Table 1.
Risk models for MACE in the primary prevention population
| MACE | MACE-plus | CVD-related death | ||||
|---|---|---|---|---|---|---|
| Validation | ||||||
| C-statistic, training set | 0.72 | 0.71 | 0.81 | |||
| C-statistic, validation set | 0.72 | 0.72 | 0.81 | |||
| Predictors | OR (95% CI) | P-value | OR (95% CI) | P-value | OR (95% CI) | P-value |
|---|---|---|---|---|---|---|
| Age group (reference: 50–54 years old) | ||||||
| 55–59 years old | 1.25 (1.04, 1.51) | 0.019* | 1.19 (1.02, 1.38) | 0.028* | 1.02 (0.65, 1.59) | 0.943 |
| 60–64 years old | 1.70 (1.43, 2.04) | < 0.001* | 1.59 (1.37, 1.83) | < 0.001* | 2.13 (1.43, 3.17) | < 0.001* |
| 65–69 years old | 1.70 (1.42, 2.04) | < 0.001* | 1.58 (1.36, 1.84) | < 0.001* | 2.35 (1.59, 3.49) | < 0.001* |
| 70–74 years old | 2.00 (1.66, 2.40) | < 0.001* | 1.85 (1.59, 2.16) | < 0.001* | 2.92 (1.96, 4.33) | < 0.001* |
| 75–79 years old | 2.49 (2.06, 3.00) | < 0.001* | 2.30 (1.97, 2.69) | < 0.001* | 4.12 (2.77, 6.13) | < 0.001* |
| 80–84 years old | 4.15 (3.45, 4.99) | < 0.001* | 3.48 (2.98, 4.05) | < 0.001* | 7.86 (5.31, 11.64) | < 0.001* |
| 85 and above | 4.48 (3.62, 5.55) | < 0.001* | 3.88 (3.24, 4.64) | < 0.001* | 7.96 (5.18, 12.23) | < 0.001* |
| Female | 0.73 (0.69, 0.78) | < 0.001* | 0.70 (0.63, 0.77) | < 0.001* | ||
| Race (reference: Caucasian) | ||||||
| African American | 0.97 (0.81, 1.15) | 0.708 | ||||
| Asian | 0.50 (0.31, 0.81) | 0.005* | ||||
| Other/unknown | 0.95 (0.83, 1.10) | 0.514 | ||||
| Ethnicity (reference: non-Hispanic) | ||||||
| Hispanic | 0.52 (0.35, 0.78) | 0.001* | ||||
| Unknown | 1.29 (1.14, 1.47) | < 0.001* | ||||
| End of baseline period prior to 2011a | 1.32 (1.23, 1.41) | < 0.001* | 1.35 (1.27, 1.43) | < 0.001* | 1.90 (1.71, 2.12) | < 0.001* |
| Geographic region (reference: South) | ||||||
| Midwest | 0.84 (0.75, 0.95) | 0.004* | ||||
| Northeast | 0.57 (0.48, 0.68) | < 0.001* | ||||
| West | 0.77 (0.65, 0.91) | 0.003* | ||||
| Other/unknown | 0.89 (0.66, 1.21) | 0.471 | ||||
| Insurance type (reference: health maintenance organization [HMO]) | ||||||
| Point-of-service (POS) | 1.20 (1.03, 1.39) | 0.020* | 1.23 (1.09, 1.40) | 0.001* | 1.03 (0.75, 1.41) | 0.841 |
| Preferred provider organization (PPO) | 1.09 (0.95, 1.24) | 0.210 | 1.17 (1.05, 1.31) | 0.006* | 1.09 (0.88, 1.35) | 0.450 |
| Exclusive provider organization (EPO) | 1.34 (1.06, 1.71) | 0.015* | 1.32 (1.08, 1.61) | 0.007* | 1.00 (0.59, 1.70) | 0.996 |
| Indemnity (IND) | 1.71 (1.38, 2.13) | < 0.001* | 1.78 (1.48, 2.13) | < 0.001* | 2.01 (1.40, 2.88) | < 0.001* |
| Other | 0.90 (0.84, 0.97) | 0.005* | 0.94 (0.88, 1.00) | 0.038* | 0.95 (0.84, 1.07) | 0.369 |
| Payer type | ||||||
| Commercial | 0.53 (0.46, 0.61) | < 0.001* | 0.58 (0.51, 0.65) | < 0.001* | 0.46 (0.34, 0.60) | < 0.001* |
