title: Development and validation of a predictive risk model for all-cause mortality in type 2 diabetes.
abstract: OBJECTIVE
  Type 2 diabetes is common and is associated with an approximate 80% increase in the rate of mortality. Management decisions may be assisted by an estimate of the patient's absolute risk of adverse outcomes, including death. This study aimed to derive a predictive risk model for all-cause mortality in type 2 diabetes.
  
  
  METHODS
  We used primary care data from a large national multi-ethnic cohort of patients with type 2 diabetes in New Zealand and linked mortality records to develop a predictive risk model for 5-year risk of mortality. We then validated this model using information from a separate cohort of patients with type 2 diabetes.
  
  
  RESULTS
  26,864 people were included in the development cohort with a median follow up time of 9.1 years. We developed three models initially using demographic information and then progressively more clinical detail. The final model, which also included markers of renal disease, proved to give best prediction of all-cause mortality with a C-statistic of 0.80 in the development cohort and 0.79 in the validation cohort (7610 people) and was well calibrated. Ethnicity was a major factor with hazard ratios of 1.37 for indigenous Maori, 0.41 for East Asian and 0.55 for Indo Asian compared with European (P<0.001).
  
  
  CONCLUSIONS
  We have developed a model using information usually available in primary care that provides good assessment of patient's risk of death. Results are similar to models previously published from smaller cohorts in other countries and apply to a wider range of patient ethnic groups.
authors: School of Population Health, University of Auckland, New Zealand. Electronic address: trob006@aucklanduni.ac.nz.
authors: Tom E
authors: TE
authors: Robinson
authors: School of Population Health, University of Auckland, New Zealand.
authors: C Raina
authors: CR
authors: Elley
authors: School of Population Health, University of Auckland, New Zealand.
authors: Tim
authors: T
authors: Kenealy
authors: Auckland Diabetes Centre, Auckland District Health Board, New Zealand.
authors: Paul L
authors: PL
authors: Drury
mesh_terms: D002423:Cause of Death / Q000639:trends; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology*; D005006:Ethnicity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009520:New Zealand / Q000453:epidemiology; D018570:Risk Assessment / Q000458:organization & administration*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
keywords: Diabetes mellitus type 2; Mortality; New Zealand; Risk assessment; Risk factors; Survival analysis