T. Sturmer et al., Analytic strategies for recurrent events in epidemiologic studies: background and application to hospitalization risk in the elderly, J CLIN EPID, 53(1), 2000, pp. 57-64
Citations number
32
Categorie Soggetti
Envirnomentale Medicine & Public Health","Medical Research General Topics
Due to the intraindividual dependence, specific analytic strategies are nee
ded to assess risk factors for recurrent events. Although well established
in the biostatistics literature, applications of these techniques are almos
t nonexistent in the field of epidemiology. The authors applied four differ
ent regression approaches for recurrent events (logistic, Poisson, and two
different Cox proportional hazards regressions) to derive rate ratios of ho
spitalizations for various prognostic factors in a cohort of 2424 frail eld
erly. Over a median follow-up of 670 days, 3299 hospitalizations were obser
ved in 1564 persons. Estimated rate ratios were similar in all four approac
hes and virtually identical in three. With all methods, confidence interval
s of the rate ratios were considerably wider than with naive Poisson regres
sion neglecting intraindividual dependence of events. Appropriate analysis
of recurrent events is feasible with minor modifications of multivariable m
odels familiar to epidemiologists and should no longer be neglected in epid
emiologic research. In our setting, Poisson regression was the most conveni
ent approach. (C) 2000 Elsevier Science Inc. All rights reserved.