Net survival 2026-10-07
For cause-specific hazard , the net survival is . Censoring all competing events in a cause-specific Kaplan–Meier estimator targets this quantity under appropriate observation-censoring assumptions. Its complement generally exceeds the actual cumulative incidence function , because all-cause survival also includes the other hazards. Identifying net survival with survival after a hypothetical elimination of competing events requires extra causal assumptions.
The probability of a first event of type in is the probability of still being at risk times . Thus its cumulative incidence function is
Similarly . In general : that latter expression ignores the competing removal caused by and instead describes a net survival complement.
The last lung-cancer failure before five years is at 4.85, where the displayed net survival estimate is 0.392. The other-death net survival estimate remains 0.498 from 4.096 until 5.065. Thus the two supplied curves imply net five-year death estimates of for lung cancer and for other causes. Their sum is 1.110, already showing that they cannot be probabilities of two disjoint actual causes of death.
In competing risks, let and be the cause-specific hazards while alive, with cumulative hazards . Treating the other cause as censored estimates the net survival . The actual probability of death from cause by time is the cumulative incidence function
Since , the net probability generally overstates the cumulative incidence function: death from the other cause prevents a later death of cause . This discrepancy exists even for independent latent cause-specific failure times. Moreover, Kaplan–Meier estimates are not generally exactly unbiased in finite samples even for their proper target. The plotted complements are not unbiased estimators of , and are not even consistent for that target in general.
For the desired probabilities, use the Aalen–Johansen estimator , with all-cause survival and independent study censoring. Removing competing deaths from subsequent risk sets is correct for estimating cause-specific hazards; the error is interpreting the separate net survival complements as cumulative incidence functions. A hypothetical elimination-of-a-cause interpretation of net survival would require additional causal assumptions.