Censoring for Loss to Follow-up in Time-to-event Analyses of Composite Outcomes or in the Presence of Competing Risks

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Abstract

BACKGROUND: In time-to-event analyses, there is limited guidance on when persons who are lost to follow-up (LTFU) should be censored. METHODS: We simulated bias in risk estimates for: (1) a composite event of measured (outcome only observable in a patient encounter) and captured events (outcome observable outside a patient encounter); and a (2) measured or (3) captured event in the presence of a competing event of the other type, under three censoring strategies: (i) censor at the last study encounter; (ii) censor when LTFU definition is met; and (iii) a new, hybrid censoring strategy. We demonstrate the real-world impact of this decision by estimating: (1) time to acquired immune deficiency syndrome (AIDS) diagnosis or death, (2) time to initiation of antiretroviral therapy (ART), and (3) time to death before ART initiation among adults engaged in HIV care. RESULTS: For (1) our hybrid censoring strategy was least biased. In our example, 5-year risk of AIDS or death was overestimated using last-encounter censoring (25%) and under-estimated using LTFU-definition censoring (21%), compared with results from our hybrid approach (24%). Last-encounter censoring was least biased for (2). When estimating 5-year risk of ART initiation, LTFU-definition censoring underestimated risk (80% vs. 85% using last-encounter censoring). LTFU-definition censoring was least biased for (3). When estimating 5-year risk of death before ART initiation, last-encounter censoring overestimated risk (5.2% vs. 4.7% using LTFU-definition censoring). CONCLUSIONS: The least biased censoring strategy for time-to-event analyses in the presence of LTFU depends on the event and estimand of interest.

Original languageEnglish (US)
Pages (from-to)817-824
Number of pages8
JournalEpidemiology (Cambridge, Mass.)
Volume30
Issue number6
DOIs
StatePublished - Nov 1 2019

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Lost to Follow-Up
Acquired Immunodeficiency Syndrome
Therapeutics
HIV

ASJC Scopus subject areas

  • Epidemiology

Cite this

@article{f40d50a15f4f4d508f25263433f9a3b2,
title = "Censoring for Loss to Follow-up in Time-to-event Analyses of Composite Outcomes or in the Presence of Competing Risks",
abstract = "BACKGROUND: In time-to-event analyses, there is limited guidance on when persons who are lost to follow-up (LTFU) should be censored. METHODS: We simulated bias in risk estimates for: (1) a composite event of measured (outcome only observable in a patient encounter) and captured events (outcome observable outside a patient encounter); and a (2) measured or (3) captured event in the presence of a competing event of the other type, under three censoring strategies: (i) censor at the last study encounter; (ii) censor when LTFU definition is met; and (iii) a new, hybrid censoring strategy. We demonstrate the real-world impact of this decision by estimating: (1) time to acquired immune deficiency syndrome (AIDS) diagnosis or death, (2) time to initiation of antiretroviral therapy (ART), and (3) time to death before ART initiation among adults engaged in HIV care. RESULTS: For (1) our hybrid censoring strategy was least biased. In our example, 5-year risk of AIDS or death was overestimated using last-encounter censoring (25{\%}) and under-estimated using LTFU-definition censoring (21{\%}), compared with results from our hybrid approach (24{\%}). Last-encounter censoring was least biased for (2). When estimating 5-year risk of ART initiation, LTFU-definition censoring underestimated risk (80{\%} vs. 85{\%} using last-encounter censoring). LTFU-definition censoring was least biased for (3). When estimating 5-year risk of death before ART initiation, last-encounter censoring overestimated risk (5.2{\%} vs. 4.7{\%} using LTFU-definition censoring). CONCLUSIONS: The least biased censoring strategy for time-to-event analyses in the presence of LTFU depends on the event and estimand of interest.",
author = "Catherine Lesko and Edwards, {Jessie K.} and Moore, {Richard D} and Lau, {Bryan M}",
year = "2019",
month = "11",
day = "1",
doi = "10.1097/EDE.0000000000001073",
language = "English (US)",
volume = "30",
pages = "817--824",
journal = "Epidemiology",
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TY - JOUR

T1 - Censoring for Loss to Follow-up in Time-to-event Analyses of Composite Outcomes or in the Presence of Competing Risks

AU - Lesko, Catherine

AU - Edwards, Jessie K.

AU - Moore, Richard D

AU - Lau, Bryan M

PY - 2019/11/1

Y1 - 2019/11/1

N2 - BACKGROUND: In time-to-event analyses, there is limited guidance on when persons who are lost to follow-up (LTFU) should be censored. METHODS: We simulated bias in risk estimates for: (1) a composite event of measured (outcome only observable in a patient encounter) and captured events (outcome observable outside a patient encounter); and a (2) measured or (3) captured event in the presence of a competing event of the other type, under three censoring strategies: (i) censor at the last study encounter; (ii) censor when LTFU definition is met; and (iii) a new, hybrid censoring strategy. We demonstrate the real-world impact of this decision by estimating: (1) time to acquired immune deficiency syndrome (AIDS) diagnosis or death, (2) time to initiation of antiretroviral therapy (ART), and (3) time to death before ART initiation among adults engaged in HIV care. RESULTS: For (1) our hybrid censoring strategy was least biased. In our example, 5-year risk of AIDS or death was overestimated using last-encounter censoring (25%) and under-estimated using LTFU-definition censoring (21%), compared with results from our hybrid approach (24%). Last-encounter censoring was least biased for (2). When estimating 5-year risk of ART initiation, LTFU-definition censoring underestimated risk (80% vs. 85% using last-encounter censoring). LTFU-definition censoring was least biased for (3). When estimating 5-year risk of death before ART initiation, last-encounter censoring overestimated risk (5.2% vs. 4.7% using LTFU-definition censoring). CONCLUSIONS: The least biased censoring strategy for time-to-event analyses in the presence of LTFU depends on the event and estimand of interest.

AB - BACKGROUND: In time-to-event analyses, there is limited guidance on when persons who are lost to follow-up (LTFU) should be censored. METHODS: We simulated bias in risk estimates for: (1) a composite event of measured (outcome only observable in a patient encounter) and captured events (outcome observable outside a patient encounter); and a (2) measured or (3) captured event in the presence of a competing event of the other type, under three censoring strategies: (i) censor at the last study encounter; (ii) censor when LTFU definition is met; and (iii) a new, hybrid censoring strategy. We demonstrate the real-world impact of this decision by estimating: (1) time to acquired immune deficiency syndrome (AIDS) diagnosis or death, (2) time to initiation of antiretroviral therapy (ART), and (3) time to death before ART initiation among adults engaged in HIV care. RESULTS: For (1) our hybrid censoring strategy was least biased. In our example, 5-year risk of AIDS or death was overestimated using last-encounter censoring (25%) and under-estimated using LTFU-definition censoring (21%), compared with results from our hybrid approach (24%). Last-encounter censoring was least biased for (2). When estimating 5-year risk of ART initiation, LTFU-definition censoring underestimated risk (80% vs. 85% using last-encounter censoring). LTFU-definition censoring was least biased for (3). When estimating 5-year risk of death before ART initiation, last-encounter censoring overestimated risk (5.2% vs. 4.7% using LTFU-definition censoring). CONCLUSIONS: The least biased censoring strategy for time-to-event analyses in the presence of LTFU depends on the event and estimand of interest.

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U2 - 10.1097/EDE.0000000000001073

DO - 10.1097/EDE.0000000000001073

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