The Restricted Mean Survival Time (RMST) has been advocated as an alternative, or supplement, to the hazard ratio (HR) for reporting the effect of an intervention in a randomized clinical trial. The RMST difference allows quantifying the postponement of an outcome over a specified (restricted) time interval and corresponds to the difference between the areas under the two survival curves for the intervention and the control arm.In this article, we present examples of its uses in a research and a clinical context. First, we show how the RMST difference can answer research questions about the efficacy of different treatments. We present estimates for the effects of pharmacological or strategy-driven glucose-lowering interventions for adults with type 2 diabetes from 36 trials and 9 follow-up studies reporting cardiovascular outcomes and mortality. We show how these measures can be used to mitigate uncertainty about the efficacy of intensive glucose control. Second, we demonstrate how the RMST difference can be used in the setting of a clinical consultation to guide the decision to start or discontinue a treatment.We then discuss the advantages of the RMST over the absolute risk difference, the number needed to treat, and the median survival difference. We argue that the RMST difference is both easily interpretable and flexible in its application to different settings. Lastly, we highlight its major limitations, including difficulties in comparing studies of heterogeneous designs and in inferring the long-term effects of treatments using trials of short duration, and summarize the available statistical software for calculating the RMST.
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record. Please cite this article as
Objective: To quantify the association between accelerometer-assessed physical activity and coronavirus disease 2019 (COVID-19) outcomes. Methods: Data from 82,253 UK Biobank participants with accelerometer data (measured 2013-2015), complete covariate data, and linked COVID-19 data from March 16, 2020, to March 16, 2021, were included. Two outcomes were investigated: severe COVID-19 (positive test result from in-hospital setting or COVID-19 as primary cause of death) and nonsevere COVID-19 (positive test result from community setting). Logistic regressions were used to assess associations with moderate to vigorous physical activity (MVPA), total activity, and intensity gradient. A higher intensity gradient indicates a higher proportion of vigorous activity. Results: Average MVPA was 48.1 (32.7) min/d. Physical activity was associated with lower odds of severe
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.