Survival prediction models: an introduction to discrete-time modeling.

Background: Prediction models for time-to-event outcomes are commonly used in biomedical research to obtain subject-specific probabilities that aid in making important clinical care decisions. There are several regression and machine learning methods for building these models that have been designed...

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Published in:BMC Medical Research Methodology Vol. 22; no. 1; pp. 1 - 19
Main Authors: Suresh, Krithika, Severn, Cameron, Ghosh, Debashis
Format: research Journal Article
Published: BioMed Central 7/26/2022
Online Access:View this record in EBSCOhost
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      dt: 7/26/2022
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      pub: BioMed Central
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        158381161
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        10.1186/s12874-022-01679-6
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        atl: Survival prediction models: an introduction to discrete-time modeling.
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          Suresh, Krithika
          Severn, Cameron
          Ghosh, Debashis
        affil: Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, USA
      sug:
        subj:
          Algorithms
          Software
          Human
          Multivariate Analysis
          Cox Proportional Hazards Model
          Comparative Studies
          Multicenter Studies
          Evaluation Research
          Validation Studies
          Scales
      ab: Background: Prediction models for time-to-event outcomes are commonly used in biomedical research to obtain subject-specific probabilities that aid in making important clinical care decisions. There are several regression and machine learning methods for building these models that have been designed or modified to account for the censoring that occurs in time-to-event data. Discrete-time survival models, which have often been overlooked in the literature, provide an alternative approach for predictive modeling in the presence of censoring with limited loss in predictive accuracy. These models can take advantage of the range of nonparametric machine learning classification algorithms and their available software to predict survival outcomes.Methods: Discrete-time survival models are applied to a person-period data set to predict the hazard of experiencing the failure event in pre-specified time intervals. This framework allows for any binary classification method to be applied to predict these conditional survival probabilities. Using time-dependent performance metrics that account for censoring, we compare the predictions from parametric and machine learning classification approaches applied within the discrete time-to-event framework to those from continuous-time survival prediction models. We outline the process for training and validating discrete-time prediction models, and demonstrate its application using the open-source R statistical programming environment.Results: Using publicly available data sets, we show that some discrete-time prediction models achieve better prediction performance than the continuous-time Cox proportional hazards model. Random survival forests, a machine learning algorithm adapted to survival data, also had improved performance compared to the Cox model, but was sometimes outperformed by the discrete-time approaches. In comparing the binary classification methods in the discrete time-to-event framework, the relative performance of the different methods varied depending on the data set.Conclusions: We present a guide for developing survival prediction models using discrete-time methods and assessing their predictive performance with the aim of encouraging their use in medical research settings. These methods can be applied to data sets that have continuous time-to-event outcomes and multiple clinical predictors. They can also be extended to accommodate new binary classification algorithms as they become available. We provide R code for fitting discrete-time survival prediction models in a github repository.
      pubtype: Academic Journal
      doctype:
        research
        Journal Article
      ougenre: Article
    language: English
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