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Am J Public Health. 2013 Jan;103(1):177-82. doi: 10.2105/AJPH.2011.300458. Epub 2012 Apr 19.

A method for partitioning the attributable fraction of multiple time-dependent coexisting risk factors for an adverse health outcome.

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  • 1Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT, USA.



We decomposed the total effect of coexisting diseases on a timed occurrence of an adverse outcome into additive effects from individual diseases.


In a cohort of older adults enrolled in the Precipitating Events Project in New Haven County, Connecticut, we assessed a longitudinal extension of the average attributable fraction method (LE-AAF) to estimate the additive and order-free contributions of multiple diseases to the timed occurrence of a health outcome, with right censoring, which may be useful when relationships among diseases are complex. We partitioned the contribution to death into additive LE-AAFs for multiple diseases.


The onset of heart failure and acute episodes of pneumonia during follow-up contributed the most to death, with the overall LE-AAFs equal to 13.0% and 12.1%, respectively. The contribution of preexisting diseases decreased over the years, with a trend of increasing contribution from new onset of diseases.


LE-AAF can be useful for determining the additive and order-free contribution of individual time-varying diseases to a time-to-event outcome.

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