Caring about trees in the forest: incorporating frailty in risk analysis for personalized medicine.
Caring about trees in the forest: incorporating frailty in risk analysis for personalized medicine.
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DOI：
10.2217/pme.11.72
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发表时间：
2011-11
影响因子：
2.3
通讯作者：
Forney LJ
中科院分区：
文献类型：
--
作者：
Ma ZS;Abdo Z;Forney LJ
脆弱性分析起源于老龄化和人口统计学研究，其目的是证明群体中个体的危险率（死亡风险）可能与整体群体危险率显着不同。这两种风险率之间的差异可能来自脆弱性-研究中未观察到的个体差异。我们认为，脆弱性建模是个性化医疗风险分析的一种有用方法，因为它提供了一种方法来解决如何将人群研究的结果转化为特定个体疾病的诊断和治疗这一重要而令人困惑的问题。我们的建议是基于脆弱性模型的三个独特优势：脆弱性模型提供了一种有效的方法来分析个体和群体水平的风险，并可以用来推断两者之间的关系;脆弱性模型可以用来分析生存事件之间的依赖性-这是任何涉及常见风险的领域中最困难的问题之一;脆弱性建模可用于描述未观察到或不可观察到的风险。最后，我们建议脆弱性建模在研究和治疗由人类微生物组引起或影响的疾病方面特别有用。通过这样做，真正的“个性化”医学可以在更好地了解“树木”（个人）和“森林”（人群）风险的基础上发展。
The analysis of frailty originated in studies of aging and demography in which the objective was to demonstrate that the hazard rates (mortality risks) of individuals in a population could significantly differ from the population hazard rate as a whole. The differences between these two hazard rates can arise from frailty – differences among individuals that are not observed in a study. We posit that frailty modeling is a useful approach for risk analysis in personalized medicine because it provides a way to address the important and perplexing question of how to translate findings from population studies to the diagnosis and treatment of disease in specific individuals. Our suggestion is based on three unique advantages of frailty modeling: frailty modeling offers an effective approach to analyze the risks at both the individual and population levels and can be used to infer relationships between the two; frailty modeling can be used to analyze the dependence between survival events – one of the most difficult issues in any field that involves common risks; and frailty modeling can be used to describe unobserved or unobservable risks. Finally, we suggest that frailty modeling should be particularly useful in the study and treatment of diseases that are caused or influenced by the human microbiome. By doing so, truly ‘personalized’ medicine can advance based on a better understanding of the risks to both ‘trees’ (individuals) and ‘forests’ (populations).