{"doi":"10.1002/alz.12168","title":"The competing risk of death and selective survival cannot fully explain the inverse cancer‐dementia association","abstract":"INTRODUCTION: We evaluated whether competing risk of death or selective survival could explain the reported inverse association between cancer history and dementia incidence (incidence rate ratio [IRR] ≈ 0.62-0.85). METHODS: A multistate simulation model of a cancer- and dementia-free cohort of 65-year-olds was parameterized with real-world data (cancer and dementia incidence, mortality), assuming no effect of cancer on dementia (true IRR = 1.00). To introduce competing risk of death, cancer history increased mortality. To introduce selective survival, we included a factor (prevalence ranging from 10% to 50%) that reduced cancer mortality and dementia incidence (IRRs ranged from 0.30 to 0.90). We calculated IRRs for cancer history on dementia incidence in the simulated cohorts. RESULTS: Competing risk of death yielded unbiased cancer-dementia IRRs. With selective survival, bias was small (IRRs = 0.89 to 0.99), even under extreme scenarios. DISCUSSION: The bias induced by selective survival in simulations was too small to explain the observed inverse cancer-dementia link, suggesting other mechanisms drive this association.","journal":"Alzheimer s & Dementia","year":2020,"id":98673,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":31,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.8556,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":366569,"name":"Sarah F. Ackley","orcid":"0000-0003-0181-6063","position":1,"is_corresponding":false},{"id":486557,"name":"Scott C. Zimmerman","orcid":"0000-0002-4431-6520","position":2,"is_corresponding":false},{"id":486558,"name":"Monica Ospina‐Romero","orcid":"0000-0001-7719-7284","position":3,"is_corresponding":false},{"id":106142,"name":"M. Maria Glymour","orcid":"0000-0001-9644-3081","position":4,"is_corresponding":false},{"id":233917,"name":"Rebecca E. Graff","orcid":"0000-0003-0316-8303","position":5,"is_corresponding":false},{"id":233930,"name":"John S. Witte","orcid":"0000-0003-0146-1434","position":6,"is_corresponding":false},{"id":264318,"name":"Lindsay C. Kobayashi","orcid":"0000-0003-2725-3107","position":7,"is_corresponding":false},{"id":486559,"name":"Elizabeth Rose Mayeda","orcid":"0000-0002-6326-0163","position":8,"is_corresponding":false},{"id":486556,"name":"Eleanor Hayes‐Larson","orcid":"0000-0001-8299-2389","position":0,"is_corresponding":true}],"reference_count":39,"raw_metadata":null,"created_at":"2026-07-18T22:36:58.511143Z","pmid":"32881307","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}