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Development and Val...
Development and Validation of the US Diabetes, Obesity, Cardiovascular Disease Microsimulation (DOC-M) Model : Health Disparity and Economic Impact Model
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- Kim, David D. (författare)
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA.
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- Wang, Lu (författare)
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
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- Lauren, Brianna N. (författare)
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
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- Liu, Junxiu (författare)
- Department of Population Health Science and Policy, the Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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- Marklund, Matti (författare)
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
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- Lee, Yujin (författare)
- Department of Food and Nutrition, Myongji University, Yongin, South Korea.
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- Micha, Renata (författare)
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
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- Mozaffarian, Dariush (författare)
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
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- Wong, John B. (författare)
- Division of Clinical Decision Making, Tufts Medical Center, Boston, MA, USA.
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Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA. (creator_code:org_t)
- 2023
- 2023
- Engelska.
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Ingår i: Medical decision making. - 0272-989X .- 1552-681X. ; 43:7-8, s. 930-948
- Relaterad länk:
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https://uu.diva-port... (primary) (Raw object)
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Ämnesord
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- BACKGROUND: Few simulation models have incorporated the interplay of diabetes, obesity, and cardiovascular disease (CVD); their upstream lifestyle and biological risk factors; and their downstream effects on health disparities and economic consequences.METHODS: We developed and validated a US Diabetes, Obesity, Cardiovascular Disease Microsimulation (DOC-M) model that incorporates demographic, clinical, and lifestyle risk factors to jointly predict overall and racial-ethnic groups-specific obesity, diabetes, CVD, and cause-specific mortality for the US adult population aged 40 to 79 y at baseline. An individualized health care cost prediction model was further developed and integrated. This model incorporates nationally representative data on baseline demographics, lifestyle, health, and cause-specific mortality; dynamic changes in modifiable risk factors over time; and parameter uncertainty using probabilistic distributions. Validation analyses included assessment of 1) population-level risk calibration and 2) individual-level risk discrimination. To illustrate the application of the DOC-M model, we evaluated the long-term cost-effectiveness of a national produce prescription program.RESULTS: Comparing the 15-y model-predicted population risk of primary outcomes among the 2001-2002 National Health and Nutrition Examination Survey (NHANES) cohort with the observed prevalence from age-matched cross-sectional 2003-2016 NHANES cohorts, calibration performance was strong based on observed-to-expected ratio and calibration plot analysis. In most cases, Brier scores fell below 0.0004, indicating a low overall prediction error. Using the Multi-Ethnic Study of Atherosclerosis cohorts, the c-statistics for assessing individual-level risk discrimination were 0.85 to 0.88 for diabetes, 0.93 to 0.95 for obesity, 0.74 to 0.76 for CVD history, and 0.78 to 0.81 for all-cause mortality, both overall and in three racial-ethnic groups. Open-source code for the model was posted at https://github.com/food-price/DOC-M-Model-Development-and-Validation.CONCLUSIONS: The validated DOC-M model can be used to examine health, equity, and the economic impact of health policies and interventions on behavioral and clinical risk factors for obesity, diabetes, and CVD.HIGHLIGHTS: We developed a novel microsimula'tion model for obesity, diabetes, and CVD, which intersect together and - critically for prevention and treatment interventions - share common lifestyle, biologic, and demographic risk factors.Validation analyses, including assessment of (1) population-level risk calibration and (2) individual-level risk discrimination, showed strong performance across the overall population and three major racial-ethnic groups for 6 outcomes (obesity, diabetes, CVD, and all-cause mortality, CVD- and DM-cause mortality)This paper provides a thorough explanation and documentation of the development and validation process of a novel microsimulation model, along with the open-source code (https://github.com/food-price/ DOCM_validation) for public use, to serve as a guide for future simulation model assessments, validation, and implementation.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Endokrinologi och diabetes (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Endocrinology and Diabetes (hsv//eng)
Nyckelord
- calibration
- cardiovascular disease
- diabetes
- microsimulation model
- obesity
- validation
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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