Time at risk and intention-to-treat analyses: parallels and implications for inference

Although the standard recommendation is to exclude person-time not at risk (ie, time during which the outcome could not have occurred) from the denominators of disease rates, there are scenarios where person-time not at risk should be included. In particular, we draw an analogy between including person-time not at risk and intention-to-treat (ITT) analyses of randomized trials, and excluding person-time not at risk and compliance-corrected analysis of these same trials. Excluding person-time not at risk is appropriate when addressing questions of the biologic or mechanistic effects of an exposure, whereas the ITT-type approach typically addresses questions regarding the effect of an exposure under observed compliance patterns. The choice of approach directly affects the causal question being addressed and subsequent inference, with potential implications for public health. When interested in estimating treatment effects that allow and account for potential noncompliance, or where the exposure may be associated with the time at risk, we argue that person-time not at risk should be included. In the case of time to pregnancy, although the ITT-type analysis may underestimate the biological fecundity of the population, it may also yield an answer to a question that is of more interest to couples trying to become pregnant.