Cumulative Incidence Function – How to extract the cumulative incidence, n(%) with 95% CI

competing-risksrsurvival

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I would like to replicate the above study in R on my own data, but I am not sure how to do it. How to extract the cumulative incidence, n(%) with 95% CI? I suppose the cumulative incidence is at the end of the study. and the fisher exact test probably calculated separately based on the n.

Best Answer

The authors of this paper aren't very clear about how they generated Table II for this study on graft-versus-host disease (GVHD), a common complication following hematopoietic cell transplantation. According to Table I, there were 88 patients in the Haplo group (haploidentical donor for transplantation) and 444 in the MUD group (matched unrelated donor). Given the $n$ values, the % values are simply with respect to those totals in each group, and the p-values are corresponding Fisher exact test results.

The question is where the $n$ values came from. The methods seem to imply that Fine-Gray models were set up for each type of GVHD separately, with death as a competing risk in each case. That could produce the GVHD incidence percentages (and CI), which would then be multiplied by the numbers in the corresponding groups and rounded to the nearest integer to get the $n$ values. It's not clear that a Fisher test on the resulting integer point estimates of $n$ values would then be appropriate; tests comparing the Haplo and MUD groups more directly based on the Fine-Gray estimates would seem to be preferable.

That could be a less-than-ideal approach if there can be transitions among the different types of GVHD (e.g., an acute-to-chronic transition). A true multi-state model representing all possible transitions among outcomes would seem to be preferable. In the next-to-last row, where analysis was restricted to those with chronic GVHD to evaluate sclerosis, the result with a separate Fine-Gray model might even be misleading: it's not clear how the competing risk of death was evaluated in terms of getting into the chronic GVHD group in the first place.

The multi-state vignette of the R survival package explains several ways to approach competing-risk analysis. The Fine-Gray competing risks approach, which "turn[s] the multi-state problem into a collection of two-state ones," is explained in detail in Section 4 of the vignette with illustration of how to format and analyze data for Fine-Gray. Be sure to read that Section carefully before you jump into the Fine-Gray analysis, however, as there are alternate approaches that might be superior.

If you are going to analyze your own data on this subject, I'd recommend working with a statistician with experience in multi-state survival modeling to see if a better type of analysis than that shown in this paper is possible.

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