Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of hospitalizations, strongly associated with decreased survival, yet predicting the timing of these events remains challenging and has received limited attention in the literature. In this study, we performed survival analysis to predict hospitalization and death in COPD patients using longitudinal electronic health records (EHRs), comparing statistical models, machine learning (ML), and deep learning (DL) approaches. We analyzed data from more than 150k patients from the SIDIAP database in Catalonia, Spain, from 2013 to 2017, modeling hospitalization as a first event and death as a semi-competing terminal event. Multiple models were evaluated, including Cox proportional hazards, SurvivalBoost, DeepPseudo, SurvTRACE, Dynamic Deep-Hit, and Deep Recurrent Survival Machine. Results showed that DL models utilizing recurrent architectures outperformed both ML and linear approaches in concordance and time-dependent AUC, especially for hospitalization, which proved to be the harder event to predict. This study is, to our knowledge, the first to apply deep survival analysis on longitudinal EHR data to jointly predict multiple time-to-event outcomes in COPD patients, highlighting the potential of DL approaches to capture temporal patterns and improve risk stratification.

The use of cumulative incidence functions for characterizing the risk of one type of event in the presence of others has become increasingly popular over the past decade. The problems of modeling, estimation and inference have been treated using parametric, nonparametric and semi-parametric methods. Efforts to develop suitable extensions of machine learning methods, such as regression trees and related ensemble methods, have begun only recently. In this paper, we develop a novel approach to building regression trees for estimating cumulative incidence curves in a competing risks setting. The proposed methods employ augmented estimators of the Brier score risk as the primary basis for building and pruning trees.