title: Risk Factors Predicting Infectious Lactational Mastitis: Decision Tree Approach versus Logistic Regression Analysis.
abstract: Objectives Lactational mastitis frequently leads to a premature abandonment of breastfeeding; its development has been associated with several risk factors. This study aims to use a decision tree (DT) approach to establish the main risk factors involved in mastitis and to compare its performance for predicting this condition with a stepwise logistic regression (LR) model. Methods Data from 368 cases (breastfeeding women with mastitis) and 148 controls were collected by a questionnaire about risk factors related to medical history of mother and infant, pregnancy, delivery, postpartum, and breastfeeding practices. The performance of the DT and LR analyses was compared using the area under the receiver operating characteristic (ROC) curve. Sensitivity, specificity and accuracy of both models were calculated. Results Cracked nipples, antibiotics and antifungal drugs during breastfeeding, infant age, breast pumps, familial history of mastitis and throat infection were significant risk factors associated with mastitis in both analyses. Bottle-feeding and milk supply were related to mastitis for certain subgroups in the DT model. The areas under the ROC curves were similar for LR and DT models (0.870 and 0.835, respectively). The LR model had better classification accuracy and sensitivity than the DT model, but the last one presented better specificity at the optimal threshold of each curve. Conclusions The DT and LR models constitute useful and complementary analytical tools to assess the risk of lactational infectious mastitis. The DT approach identifies high-risk subpopulations that need specific mastitis prevention programs and, therefore, it could be used to make the most of public health resources.
authors.affiliation: Departamento de Nutrición, Bromatología y Tecnología de los Alimentos, Universidad Complutense de Madrid, Ciudad Universitaria, Avda. Puerta de Hierro, s/n, 28040, Madrid, Spain.
authors.forename: Leónides
authors.initials: L
authors.lastname: Fernández
authors.affiliation: Departamento de Nutrición, Bromatología y Tecnología de los Alimentos, Universidad Complutense de Madrid, Ciudad Universitaria, Avda. Puerta de Hierro, s/n, 28040, Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Mediano
authors.affiliation: Computing Services, Research Support, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: García
authors.affiliation: Departamento de Nutrición, Bromatología y Tecnología de los Alimentos, Universidad Complutense de Madrid, Ciudad Universitaria, Avda. Puerta de Hierro, s/n, 28040, Madrid, Spain.
authors.forename: Juan M
authors.initials: JM
authors.lastname: Rodríguez
authors.affiliation: Departamento de Nutrición, Bromatología y Tecnología de los Alimentos, Universidad Complutense de Madrid, Ciudad Universitaria, Avda. Puerta de Hierro, s/n, 28040, Madrid, Spain. mlmarin@ucm.es.
authors.forename: María
authors.initials: M
authors.lastname: Marín
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects; D001942:Breast Feeding / Q000009:adverse effects* / Q000706:statistics & numerical data; D061186:Breast Milk Expression / Q000009:adverse effects; D016022:Case-Control Studies; D003663:Decision Trees; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007774:Lactation; D016015:Logistic Models; D008413:Mastitis / Q000175:diagnosis / Q000209:etiology; D009558:Nipples / Q000293:injuries; D049590:Postpartum Period; D011237:Predictive Value of Tests; D012372:ROC Curve; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents
keywords: Decision tree; Lactational mastitis; Logistic regression; Public health; Risk factors