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During the course of an epidemic of a potentially fatal disease, it is important that the case fatality ratio be well estimated. The authors propose a novel method for doing so based on the Kaplan-Meier survival procedure, jointly considering two outcomes (death and recovery), and evaluate its performance by using data from the 2003 epidemic of severe acute respiratory syndrome in Hong Kong, People's Republic of China. They compare this estimate obtained at various points in the epidemic with the case fatality ratio eventually observed; with two commonly quoted, naïve estimates derived from cumulative incidence and mortality statistics at single time points; and with estimates in which a parametric mixture model is used. They demonstrate the importance of patient characteristics regarding outcome by analyzing subgroups defined by age at admission to the hospital.

Original publication




Journal article


American journal of epidemiology

Publication Date





479 - 486


Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom.


Humans, Communicable Diseases, Emerging, Severe Acute Respiratory Syndrome, Incidence, Models, Statistical, Survival Analysis, Hong Kong, Female, Male