Prediction of the 20-year incidence of diabetes in older Chinese: Application of the competing risk method in a longitudinal study.
Prediction of the 20-year incidence of diabetes in older Chinese: Application of the competing risk method in a longitudinal study.
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中国老年人20年糖尿病发病率的预测：竞争风险法在纵向研究中的应用
DOI：
10.1097/md.0000000000005057
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发表时间：
2016-10
期刊：
影响因子：
1.6
通讯作者：
Guo X
中科院分区：
文献类型：
--
作者：
Liu X;Fine JP;Chen Z;Liu L;Li X;Wang A;Guo J;Tao L;Mahara G;Tang Z;Guo X
竞争风险方法已成为更容易接受的时间到事件的数据分析，因为它的优势，标准的考克斯模型在占竞争事件的风险集。本研究旨在利用子分布风险模型建立糖尿病的预测模型。我们前瞻性随访了1857名社区居民，他们年龄≥ 55岁，在1992年8月至2012年12月的基线检查时无糖尿病。糖尿病定义为自我报告的糖尿病诊断史、服用抗糖尿病药物或空腹血糖（FPG）≥ 7.0 mmol/L。 调查问卷用于测量糖尿病风险因素，包括饮食习惯，生活方式，心理因素，认知功能和身体状况。采用灰色检验和子分布风险模型构建了糖尿病20年风险预测算法。使用受试者工作特征（ROC）曲线、自助交叉验证Wolber一致性指数（C指数）统计和校准图评估模型性能。在20年的随访期间，记录了144例糖尿病发病率，中位随访时间为10.9年（四分位距：8.0-15.3年）。在调整非糖尿病死亡的竞争风险后，20年糖尿病发病率的累积发病率函数为11.60%。灰色检验显示，调整年龄后，体重指数、空腹血糖、自测健康状况和体力活动与糖尿病累积发病率相关。最后，5个标准危险因素（自评健康状况差[子分布风险比（SHR）= 1.73，P = 0.005]，体力活动少[SHR = 1.39，P = 0.047]，55-65岁[SHR = 4.37，P <0.001]，超重[SHR = 2.15，P <0.001]或肥胖[SHR = 1.96，P = 0.003]和空腹血糖受损[IFG] [SHR = 1.99，P <0.001]）与糖尿病事件显著相关。 模型性能为中等至优异，如其自助交叉验证的区分C指数（0.74，95% CI：0.70-0.79）和校准图所示。自评健康状况不佳、缺乏身体活动、年龄在55至65岁之间、超重/肥胖和IFG是糖尿病事件的重要预测因素。以达到所有危险因素的最佳水平为目标的早期预防应成为糖尿病预防的关键要素。
The competing risk method has become more acceptable for time-to-event data analysis because of its advantage over the standard Cox model in accounting for competing events in the risk set. This study aimed to construct a prediction model for diabetes using a subdistribution hazards model. We prospectively followed 1857 community residents who were aged ≥ 55 years, free of diabetes at baseline examination from August 1992 to December 2012. Diabetes was defined as a self-reported history of diabetes diagnosis, taking antidiabetic medicine, or having fasting plasma glucose (FPG) ≥ 7.0 mmol/L. A questionnaire was used to measure diabetes risk factors, including dietary habits, lifestyle, psychological factors, cognitive function, and physical condition. Gray test and a subdistribution hazards model were used to construct a prediction algorithm for 20-year risk of diabetes. Receiver operating characteristic (ROC) curves, bootstrap cross-validated Wolber concordance index (C-index) statistics, and calibration plots were used to assess model performance. During the 20-year follow-up period, 144 cases were documented for diabetes incidence with a median follow-up of 10.9 years (interquartile range: 8.0–15.3 years). The cumulative incidence function of 20-year diabetes incidence was 11.60% after adjusting for the competing risk of nondiabetes death. Gray test showed that body mass index, FPG, self-rated heath status, and physical activity were associated with the cumulative incidence function of diabetes after adjusting for age. Finally, 5 standard risk factors (poor self-rated health status [subdistribution hazard ratio (SHR) = 1.73, P = 0.005], less physical activity [SHR = 1.39, P = 0.047], 55–65 years old [SHR = 4.37, P < 0.001], overweight [SHR = 2.15, P < 0.001] or obesity [SHR = 1.96, P = 0.003], and impaired fasting glucose [IFG] [SHR = 1.99, P < 0.001]) were significantly associated with incident diabetes. Model performance was moderate to excellent, as indicated by its bootstrap cross-validated discrimination C-index (0.74, 95% CI: 0.70–0.79) and calibration plot. Poor self-rated health, physical inactivity, being 55 to 65 years of age, overweight/obesity, and IFG were significant predictors of incident diabetes. Early prevention with a goal of achieving optimal levels of all risk factors should become a key element of diabetes prevention.