Journal of diabetes and its complications · 2017
Prediction of five-year all-cause mortality in Chinese patients with type 2 diabetes mellitus - A population-based retrospective cohort study.
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Wan Eric Yuk Fai, Fong Daniel Yee Tak, Fung Colman Siu Cheung, Yu Esther Yee Tak, Chin Weng Yee, Chan Anca Ka Chun, Lam Cindy Lo Kuen
Аннотация
AIMS: This study aimed to develop and validate an all-cause mortality risk prediction model for Chinese primary care patients with type 2 diabetes mellitus(T2DM) in Hong Kong.
METHODS: A population-based retrospective cohort study was conducted on 132,462 Chinese patients who had received public primary care services during 2010. Each gender sample was randomly split on a 2:1 basis into derivation and validation cohorts and was followed-up for a median period of 5years. Gender-specific mortality risk prediction models showing the interaction effect between predictors and age were derived using Cox proportional hazards regression with forward stepwise approach. Developed models were compared with pre-existing models by Harrell's C-statistic and calibration plot using validation cohort.
RESULTS: Common predictors of increased mortality risk in both genders included: age; smoking habit; diabetes duration; use of anti-hypertensive agents, insulin and lipid-lowering drugs; body mass index; hemoglobin A1c; systolic blood pressure(BP); total cholesterol to high-density lipoprotein-cholesterol ratio; urine albumin to creatinine ratio(urine ACR); and estimated glomerular filtration rate(eGFR). Prediction models showed better discrimination with Harrell"'s C-statistics of 0.768(males) and 0.782(females) and calibration power from the plots than previously established models.
CONCLUSIONS: Our newly developed gender-specific models provide a more accurate predicted 5-year mortality risk for Chinese diabetic patients than other established models.
METHODS: A population-based retrospective cohort study was conducted on 132,462 Chinese patients who had received public primary care services during 2010. Each gender sample was randomly split on a 2:1 basis into derivation and validation cohorts and was followed-up for a median period of 5years. Gender-specific mortality risk prediction models showing the interaction effect between predictors and age were derived using Cox proportional hazards regression with forward stepwise approach. Developed models were compared with pre-existing models by Harrell's C-statistic and calibration plot using validation cohort.
RESULTS: Common predictors of increased mortality risk in both genders included: age; smoking habit; diabetes duration; use of anti-hypertensive agents, insulin and lipid-lowering drugs; body mass index; hemoglobin A1c; systolic blood pressure(BP); total cholesterol to high-density lipoprotein-cholesterol ratio; urine albumin to creatinine ratio(urine ACR); and estimated glomerular filtration rate(eGFR). Prediction models showed better discrimination with Harrell"'s C-statistics of 0.768(males) and 0.782(females) and calibration power from the plots than previously established models.
CONCLUSIONS: Our newly developed gender-specific models provide a more accurate predicted 5-year mortality risk for Chinese diabetic patients than other established models.