{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T13:13:28Z","timestamp":1787318008285,"version":"build-2736575974"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2022,2,1]],"date-time":"2022-02-01T00:00:00Z","timestamp":1643673600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The Fine-Gray subdistribution hazard model is frequently used in the cardiovascular literature to estimate subject-specific probabilities of the occurrence of an event of interest over time in the presence of competing risks. A little-known limitation of this approach is that, for some subjects and for some time points, the sum of the subject-specific probabilities for the different event types (eg, cardiovascular and noncardiovascular death) can exceed one.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We used data on 8238 patients hospitalized with congestive heart failure in Ontario, Canada. We fit 2 Fine-Gray subdistribution hazards models, one for cardiovascular death and one for noncardiovascular death and estimated the probability of death due to each cause within 5 years of hospital admission. We also fit 2 cause-specific hazard models for the 2 event types and combined the estimated cause-specific hazard functions to obtain subject-specific estimates of the probabilities of each of the 2 event types occurring within 5 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>When adding the probabilities of 5-year cardiovascular death and 5-year noncardiovascular death obtained from the Fine-Gray subdistribution hazard models, 8.6% of subjects had an estimated probability of 5-year all-cause mortality that exceeded 1 (100%). This problem was avoided by fitting 2 cause-specific hazard models, one for each outcome type, and combining the estimated cause-specific hazard functions to obtain subject-specific estimates of the risk of cardiovascular and noncardiovascular death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The Fine-Gray subdistribution hazard model may be problematic to use for a comprehensive assessment of absolute risks of multiple outcomes, while the combination of 2 cause-specific hazard models shows better statistical behaviour. Cause-specific modeling should not be discarded in competing risk situations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circoutcomes.121.008368","type":"journal-article","created":{"date-parts":[[2022,1,31]],"date-time":"2022-01-31T05:02:33Z","timestamp":1643605353000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":36,"title":["Estimation of the Absolute Risk of Cardiovascular Disease and Other Events: Issues With the Use of Multiple Fine-Gray Subdistribution Hazard Models"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3337-233X","authenticated-orcid":true,"given":"Peter C.","family":"Austin","sequence":"first","affiliation":[{"name":"ICES, Toronto, Ontario, Canada (P.C.A., D.S.L.)."},{"name":"Institute of Health Management, Policy and Evaluation (P.C.A., D.S.L.), University of Toronto, Ontario, Canada."},{"name":"Sunnybrook Research Institute, Toronto, Ontario, Canada (P.C.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5395-1422","authenticated-orcid":true,"given":"Hein","family":"Putter","sequence":"additional","affiliation":[{"name":"Department of Biomedical Data Sciences, Leiden University Medical Centre, the Netherlands (H.P., E.W.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7078-745X","authenticated-orcid":true,"given":"Douglas S.","family":"Lee","sequence":"additional","affiliation":[{"name":"ICES, Toronto, Ontario, Canada (P.C.A., D.S.L.)."},{"name":"Institute of Health Management, Policy and Evaluation (P.C.A., D.S.L.), University of Toronto, Ontario, Canada."},{"name":"Department of Medicine (D.S.L.), University of Toronto, Ontario, Canada."},{"name":"Peter Munk Cardiac Centre and University Health Network, Toronto, Ontario, Canada (D.S.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7787-0122","authenticated-orcid":true,"given":"Ewout W.","family":"Steyerberg","sequence":"additional","affiliation":[{"name":"Department of Biomedical Data Sciences, Leiden University Medical Centre, the Netherlands (H.P., E.W.S.)."},{"name":"Department of Public Health, Erasmus MC, Rotterdam, the Netherlands (E.W.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.2712"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwp107"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4384"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehu131"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0b013e3181a39056"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.017719"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3181d99107"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1080\/01621459.1999.10474144"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/9781118032985"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab423"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.119.006539"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.180462"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2021.05.003"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.1731"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.3006"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.7501"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jchf.2017.03.012"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2009.11.029"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-156-3-201202070-00007"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.115.002414"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4614-2035-4"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.9023"},{"key":"e_1_3_2_24_2","unstructured":"Therneau T Crowson C Atkinson E. 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