Survival – Treat Censoring as a Competing Risk and Use Multinomial Logit

censoringcompeting-risksmultinomial logitsurvival

Suppose I am modeling survival with the hazard rate specified using logistic regression, and the model is adequate for the data. Now add censoring, and the model formulation becomes a bit more cumbersome and the implementation a bit more involved. That holds if we assume censoring to be independent of the survival process, but I guess gets even worse if we relax that assumption.

On the other hand, could we perhaps treat censoring as a competing risk and go for a multinomial logit model? Both interpretation and implementation would be pleasantly easy again. Moreover, I think we would not have to assume the survival and censoring processes to be independent.

Is it an OK approach, or am I missing something (perhaps some implicit assumptions that can be problematic)?

Best Answer

What's typically of interest in survival analysis is the process underlying the distribution of events in time. The tools of survival analysis are designed to deal with missing (censored) event times in a way that provides reliable estimates of the event process itself.

What you describe is a model of whether you observe an event or a censoring time. By itself it wouldn't directly describe the event process if censoring is informative. The review by Leung et al. provides an introduction the problems introduced by making incorrect assumptions about censoring.

Modeling the distribution of censoring times, however, can be a first step toward dealing with potentially informative censoring. As Tutz and Schmid explain in Chapter 4, inversely weighting cases with respect to their probabilities of having been censored over time (inverse probability of censoring weighting, IPCW) can "'reconstruct' the characteristics of the unknown [due to censoring] full data sample by using the weights" (page 89).

Although Tutz and Schmid present IPCW in the context of estimating prediction errors, in some circumstances it can correct for informative censoring. Robins and Finkelstein illustrate this in "Correcting for Noncompliance and Dependent Censoring in an AIDS Clinical Trial with Inverse Probability of Censoring Weighted (IPCW) Log-Rank Tests," Biometrics 56: 779-788 (2000).

HernĂ¡n and Robins devote much of their book "Causal Inference: What If" to the problems introduced by censoring. Chapters 8 and 12 explain the problems for analysis that doesn't explicitly involve time (e.g., continuous or binary outcomes when some individuals are lost to follow up); Chapters 21 and 22 cover situations where censoring is a function of time, as in survival analysis.

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