| Other CVD-related conditions (i.e., conditions used to define CVD-related death) | 1.19 (1.11, 1.28) | < 0.001* | 1.33 (1.26, 1.41) | < 0.001* | 1.10 (0.98, 1.23) | 0.116 |
| At least 1 diabetes-related hospitalization | 1.36 (1.26, 1.46) | < 0.001* | 1.27 (1.19, 1.35) | < 0.001* | 1.42 (1.27, 1.59) | < 0.001* |
| Adapted diabetes complications severity index | 1.15 (1.13,1.17) | < 0.001* | 1.17 (1.15, 1.19) | < 0.001* | 1.19 (1.15, 1.23) | < 0.001* |
| Recorded diagnoses (ref: no diagnosis) | ||||||
| Hypertension | 1.09 (1.01, 1.18) | 0.024* | ||||
| Chronic pulmonary disease | 1.31 (1.22, 1.41) | < 0.001* | 1.36 (1.27, 1.44) | < 0.001* | 1.52 (1.35, 1.70) | < 0.001* |
| Cancer | 1.14 (1.05, 1.24) | 0.003* | 1.12 (1.04, 1.20) | 0.003* | 1.52 (1.35, 1.72) | < 0.001* |
| Fluid and electrolyte disorders | 1.20 (1.09, 1.32) | < 0.001* | 1.21 (1.11, 1.31) | < 0.001* | 1.22 (1.06, 1.40) | 0.007* |
| Deficiency anemia | 1.22 (1.04, 1.43) | 0.013* | ||||
| Coagulopathy | 1.45 (1.25, 1.68) | < 0.001* | 1.37 (1.20, 1.56) | < 0.001* | 1.97 (1.60, 2.41) | < 0.001* |
| Pulmonary circulation disorders | 1.32 (1.03, 1.69) | 0.026* | ||||
| Time interval (reference: 0–6 months) | ||||||
| 6–12 months | 1.00 (0.91, 1.09) | 0.980 | 0.97 (0.90, 1.05) | 0.501 | 1.05 (0.90, 1.22) | 0.527 |
| 12–18 months | 1.05 (0.95, 1.15) | 0.363 | 1.02 (0.94, 1.11) | 0.564 | 1.20 (1.02, 1.41) | 0.025* |
| 18–24 months | 0.96 (0.86, 1.08) | 0.528 | 0.97 (0.88, 1.07) | 0.531 | 1.15 (0.96, 1.38) | 0.132 |
| 24–30 months | 1.06 (0.94, 1.20) | 0.361 | 0.98 (0.88, 1.09) | 0.664 | 1.20 (0.99, 1.47) | 0.068 |
| 30–36 months | 1.02 (0.89, 1.17) | 0.785 | 0.99 (0.88, 1.11) | 0.826 | 1.27 (1.03, 1.57) | 0.028* |
| 36–42 months | 1.12 (0.96, 1.30) | 0.141 | 1.06 (0.93, 1.21) | 0.380 | 1.29 (1.02, 1.63) | 0.035* |
| 42–48 months | 0.98 (0.82, 1.17) | 0.820 | 1.00 (0.86, 1.16) | 0.970 | 1.02 (0.77, 1.35) | 0.904 |
| 48–54 months | 1.07 (0.88, 1.29) | 0.511 | 1.00 (0.84, 1.18) | 0.971 | 1.39 (1.06, 1.83) | 0.018* |
| 54–60 months | 1.17 (0.95, 1.43) | 0.138 | 1.00 (0.83, 1.21) | 0.979 | 1.18 (0.85, 1.63) | 0.328 |
| Over 60 months | 1.02 (0.88, 1.18) | 0.828 | 0.97 (0.86, 1.11) | 0.693 | 0.93 (0.74, 1.18) | 0.570 |
CVD cardiovascular disease, MACE major adverse cardiovascular events, OR odds ratio, CI confidence interval
* Indicates statistical significance at the 5% level
aA glycated hemoglobin threshold (i.e., < 8%) was added to Healthcare Effectiveness Data and Information Set (HEDIS) measure for Comprehensive Diabetes Care in 2009 and to the Diabetes Recognition Program of the National Committee for Quality Assurance in 2010, which may have impacted CVD risk in patients with diabetes (See [43])