A competing-risk-based score for predicting twenty-year risk of incident diabetes: the Beijing Longitudinal Study of Ageing study.

Xiangtong Liu,Zhenghong Chen,Kuo Liu,Yanxia Luo,Sijia Tian,Kun Yang,Xiuhua Guo,Long Liu,Lixin Tao,Gehendra Mahara,Haibin Li,Anxin Wang,Jie Zhang,Zhe Tang,Jason Peter Fine,Jin Guo,Feng Zhang

doi:10.1038/srep37248

Abstract

Few risk tools have been proposed to quantify the long-term risk of diabetes among middle-aged and elderly individuals in China. The present study aimed to develop a risk tool to estimate the 20-year risk of developing diabetes while incorporating competing risks. A three-stage stratification random-clustering sampling procedure was conducted to ensure the representativeness of the Beijing elderly. We prospectively followed 1857 community residents aged 55 years and above who were free of diabetes at baseline examination. Sub-distribution hazards models were used to adjust for the competing risks of non-diabetes death. The cumulative incidence function of twenty-year diabetes event rates was 11.60% after adjusting for the competing risks of non-diabetes death. Age, body mass index, fasting plasma glucose, health status, and physical activity were selected to form the score. The area under the ROC curve (AUC) was 0.76 (95% Confidence Interval: 0.72–0.80), and the optimism-corrected AUC was 0.78 (95% Confidence Interval: 0.69–0.87) after internal validation by bootstrapping. The calibration plot showed that the actual diabetes risk was similar to the predicted risk. The cut-off value of the risk score was 19 points, marking mark the difference between low-risk and high-risk patients, which exhibited a sensitivity of 0.74 and specificity of 0.65.

Highlights

Few risk tools have been proposed to quantify the long-term risk of diabetes among middle-aged and elderly individuals in China
There are a number of risk assessment tools based on readily available clinical variables that predict the development of new diabetes cases, including ones proposed by the Framingham Offspring study[8], Rancho Bemardo study[9], and Guangzhou Biobank Cohort study[10]
We develop a risk tool for estimating the 20-year risk of developing diabetes among middle-aged and elderly individuals who are free of diabetes at baseline

Summary

Introduction

Few risk tools have been proposed to quantify the long-term risk of diabetes among middle-aged and elderly individuals in China. Sub-distribution hazards models were used to adjust for the competing risks of non-diabetes death. The sum of the estimates of each event type’s incidence will exceed the estimates of the incidence of the composite outcome, defined as any of the event types[25] To overcome this problem, sub-distribution hazards models (e.g., Fine-Gray model) were proposed, in which the cumulative incidence function (CIF) is provided to estimate the incidence of an event while accounting for the presence of competing events[25]. To the best of our knowledge, no algorithm has been proposed that quantifies the 20-year risk of diabetes among middle-aged and elderly individuals using a sub-distribution hazards model

Methods

Results

Conclusion