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Table 2 Risk models for MACE in the secondary prevention population

From: Development of predictive risk models for major adverse cardiovascular events among patients with type 2 diabetes mellitus using health insurance claims data

  MACE MACE-plus CVD-related death
Validation
 C-statistic, training set 0.70 0.72 0.78
 C-statistic, validation set 0.70 0.72 0.77
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 1.08 (0.86, 1.36) 0.513 1.01 (0.85, 1.21) 0.883 1.33 (0.84, 2.11) 0.230
 60–64 years old 1.24 (1.00, 1.54) 0.049* 1.12 (0.95, 1.33) 0.168 1.72 (1.11, 2.66) 0.014*
 65–69 years old 1.35 (1.10, 1.67) 0.005* 1.20 (1.01, 1.41) 0.033* 2.15 (1.41, 3.28) < 0.001*
 70–74 years old 1.52 (1.24, 1.88) < 0.001* 1.30 (1.11, 1.54) 0.001* 2.67 (1.76, 4.06) < 0.001*
 75–79 years old 1.72 (1.40, 2.12) < 0.001* 1.43 (1.21, 1.68) < 0.001* 3.13 (2.06, 4.75) < 0.001*
 80–84 years old 2.20 (1.79, 2.70) < 0.001* 1.82 (1.55, 2.14) < 0.001* 4.60 (3.04, 6.97) < 0.001*
 85 and above 2.23 (1.79, 2.77) < 0.001* 1.81 (1.52, 2.15) < 0.001* 4.82 (3.14, 7.39) < 0.001*
Race (reference: Caucasian)
 African American      0.81 (0.70, 0.93) 0.003*
 Asian      0.58 (0.37, 0.92) 0.021*
 Other/unknown      1.04 (0.93, 1.17) 0.474
Ethnicity (reference: non-Hispanic)
 Hispanic 0.98 (0.82, 1.17) 0.830 0.92 (0.79, 1.08) 0.315 0.69 (0.51, 0.93) 0.016*
 Unknown 1.16 (1.10, 1.24) < 0.001* 1.14 (1.09, 1.20) < 0.001* 1.14 (1.03, 1.27) 0.013*
End of baseline period prior to 2011a 1.43 (1.34, 1.53) < 0.001* 1.39 (1.32, 1.48) < 0.001* 1.83 (1.67, 2.01) < 0.001*
Geographic region (reference: South)
 Midwest      0.83 (0.75, 0.91) < 0.001*
 Northeast      0.73 (0.63, 0.83) < 0.001*
 West      0.84 (0.73, 0.97) 0.014*
 Other/unknown      1.07 (0.85, 1.33) 0.570
Insurance type (reference: health maintenance organization [HMO])
 Point-of-service (POS)    1.11 (0.97, 1.27) 0.142 0.79 (0.60, 1.05) 0.105
 Preferred provider organization (PPO)    1.21 (1.08, 1.34) < 0.001* 0.84 (0.69, 1.03) 0.092
 Exclusive provider organization (EPO)    1.08 (0.86, 1.36) 0.483 0.58 (0.34, 0.98) 0.043*
 Indemnity (IND)    1.29 (1.07, 1.55) 0.007* 1.23 (0.91, 1.66) 0.183
 Other    1.01 (0.96, 1.07) 0.631 0.89 (0.81, 0.98) 0.018*
Payer type
 Commercial 0.81 (0.75, 0.89) < 0.001* 0.77 (0.68, 0.87) < 0.001* 0.84 (0.67, 1.06) 0.135
Prior CVD diagnoses (ref: no diagnosis)
 Myocardial infarction 1.24 (1.16, 1.33) < 0.001* 1.13 (1.07, 1.20) < 0.001*   
 Stroke 1.34 (1.26, 1.43) < 0.001* 1.13 (1.06, 1.19) < 0.001*   
 Congestive heart failure 1.39 (1.30, 1.49) < 0.001* 1.91 (1.80, 2.03) < 0.001* 1.97 (1.78, 2.18) < 0.001*
Time from last observed CVD diagnosis to end of baseline period, months (reference: less than 1 month)
 1–3 months 0.80 (0.73, 0.87) < 0.001* 0.76 (0.70, 0.82) < 0.001* 0.83 (0.74, 0.93) 0.002*
