A multi-state model for joint modelling of terminal and non-terminal events with application to Whitehall II

• Published in: Statistics in medicine Vol. 26; no. 2; pp. 426 - 442
• Main Authors: Siannis, F., Farewell, V. T., Head, J.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 30.01.2007; Wiley Subscription Services, Inc
• Subjects: Adult; Age Factors; Cardiovascular disease; Coronary Disease - epidemiology; Coronary Disease - mortality; Employment; Female; Humans; Male; Markov Chains; Medical statistics; Medicin och hälsovetenskap; Middle Aged; Models, Biological; Models, Statistical; multi-state models; semi-competing risks; Sex Factors; Statistical analysis; United Kingdom - epidemiology; Weibull models; England
• ISSN: 0277-6715; 1097-0258
• DOI: 10.1002/sim.2342

Serious coronary heart disease (CHD) is a primary outcome in the Whitehall II study, a large epidemiological study of British civil servants. Both fatal (F) and non‐fatal (NF) CHD events are of interest and while essentially complete information is available on F events, the observation of NF events is subject to potentially informative censoring. A multi‐state model with an unobserved state is introduced for the joint modelling of F and NF events. Two model‐based assumptions ensure identifiability of the model and a parameter is introduced to allow sensitivity analyses concerning the assumption linked to informative censoring. Weibull transition rates, which include dependence on explanatory variables, are used in the analysis of Whitehall II data with a particular focus on the relationship between civil service grade and CHD events. Copyright © 2005 John Wiley & Sons, Ltd.