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Modelling recurrent events: a tutorial for analysis in epidemiology

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Amorim, Leila DAF, Cai, Jianwen·2015·International Journal of Epidemiology

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Abstract

In many biomedical studies, the event of interest can occur more than once in a participant. These events are termed recurrent events. However, the majority of analyses focus only on time to the first event, ignoring the subsequent events. Several statistical models have been proposed for analysing multiple events. In this paper we explore and illustrate several modelling techniques for analysis of recurrent time-to-event data, including conditional models for multivariate survival data (AG, PWP-TT and PWP-GT), marginal means/rates models, frailty and multi-state models. We also provide a tutorial for analysing such type of data, with three widely used statistical software programmes. Different approaches and software are illustrated using data from a bladder cancer project and from a study on lower respiratory tract infection in children in Brazil. Finally, we make recommendations for modelling strategy selection for analysis of recurrent event data.

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Authors: Amorim, L. D., & Cai, J.
Affiliations: University of North Carolina at Chapel Hill (US)
ORCID: Cai, Jianwen
Venue: International Journal of Epidemiology
Publisher: Oxford University Press (OUP)
Published: 2014-12-09
Volume: 44
Issue: 1
Pages: 324-333
ISSN: 0300-5771 (ISSN-L)
1464-3685
DOI: 10.1093/ije/dyu222
PMC: PMC4339761
OpenAlex: W2102630933
Cited by: 564
References: 30
Citations by year: 2026: 57 · 2025: 84 · 2024: 53 · 2023: 76 · 2022: 63 · 2021: 58 · 2020: 53 · 2019: 58 · 2018: 33 · 2017: 13 · 2016: 10 · 2015: 5
FWCI: 9.87
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: International Journal of Epidemiology (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
UNC Libraries
Funders: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
Conselho Nacional de Desenvolvimento Científico e Tecnológico
National Institutes of Health (CA 142538)
U.S. Public Health Service (ULIRR025747)
National Cancer Institute (P01CA142538)
Topics: Physical Sciences › Mathematics › Statistics and Probability › Probability and Statistical Research
Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods and Inference
Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
Keywords: recurrent events, multivariate survival models, frailty models, multi-state models, bladder cancer
MeSH terms: Algorithms, Data Interpretation, Statistical, Epidemiologic Methods, Humans, Models, Statistical, Bias, Epidemiologic Studies

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Modelling recurrent events: a tutorial for analysis in epidemiology

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