 3–6 months 0.66 (0.60, 0.73) < 0.001* 0.62 (0.57, 0.67) < 0.001* 0.63 (0.56, 0.72) < 0.001*
 6–12 months 0.58 (0.53, 0.63) < 0.001* 0.52 (0.48, 0.56) < 0.001* 0.51 (0.45, 0.58) < 0.001*
 12 months and above 0.56 (0.51, 0.61) < 0.001* 0.48 (0.45, 0.52) < 0.001* 0.48 (0.42, 0.54) < 0.001*
Other CVD-related conditions (i.e., Conditions used to define CVD-related death) 1.10 (1.00, 1.20) 0.043* 1.18 (1.09, 1.27) < 0.001*   
At least 1 diabetes-related hospitalization 1.30 (1.23, 1.39) < 0.001* 1.27 (1.20, 1.33) < 0.001* 1.36 (1.25, 1.49) < 0.001*
Adapted diabetes complications severity index 1.10 (1.08, 1.11) < 0.001* 1.09 (1.07, 1.11) < 0.001* 1.11 (1.09, 1.13) < 0.001*
Recorded diagnoses (ref: no diagnosis)
 Mental disorders      1.14 (1.05, 1.24) 0.002*
 Chronic pulmonary disease 1.18 (1.11, 1.25) < 0.001* 1.27 (1.21, 1.34) < 0.001* 1.28 (1.18, 1.40) < 0.001*
 Obesity 0.81 (0.74, 0.89) < 0.001*    0.78 (0.68, 0.88) < 0.001*
 Cancer      1.16 (1.05, 1.29) 0.005*
 Peripheral vascular disorders    1.07 (1.01, 1.13) 0.017*   
 Fluid and electrolyte disorders 1.16 (1.09, 1.24) < 0.001* 1.14 (1.08, 1.21) < 0.001* 1.15 (1.05, 1.26) 0.002*
 Deficiency anemia 1.19 (1.10, 1.28) < 0.001* 1.15 (1.08, 1.23) < 0.001* 1.22 (1.10, 1.35) < 0.001*
 Erectile dysfunction, organic origin      0.60 (0.43, 0.84) 0.003*
 Coagulopathy    1.14 (1.05, 1.24) 0.003* 1.17 (1.02, 1.33) 0.024*
 Pulmonary circulation disorders    1.21 (1.12, 1.30) < 0.001* 1.33 (1.18, 1.49) < 0.001*
Time interval (reference: 0–6 months)
 6–12 months 0.82 (0.76, 0.89) < 0.001* 0.78 (0.73, 0.83) < 0.001* 0.89 (0.79, 0.99) 0.030*
 12–18 months 0.77 (0.70, 0.84) < 0.001* 0.74 (0.69, 0.80) < 0.001* 0.81 (0.72, 0.93) 0.002*
 18–24 months 0.80 (0.72, 0.89) < 0.001* 0.70 (0.64, 0.77) < 0.001* 0.82 (0.71, 0.95) 0.009*
 24–30 months 0.71 (0.62, 0.80) < 0.001* 0.58 (0.52, 0.66) < 0.001* 0.78 (0.65, 0.92) 0.004*
 30–36 months 0.67 (0.58, 0.78) < 0.001* 0.57 (0.50, 0.66) < 0.001* 0.79 (0.65, 0.96) 0.019*
 36–42 months 0.71 (0.59, 0.84) < 0.001* 0.63 (0.54, 0.74) < 0.001* 0.73 (0.58, 0.93) 0.009*
 42–48 months 0.77 (0.63, 0.93) 0.007* 0.70 (0.59, 0.83) < 0.001* 0.77 (0.59, 1.00) 0.052
 48–54 months 0.61 (0.47, 0.78) < 0.001* 0.50 (0.39, 0.63) < 0.001* 0.66 (0.48, 0.90) 0.010*
 54–60 months 0.69 (0.53, 0.91) 0.007* 0.63 (0.49, 0.81) < 0.001* 0.75 (0.53, 1.05) 0.097
 Over 60 months 0.56 (0.46, 0.69) < 0.001* 0.50 (0.41, 0.61) < 0.001* 0.51 (0.38, 0.67) < 0.001*
  1. CVD cardiovascular disease, MACE major adverse cardiovascular events, OR odds ratio, CI confidence interval
  2. * Indicates statistical significance at the 5% level
  3. 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])
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Cardiovascular Diabetology

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