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Statistical Models and Causal Inference by Jasjeet S. Sekhon, David Collier, David A. Freedman

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11Survival Analysis: An Epidemiological Hazard?

        ABSTRACT. Proportional-hazards models are frequently used to analyze data from randomized controlled trials. This is a mistake. Randomization does not justify the models, which are rarely informative. Simpler methods work better. This discussion is salient because the misuse of survival analysis has introduced a new hazard in epidemiology: It can lead to serious mistakes in medical treatment. Life tables, Kaplan-Meier curves, and proportional-hazards models, aka “Cox models,” all require strong assumptions, such as stationarity of mortality and independence of competing risks. Where the assumptions fail, the methods also tend to fail. Justifying those assumptions is fraught with difficulty. ...

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