JSM 2005 - Toronto

Abstract #303632

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Legend: = Applied Session, = Theme Session, = Presenter
Activity Number: 217
Type: Topic Contributed
Date/Time: Tuesday, August 9, 2005 : 8:30 AM to 10:20 AM
Sponsor: Section on Statistics in Epidemiology
Abstract - #303632
Title: Evaluating Racial Disparities in the Clinical Course of HIV Infection as Time-to-event Data Using Standardized Kaplan-Meier Estimation
Author(s): Felicia Hardnett*+ and John Karon and Lorena Espinoza
Companies: Centers for Disease Control and Prevention and Emergint Corporation and Centers for Disease Control and Prevention
Address: 1600 Clifton Road, Atlanta, GA, 30333, United States
Keywords: AIDS ; survival analysis ; Kaplan-Meier estimation ; racial disparities ; proportional hazards
Abstract:

We evaluated racial disparities in survival after AIDS diagnosis while adjusting for potential confounders using standardized Kaplan-Meier (SKM) estimation. We used the Therneau-Grambsch procedure to test the proportional hazards (PH) assumption. Of 44,909 AIDS cases diagnosed from 1996--2002 with HIV transmission attributed to heterosexual contact, 9,420 deaths were reported by the end of 2003. We used the entire population as the standard and adjusted for the potentially confounding effects of diagnosis year, age, gender, CD4 count, and geographic region of residence. The KM and SKM estimates were approximately equal at 12-month, 24-month, and 36-month survival time. Consequently, there was no evidence of confounding. The Therneau-Grambsch procedure rejected the PH assumption (p < .01), rendering any Cox model results suspect. The SKM procedure allowed for covariate adjustment without the assumption of proportionality. The SKM procedure also provided a means of comparing adjusted survival probabilities at specific survival times. As a result, we prefer the SKM procedure to check for confounding in KM estimates and as a complement to Cox model results when the PH assumption holds.

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