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Development and validation of the Michigan Chronic Disease Simulation Model (MICROSIM)
James F Burke1, Luciana L Copeland2, Jeremy B Sussman3,4,5
1Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America.
Abstract:
Strategies to prevent or delay Alzheimer's disease and related dementias (AD/ADRD) are urgently needed, and blood pressure (BP) management is a promising strategy. Yet the effects of different BP control strategies across the life course on AD/ADRD are unknown. Randomized trials may be infeasible due to prolonged follow-up and large sample sizes. Simulation analysis is a practical approach to estimating these effects using the best available existing data. However, existing simulation frameworks cannot estimate the effects of BP control on both dementia and cardiovascular disease. This manuscript describes the design principles, implementation details, and population-level validation of a novel population-health microsimulation framework, the MIchigan ChROnic Disease SIMulation (MICROSIM), for The Effect of Lower Blood Pressure over the Life Course on Late-life Cognition in Blacks, Hispanics, and Whites (BP-COG) study of the effect of BP levels over the life course on dementia and cardiovascular disease. MICROSIM is an agent-based Monte Carlo simulation designed using computer programming best practices. MICROSIM estimates annual vascular risk factor levels and transition probabilities in all-cause dementia, stroke, myocardial infarction, and mortality in a nationally representative sample of US adults 18+ using the National Health and Nutrition Examination Survey (NHANES). MICROSIM models changes in risk factors over time, cognition and dementia using changes from a pooled dataset of individual participant data from 6 US prospective cardiovascular cohort studies. Cardiovascular risks were estimated using a widely used risk model and BP treatment effects were derived from meta-analyses of randomized trials. MICROSIM is an extensible, open-source framework designed to estimate the population-level impact of different BP management strategies and reproduces US population-level estimates of BP and other vascular risk factors levels, their change over time, and incident all-cause dementia, stroke, myocardial infarction, and mortality.
Insights
Managing blood pressure (BP) across a lifetime may help prevent Alzheimer's disease and related dementias (AD/ADRD). A new simulation model, MICROSIM, can now estimate the population-level impact of BP control on both dementia and cardiovascular disease.
Area of Science:
- Gerontology
- Epidemiology
- Computational Biology
Background:
- Alzheimer's disease and related dementias (AD/ADRD) pose a significant public health challenge, necessitating effective prevention strategies.
- Blood pressure (BP) management is a promising avenue for delaying or preventing AD/ADRD, but its long-term effects across the life course remain unclear.
- Existing simulation models lack the capability to assess the combined impact of BP control on both dementia and cardiovascular disease outcomes.
Purpose of the Study:
- To introduce and validate a novel population-health microsimulation framework, MICROSIM (MIchigan ChROnic Disease SIMulation).
- To enable the estimation of population-level effects of various BP management strategies on dementia and cardiovascular disease.
- To support the "Effect of Lower Blood Pressure over the Life Course on Late-life Cognition in Blacks, Hispanics, and Whites" (BP-COG) study.
Main Methods:
- Developed MICROSIM as an agent-based Monte Carlo simulation framework using best programming practices.
- Utilized National Health and Nutrition Examination Survey (NHANES) data for a nationally representative US adult sample (18+).
- Incorporated data from 6 US prospective cardiovascular cohort studies to model risk factors, cognition, and dementia transitions; BP treatment effects derived from meta-analyses.
Main Results:
- MICROSIM successfully reproduces US population-level estimates for BP, vascular risk factors, and their changes over time.
- The framework accurately models incident all-cause dementia, stroke, myocardial infarction, and mortality.
- Validated population-level estimates for key health outcomes, demonstrating the model's reliability.
Conclusions:
- MICROSIM is a validated, extensible, open-source simulation framework for assessing the population-level impact of BP management strategies.
- This novel tool can now estimate the effects of BP control on both dementia and cardiovascular disease across the life course.
- MICROSIM provides a practical approach to inform public health policies aimed at preventing AD/ADRD and cardiovascular diseases.
