title: Evaluating cardiovascular mortality in type 2 diabetes patients: an analysis based on competing risks Markov chains and additive regression models.
abstract: OBJECTIVE
  Type 2 diabetes represents a condition significantly associated with increased cardiovascular mortality. The aims of the study are: (i) to estimate the cumulative incidence function for cause-specific mortality using Cox and Aalen model; (ii) to describe how the prediction of cardiovascular or other causes mortality changes for patients with different pattern of covariates; (iii) to show if different statistical methods may give different results.
  
  
  METHODS
  Cox and Aalen additive regression model through the Markov chain approach, are used to estimate the cause-specific hazard for cardiovascular or other causes mortality in a cohort of 2865 type 2 diabetic patients without insulin treatment. The models are compared in the estimation of the risk of death for patients of different severity.
  
  
  RESULTS
  For younger patients with a better covariates profile, the Cumulative Incidence Function estimated by Cox and Aalen model was almost the same; for patients with the worst covariates profile, models gave different results: at the end of follow-up cardiovascular mortality rate estimated by Cox and Aalen model was 0.26 [95% confidence interval (CI) = 0.21-0.31] and 0.14 (95% CI = 0.09-0.18).
  
  
  CONCLUSIONS
  Standard Cox and Aalen model capture the risk process for patients equally well with average profiles of co-morbidities. The Aalen model, in addition, is shown to be better at identifying cause-specific risk of death for patients with more severe clinical profiles. This result is relevant in the development of analytic tools for research and resource management within diabetes care.
authors.affiliation: Unit of Cancer Epidemiology, S. Giovanni Battista Hospital and University of Turin and CPO Piemonte, Italy. r_rosato@yahoo.com
authors.forename: Rosalba
authors.initials: R
authors.lastname: Rosato
authors.forename: G
authors.initials: G
authors.lastname: Ciccone
authors.forename: S
authors.initials: S
authors.lastname: Bo
authors.forename: G F
authors.initials: GF
authors.lastname: Pagano
authors.forename: F
authors.initials: F
authors.lastname: Merletti
authors.forename: D
authors.initials: D
authors.lastname: Gregori
mesh_terms: D002318:Cardiovascular Diseases / Q000401:mortality*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D016016:Proportional Hazards Models; D012044:Regression Analysis; D018570:Risk Assessment