Communication-efficient distributed hazard difference estimation for heterogeneous multi-site survival data

Multi-site collaboration can power survival models that no single hospital could fit alone, but privacy rules and protected computing environments block patient-level data sharing and the persistent server connections required by iterative federated methods. We present DiSAH (underlineDistributed underlineSurvival via underlineAdditive underlineHazards), a federated algorithm for time-to-event analysis whose closed-form, non-iterative structure removes the need for a dedicated central server. Coordination requires only aggregation of summary statistics, which any site can perform, with no patient-level data leaving the site. DiSAH is the first federated method to estimate hazard differences, the absolute change in event rate attributable to each risk factor, providing an actionable scale for triage, resource allocation, and health-economic evaluation. Across simulations and 47,778 emergency-department patients from the United States and Singapore, DiSAH matches centralized analysis in accuracy and discrimination, recovers mortality risk factors no individual site was powered to detect, and outperforms meta-analysis and local models.