A practical guide to handling competing events in etiologic time-to-event studies

Competing events are events that preclude the occurrence of the primary outcome. Much has been written on mainly the statistics behind competing events analyses. However, many of these publications and tutorials have a strong statistical tone and might fall short in providing a practical guide to clinician researchers as to when to use a competing event analysis and more importantly which method to use and why.

Here we discuss the different target effects in the Fine-Gray and cause-specific methods using simple causal diagrams and provide strengths and limitations of both approaches for addressing etiologic questions. We argue why the Fine-Gray method might not be the best approach for handling competing events in etiological time-to-event studies.