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在末期脏疾病中,空间时间多层次的纵向和生存结果的联合建模
Esra Kürüm1, Danh V Nguyen2, Qi Qian3
1Department of Statistics, University of California, Riverside, CA, 92521, USA. esra.kurum@ucr.edu.
Lifetime data analysis
|October 4, 2024
概括
末期病患者 (ESKD) 面临高死亡率和住院率. 一个新的时空模型揭示了患者和区域因素如何在透析上随着时间的推移动态影响这些风险.
科学领域:
- 生物统计学 生物统计学
- 流行病学 流行病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 与非ESKD医疗保险受益者相比,透析期末病 (ESKD) 患者的死亡率和住院率更高.
- 了解影响住院和死亡率的风险因素的动态相互作用对于这一群体至关重要.
研究的目的:
- 开发和应用一种新的时空多层关节模型 (STM-JM) 来分析ESKD患者的相关住院和死亡结果.
- 调查患者和区域一级风险因素对住院治疗轨迹和死亡率的时间变化的影响.
主要方法:
- 利用来自美国脏数据系统 (USRDS) 的多层次数据.
- 开发了一个时空多层联合模型 (STM-JM),包含层次数据结构和空间相关性.
- 采用贝叶斯框架,使用薄板线条来有效估计时间变化的效应.
主要成果:
- STM-JM有效地模拟了住院和死亡的等级结构和时空变化.
- 确定了患者和区域层面因素对两种结果的显著时间变化的影响.
- 突出了美国与风险增加相关的特定时间段和地理位置.
结论:
- 拟议的STM-JM为分析ESKD群体中复杂的相关结果提供了一个强大的框架.
- 调查结果强调了在管理ESKD护理时考虑动态,多层次的风险因素和空间变化的重要性.
- 该研究确定了需要有针对性的干预措施以减轻住院和死亡风险的关键时期和地区.
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