Abstract Background We evaluate three methods for competing risks analysis with time-dependent covariates in comparison with the corresponding methods with time-independent covariates. Methods We used cause-specific hazard analysis and two summary approaches for in-hospital death: logistic regression and regression of the subdistribution hazard. We analysed real hospital data (n=1864) and considered pneumonia on admission / hospital-acquired pneumonia as time-independent / time-dependent covariates for the competing events ’discharge alive’ and ’in-hospital death’. Several simulation studies with time-constant hazards were conducted. Results All approaches capture the effect of time-independent covariates, whereas the approaches perform differently with time-dependent covariates. The subdistribution approach for time-dependent covariates detected effects in a simulated no-effects setting and provided counter-intuitive effects in other settings. Conclusions The extension of the Fine and Gray model to time-dependent covariates is in general not a helpful synthesis of the cause-specific hazards. Cause-specific hazard analysis and, for uncensored data, the odds ratio are capable of handling competing risks data with time-dependent covariates but the use of the subdistribution approach should be neglected until the problems can be resolved. For general right-censored data, cause-specific hazard analysis is the method of choice.

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timeconstant hazards causespecific hazards causespecific hazard analysis odds ratio fine and gray model summary approaches competing events discharge alive and inhospital noeffects subdistribution approach competing risks analysis timeindependent timedependent covariates real hospital data inhospital death logistic regression and regression of the subdistribution hospitalacquired pneumonia

Inga Poguntke,Martin Schumacher,Jan Beyersmann,Martin Wolkewitz,.Simulation shows undesirable results for competing risks analysis with time-dependent covariates for clinical outcomes. 18 (1),.

Inga Poguntke,Martin Schumacher,Jan Beyersmann,Martin Wolkewitz,"Simulation shows undesirable results for competing risks analysis with time-dependent covariates for clinical outcomes" 18

Inga Poguntke,Martin Schumacher,Jan Beyersmann,Martin Wolkewitz,"Simulation shows undesirable results for competing risks analysis with time-dependent covariates for clinical outcomes"