A Linear Models Application of Competing Risks to Multiple Causes of Death

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Abstract
The joint incidence of 2 causes of death, acute myocardial infarction and stroke, for the deaths of residents of Massachusetts and North Carolina, USA, in 1969 was ascertained. To assay their association an explicit biological model of the nature of the relation is proposed. Under this model, Chiang''s theory of competing risks may be extended to the case in which an individual''s death may have multiple causes. Techniques are developed which allow modeling of the survival parameters derived under the model by categorical data procedures of the type introduced by Grizzle, Starmer and Koch. There is a greater incidence of the joint occurrence of stroke and myocardial infarction on death certificates in North Carolina than in Massachusetts, a pattern consistent with the generally higher stroke mortality in North Carolina. The incidence of the joint occurrence of the 2 diseases shows a clear age gradient increasing through the age range of the analysis. Males and females show somewhat different patterns of age variation in that state-by-age interaction terms are more prominent in the model fitted for females than for males.

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