Attributable risk estimation for adjusted disability multistate models: application to nosocomial infections.

نویسندگان

  • Jean-François Coeurjolly
  • Moliere Nguile-Makao
  • Jean-François Timsit
  • Benoit Liquet
چکیده

Attributable risk has become an important concept in clinical epidemiology. In this paper, we suggest to estimate the attributable risk of nosocomial infections using a multistate approach. Recently, a multistate model (called progressive disability model in the literature) has been developed in order to take into consideration both the time-dependency of the risk factor (e.g., nosocomial infections) and the presence of competing risks (e.g., death and discharge) at each time point. However, this approach does not take into account the possible heterogeneity of the study population. In this paper, we investigate an extension of this model and suggest an adjusted disability multistate model including covariates in each transition. This new multistate model has led us to define the concepts of overall and profiled attributable risk. We use a classical semiparametric approach to estimate the model and the new attributable risk. A simulation study is investigated and we show, in particular, that neglecting the presence of covariates when estimating the model can lead to an important bias. The methodology developed in this paper is applied to data on ventilator-associated pneumonia in 12 French intensive care units.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Attributable mortality due to nosocomial infections. A simple and useful application of multistate models.

OBJECTIVES Nosocomial infections constitute a major medical problem leading to increased morbidity and mortality of patients. Besides prolongation of length of hospital stay, hospital mortality attributable to those infections is often the quantity of interest when describing their impact and consequences. Since occurrence of nosocomial infections is a time-dynamic process, estimation of this q...

متن کامل

Burden of Disease Attributable to Suboptimal Breastfeeding in Iran during 1990-2010; Findings from the Global Burden of Disease Study 2010

Background: This study uses data of the global burden of diseases (GBD) study 2010 to report death, disability-adjusted life year (DALYs), years of life lived with disability (YLDs) and years of life lost due to premature mortality (YLLs), attributed to suboptimal breastfeeding by age and gender during 1990 to 2010 in Iran. Materials and Methods:The GBD assessments were used, together with esti...

متن کامل

A multistate model to project elderly disability in case of limited data

BACKGROUND Prevalence of disability depends on when a person becomes disabled (disability incidence) and when he or she dies (mortality). Multistate projection models can take into account both underlying processes of disability prevalence. The application of these models, however, is often hampered by high data requirements. OBJECTIVE This paper describes a generic estimation procedure for cal...

متن کامل

Risk factors for C-section delivery and population attributable risk for C-section risk factors in Southwest of Iran: a prospective cohort study

Background: Iran has a high C-section rate (40.6% in 2005). The objective of this study was to assess the associations and population-attributable risks (PAR) of risk factors combinations and C-section in the Southwest Iran. Methods: We performed a population-based cohort study using the reports provided by Shiraz University of Medical Sciences. The cohort included pregnant women within Sept...

متن کامل

Epidemiology and Burden of Bloodstream Infections Caused by Extended-Spectrum Beta-Lactamase Producing Enterobacteriaceae in a Pediatric Hospital in Senegal.

CONTEXT Severe bacterial infections are not considered as a leading cause of death in young children in sub-Saharan Africa. The worldwide emergence of extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-E) could change the paradigm, especially in neonates who are at high risk of developing healthcare-associated infections. OBJECTIVE To evaluate the epidemiology and the burden ...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • Biometrical journal. Biometrische Zeitschrift

دوره 54 5  شماره 

صفحات  -

تاریخ انتشار 2012