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In population-based studies performed by
cancer registries, the available data often do not allow the identification of specific
causes of death. It is thus difficult to differentiate between the effects of age and
gender on the general mortality of the population and on the cancer-related mortality and
to completely eliminate confounding due to age and gender. In order to overcome these
difficulties, Esteve proposed to include in a single additive model the disease-related
mortality hazard l c and the general population
mortality hazard l e. In our study, the general
population mortality hazard is estimated based on published age and gender specific
mortality rates in the general French population. The disease-related mortality hazard is
estimated from the data at hand, assuming a proportional hazards model, similar to the Cox
model. As a consequence the relative survival model proposed by Esteve imposes the
proportional hazard assumption for all covariates so that for each covariate the estimated
effect b j is assumed to remain constant. The only
difference with the Cox model is that although in the Cox model there is no restriction on
the baseline hazard, in the Esteve 's model the baseline hazard is expressed as a step
function of the follow-up time t. Accordingly, t k
represents the baseline mortality hazard in the k-th time segment. |