title: Prediction of five-year all-cause mortality in Chinese patients with type 2 diabetes mellitus - A population-based retrospective cohort study.
abstract: OBJECTIVE
  This study aimed to develop and validate an all-cause mortality risk prediction model for Chinese primary care patients with type 2 diabetes mellitus(T2DM) in Hong Kong.
  
  
  METHODS
  A population-based retrospective cohort study was conducted on 132,462 Chinese patients who had received public primary care services during 2010. Each gender sample was randomly split on a 2:1 basis into derivation and validation cohorts and was followed-up for a median period of 5years. Gender-specific mortality risk prediction models showing the interaction effect between predictors and age were derived using Cox proportional hazards regression with forward stepwise approach. Developed models were compared with pre-existing models by Harrell's C-statistic and calibration plot using validation cohort.
  
  
  RESULTS
  Common predictors of increased mortality risk in both genders included: age; smoking habit; diabetes duration; use of anti-hypertensive agents, insulin and lipid-lowering drugs; body mass index; hemoglobin A1c; systolic blood pressure(BP); total cholesterol to high-density lipoprotein-cholesterol ratio; urine albumin to creatinine ratio(urine ACR); and estimated glomerular filtration rate(eGFR). Prediction models showed better discrimination with Harrell"'s C-statistics of 0.768(males) and 0.782(females) and calibration power from the plots than previously established models.
  
  
  CONCLUSIONS
  Our newly developed gender-specific models provide a more accurate predicted 5-year mortality risk for Chinese diabetic patients than other established models.
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong. Electronic address: yfwan@hku.hk.
authors.forename: Eric Yuk Fai
authors.initials: EYF
authors.lastname: Wan
authors.affiliation: School of Nursing, The University of Hong Kong, Hong Kong.
authors.forename: Daniel Yee Tak
authors.initials: DYT
authors.lastname: Fong
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong.
authors.forename: Colman Siu Cheung
authors.initials: CSC
authors.lastname: Fung
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong.
authors.forename: Esther Yee Tak
authors.initials: EYT
authors.lastname: Yu
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong.
authors.forename: Weng Yee
authors.initials: WY
authors.lastname: Chin
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong.
authors.forename: Anca Ka Chun
authors.initials: AKC
authors.lastname: Chan
authors.affiliation: Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong.
authors.forename: Cindy Lo Kuen
authors.initials: CLK
authors.lastname: Lam
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000706:statistics & numerical data; D002423:Cause of Death; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality*; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis
keywords: Mortality; Prediction; Primary care; Risk; Type 2 diabetes mellitus