Do changes in health reveal the possibility of undiagnosed pancreatic cancer? Development of a risk-prediction model based on healthcare claims data
Do changes in health reveal the possibility of undiagnosed pancreatic cancer? Development of a risk-prediction model based on healthcare claims data
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DOI：
10.1371/journal.pone.0218580
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发表时间：
2019-06-25
期刊：
影响因子：
3.7
通讯作者：
Jeon, Christie Y.
中科院分区：
文献类型：
--
作者：
Baecker, Aileen;Kim, Sungjin;Jeon, Christie Y.
背景与目的胰腺癌的早期检测方法缺乏。我们的目的是建立一个预测模型，胰腺癌的基础上，在健康的变化所捕获的医疗索赔data.MethodsWe进行了一项病例对照研究，对29,646名年龄68岁及以上的医疗保险登记患者胰腺导管腺癌（PDAC）报告的监测流行病学和最终结果（SEER）肿瘤登记计划在2004年至2011年和88，938名年龄和性别匹配的对照组。我们开发了一个预测模型，使用多变量逻辑回归对医疗保险索赔的16个危险因素和诊断前症状的PDAC诊断前15个月内存在。在敏感性分析中排除了PDAC诊断后3个月内的索赔。我们评估了该模型的判别能力与受试者工作曲线（AUC）下的面积，并进行交叉验证bootstrapping.ResultsThe预测模型对所有病例和对照达到AUC为0.68。排除最后3个月的索赔，AUC降至0.58。在新发糖尿病患者中，预测模型的AUC达到0.73，当排除最后3个月的索赔时，AUC降至0.63。性能指标的预测模型进行了内部验证使用bootstrap method.ConclusionModels的基础上的医疗索赔的临床风险因素，症状和体征的胰腺癌是有限的，在分类那些谁去诊断胰腺癌和那些谁不，特别是当排除索赔，立即之前的诊断PDAC。
Background and objectiveEarly detection methods for pancreatic cancer are lacking. We aimed to develop a prediction model for pancreatic cancer based on changes in health captured by healthcare claims data.MethodsWe conducted a case-control study on 29,646 Medicare-enrolled patients aged 68 years and above with pancreatic ductal adenocarcinoma (PDAC) reported to the Surveillance Epidemiology an End Results (SEER) tumor registries program in 2004-2011 and 88,938 age and sex-matched controls. We developed a prediction model using multivariable logistic regression on Medicare claims for 16 risk factors and pre-diagnostic symptoms of PDAC present within 15 months prior to PDAC diagnosis. Claims within 3 months of PDAC diagnosis were excluded in sensitivity analyses. We evaluated the discriminatory power of the model with the area under the receiver operating curve (AUC) and performed cross-validation by bootstrapping.ResultsThe prediction model on all cases and controls reached AUC of 0.68. Excluding the final 3 months of claims lowered the AUC to 0.58. Among new-onset diabetes patients, the prediction model reached AUC of 0.73, which decreased to 0.63 when claims from the final 3 months were excluded. Performance measures of the prediction models was confirmed by internal validation using the bootstrap method.ConclusionModels based on healthcare claims for clinical risk factors, symptoms and signs of pancreatic cancer are limited in classifying those who go on to diagnosis of pancreatic cancer and those who do not, especially when excluding claims that immediately precede the diagnosis of PDAC.