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European Heart Journal Advance Access published online on March 6, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn079
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Relative survival: what can cardiovascular disease learn from cancer?

Christopher P. Nelson1,*, Paul C. Lambert1, Iain B. Squire2 and David R. Jones1

1 Centre for Biostatistics and Genetic Epidemiology, Department of Health Sciences, University of Leicester, 2nd Floor, Adrian Building, University Road, Leicester LE1 7RH, UK
2 Department of Cardiovascular Sciences, University of Leicester, Leicester, UK

Received 10 October 2007; revised 31 January 2008; accepted 8 February 2008.

* Corresponding author. Tel: +44 116 229 7254, Fax: +44 116 229 7250, Email: cn46{at}le.ac.uk

Aims: To illustrate the application of relative survival to observational studies in coronary heart disease (CHD) and potential advantages compared with all-cause survival methods. Survival after myocardial infarction (MI) is generally assessed using all-cause or cause-specific methods. Neither method is able to assess the impact of the disease or condition of interest in comparison with expected survival in a similar population. Relative survival, the ratio of the observed and the expected survival rates, is applied routinely in cancer studies and may improve on current methods for assessment of survival in CHD.

Methods and results: Using a cohort of subjects after a first recorded acute MI, we discuss the application of relative survival in CHD and illustrate a number of the key issues. We compare the findings from relative survival with those obtained using Cox proportional and non-proportional hazards models in standard all-cause survival. Estimated survival rates are higher using relative survival models compared with all-cause methods.

Conclusion: Estimates obtained from all-cause mortality fail to disentangle mortality associated with the condition of interest from that due to all other causes. Relative survival gives an estimate of survival due to the disease of interest without the need for cause of death information.

Key Words: Relative survival • Survival analysis • Population-based research


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