles, and software unavailability.
  • The review aims to bridge this gap by providing a survey and suggesting adoption strategies.

Conclusions:

  • Semicompeting risks methodology requires greater accessibility and understanding within the aging research community.
  • Addressing conceptual and practical barriers is crucial for effective application.
  • Further work is needed to develop user-friendly tools and educational resources to promote uptake.