Abstract：
BACKGROUND:With linked register and cause of death data becoming more accessible than ever, competing risks methodology is being increasingly used as a way of obtaining "real world" probabilities of death broken down by specific causes. It is important, in terms of the validity of these studies, to have accurate cause of death information. However, it is well documented that cause of death information taken from death certificates is often lacking in accuracy and completeness. METHODS:We assess through use of a simulation study the effect of under and over-recording of cancer on death certificates in a competing risks analysis consisting of three competing causes of death: cancer, heart disease and other causes. Using realistic levels of misclassification, we consider 24 scenarios and examine the bias in the cause-specific hazard ratios and the cumulative incidence function. RESULTS:The bias in the cumulative incidence function was highest in the oldest age group reaching values as high as 2.6 percentage units for the "good" cancer prognosis scenario and 9.7 percentage units for the "poor" prognosis scenario. CONCLUSION:The bias resulting from the chosen levels of misclassification in this study accentuate concerns that unreliable cause of death information may be providing misleading results. The results of this simulation study convey an important message to applied epidemiological researchers.
journal_name
Cancer Epidemioljournal_title
Cancer epidemiologyauthors
Hinchliffe SR,Abrams KR,Lambert PCdoi
10.1016/j.canep.2012.08.012subject
Has Abstractpub_date
2013-02-01 00:00:00pages
11-9issue
1eissn
1877-7821issn
1877-783Xpii
S1877-7821(12)00128-2journal_volume
37pub_type
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