Patient death as a censoring event or competing risk event in models of nursing home placement

Szychowski et al have a new paper in Statistics in Medicine. This looks at competing risks data where the event of interest is placement in a nursing home with death the other competing event. They compare the classical cause-specific-hazards regression approach with that of the Fine-Gray proportional subdistribution hazards model. The data were from a RCT on the effectiveness of an enhanced counseling and support invervention. The estimate of the effect of the intervention was similar in both cases (some evidence of a benefit in delaying admission to a nursing home). The authors attribute the similarity to a lack of a significant effect of the intervention on CSH of death. They recommend that both CSH and proportional subdistribution hazards approaches to covariate effect modelling should be considered.