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目的介绍原因别竞争风险模型原理及其在健康风险评估中的应用。方法围绕慢性病风险评估广泛存在竞争风险这一问题,对比传统的Cox模型,分别从建模原理、参数估计等方面介绍原因别竞争风险,进一步结合山东多中心出血性脑卒中病例随访队列,阐明原因别竞争风险模型的实际应用和效果。结果在竞争风险框架下,原因别风险模型针对不同的原因别结局分别建立Cox类(Cox-type)生存分析模型,在参数和累积风险函数估计上,沿用了经典的偏似然函数方法,保证了估计量的相合性和有效性,为精确计算绝对风险奠定了基础。依托山东多中心出血性脑卒中病例随访队列,将其用于脑卒中死亡结局风险评估,显示出良好的实用性。结论在健康风险评估中,当竞争风险不容忽视时,可选取原因别竞争风险模型消除竞争风险的影响,避免产生错误的结论。
Objective To introduce the reasoning competitive risk model and its application in health risk assessment. Methods There is a widespread competitive risk around chronic disease risk assessment. Compared with the traditional Cox model, this paper introduces the reasons for the risk of non-competition from the modeling principle and parameter estimation, and further combined with the follow-up cohort of Shandong polycentric hemorrhagic stroke patients to clarify the reasons The Practical Application and Effect of Non-competition Risk Model. Results Under the framework of competitive risk, the risk-free model of the reasoning established Cox-type survival analysis model for different causes and outcomes respectively, and adopted the classical partial likelihood function method to guarantee the parameter and cumulative risk function. The coincidence and validity of the estimators have laid the foundation for accurate calculation of absolute risk. Relying on Shandong multi-center hemorrhagic stroke follow-up cohort, its risk assessment for the death outcome of stroke, showing good utility. Conclusion In the health risk assessment, when the competition risk can not be ignored, the competitive risk model can be selected to eliminate the influence of competition risk and avoid the wrong conclusion.