老年高血压患者抑郁发生风险的列线图预测模型的构建和验证

Construction and validation of a nomogram prediction model for risk of depression in elderly patients with hypertension

  • 摘要:
    目的 探讨老年高血压患者抑郁发生风险的影响因素, 构建列线图预测模型并进行验证。
    方法 从中国健康与养老追踪调查(CHARLS)2018年全国调查数据库中筛选出869例老年高血压患者作为研究对象。采用多因素Logistic回归分析探讨老年高血压患者抑郁发生风险的影响因素, 并构建列线图预测模型。采用Hosmer-Lemeshow (H-L)拟合度曲线、受试者工作特征(ROC)曲线的曲线下面积(AUC)和校准曲线验证模型的准确性和有效性。
    结果 老年高血压患者抑郁发生率为47.18%。居住地在农村(OR=2.191, P < 0.05)、日常生活活动能力(BADL)功能受损(OR=2.338, P < 0.05)、工具性日常活动能力(IADL)功能受损(OR=1.674, P < 0.05)、生活满意度差(OR=7.348, P < 0.05)、健康自评一般(OR=0.441, P < 0.05)、健康自评好(OR=0.259, P < 0.05)和睡眠时间6~9 h (OR=0.510, P < 0.05)是老年高血压患者抑郁发生风险的影响因素。ROC曲线的AUC为0.795, 校准曲线斜率接近1, 且H-L拟合度曲线χ2=5.074;对验证集的验证结果显示ROC曲线的AUC为0.703。
    结论 本研究建立的预测模型具有较高的准确度及区分度。医护人员可以针对患者的个体化因素, 采取有效的预防措施。

     

    Abstract:
    Objective To explore the influencing factors of depression risk in elderly patients with hypertension and construct and validate a nomogram prediction model.
    Methods A total of 869 elderly patients with hypertension were selected from national survey database of the China Health and Retirement Longitudinal Study (CHARLS) in 2018.Multivariate Logistic regression analysis was used to identify the risk factors for depression in elderly patients with hypertension, and a nomogram prediction model was constructed.The accuracy and effectiveness of the model were validated by the Hosmer-Lemeshow (H-L) goodness-of-fit test, the area under the curve (AUC) of the receiver operating characteristic (ROC) curve, and the calibration curve.
    Results The incidence of depression in elderly patients with hypertension was 47.18%.Factors influencing the risk of depression included rural residence (OR=2.191, P < 0.05), impaired basic activities of daily living (BADL)(OR=2.338, P < 0.05), impaired instrumental activitiesofdaily living (IADL)(OR=1.674, P < 0.05), poor life satisfaction (OR=7.348, P < 0.05), fair self-rated health (OR=0.441, P < 0.05), good self-rated health (OR=0.259, P < 0.05), and sleep duration of 6 to 9 hours (OR=0.510, P < 0.05).The AUC of the ROC curve was 0.795, the slope of the calibration curve was close to 1, and the H-L goodness-of-fit test yielded χ2=5.074.The validation set showed an AUC of 0.703.
    Conclusion The prediction model established in this study has high accuracy and discriminative ability.Healthcare professionals can take effective preventive measures based on individual patient factors.

     

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