State-of-the-Art Risk Models for Diabetes, Hypertension, Visual Diminution, and COVID-19 Severity in Mexico
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Abstract
Diabetes and hypertension are among top public health priorities, particularly in low and middle-income countries where their health and socioeconomic impact is exacerbated by the quality and accessibility of health care. Moreover, their connection with severe or deadly COVID-19 illness has further increased their societal relevance. Tools for early detection of these chronic diseases enable interventions to prevent high-impact complications, such as loss of sight and kidney failure. Similarly, prognostic tools for COVID-19 help stratify the population to prioritize protection and vaccination of high-risk groups, optimize medical resources and tests, and raise public awareness.
METHODS
We developed and validated state-of-the-art risk models for the presence of undiagnosed diabetes, hypertension, visual complications associated with diabetes and hypertension, and the risk of severe COVID-19 illness (if infected). The models were estimated using modern methods from the field of statistical learning (e.g., gradient boosting trees), and were trained on publicly available data containing health and socioeconomic information representative of the Mexican population. Lastly, we assembled a short integrated questionnaire and deployed a free online tool for massifying access to risk assessment.
RESULTS
Our results show substantial improvements in accuracy and algorithmic equity (balance of accuracy across population subgroups), compared to established benchmarks. In particular, the models: i) reached state-of-the-art sensitivity and specificity rates of 90% and 56% (0.83 AUC) for diabetes, 80% and 64% (0.79 AUC) for hypertension, 90% and 56% (0.84 AUC) for visual diminution as a complication, and 90% and 60% (0.84 AUC) for development of severe COVID disease; and ii) achieved substantially higher equity in sensitivity across gender, indigenous/non-indigenous, and regional populations. In addition, the most relevant features used by the models were in line with risk factors commonly identified by previous studies. Finally, the online platform was deployed and made accessible to the public on a massive scale.
CONCLUSIONS
The use of large databases representative of the Mexican population, coupled with modern statistical learning methods, allowed the development of risk models with state-of-the-art accuracy and equity for two of the most relevant chronic diseases, their eye complications, and COVID-19 severity. These tools can have a meaningful impact on democratizing early detection, enabling large-scale preventive strategies in low-resource health systems, increasing public awareness, and ultimately raising social well-being.
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SciScore for 10.1101/2021.01.18.21250034: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We found bar graphs of continuous data. We recommend …
SciScore for 10.1101/2021.01.18.21250034: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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