Multi-state models: a review.

Multi-state models are models for a process, for example describing a life history of an individual, which at any time occupies one of a few possible states. This can describe several possible events for a single individual, or the dependence between several individuals. The events are the transitions between the states. This class of models allows for an extremely flexible approach that can model almost any kind of longitudinal failure time data. This is particularly relevant for modeling different events, which have an event-related dependence, like occurrence of disease changing the risk of death. It can also model paired data. It is useful for recurrent events, but has limitations. The Markov models stand out as much simpler than other models from a probability point of view, and this simplifies the likelihood evaluation. However, in many cases, the Markov models do not fit satisfactorily, and happily, it is reasonably simple to study non-Markov models, in particular the Markov extension models. This also makes it possible to consider, whether the dependence is of short-term or long-term nature. Applications include the effect of heart transplantation on the mortality and the mortality among Danish twins.