Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA.
BMJ Open. 2022 Jul 6;12(7):e056546. doi: 10.1136/bmjopen-2021-056546.
To develop and validate a novel, microsimulation model that accounts for the prevalence and incidence of age-associated dementias (AAD), disease progression and associated mortality.
DESIGN, DATA SOURCES AND OUTCOME MEASURES: We developed the AAD policy (AgeD-Pol) model, a microsimulation model to simulate the natural history, morbidity and mortality associated with AAD. We populated the model with age-stratified and sex-stratified data on AAD prevalence, AAD incidence and mortality among people with AAD. We first performed internal validation using data from the Adult Changes in Thought (ACT) cohort study. We then performed external validation of the model using data from the Framingham Heart Study, the Rotterdam Study and Kaiser Permanente Northern California (KPNC). We compared model-projected AAD cumulative incidence and mortality with published cohort data using mean absolute percentage error (MAPE) and root-mean-square error (RMSE).
In internal validation, the AgeD-Pol model provided a good fit to the ACT cohort for cumulative AAD incidence, 10.4% (MAPE, 0.2%) and survival, 66.5% (MAPE, 8.8%), after 16 years of follow-up among those initially aged 65-69 years. In the external validations, the model-projected lifetime cumulative incidence of AAD was 30.5%-32.4% (females) and 16.7%-23.0% (males), using data from the Framingham and Rotterdam cohorts, and AAD cumulative incidence was 21.5% over 14 years using KPNC data. Model projections demonstrated a good fit to all three cohorts (MAPE, 0.9%-9.0%). Similarly, model-projected survival provided good fit to the Rotterdam (RMSE, 1.9-3.6 among those with and without AAD) and KPNC cohorts (RMSE, 7.6-18.0 among those with AAD).
The AgeD-Pol model performed well when validated to published data for AAD cumulative incidence and mortality and provides a useful tool to project the AAD disease burden for health systems planning in the USA.
开发和验证一种新颖的、考虑到与年龄相关的痴呆症（AAD）的流行率和发生率、疾病进展和相关死亡率的 microsimulation 模型。
设计、数据来源和结果测量：我们开发了 AAD 政策（AgeD-Pol）模型，这是一种用于模拟与 AAD 相关的自然史、发病率和死亡率的 microsimulation 模型。我们使用年龄分层和性别分层的数据对 AAD 患病率、AAD 发病率和 AAD 患者的死亡率进行了模型填充。我们首先使用 Adult Changes in Thought（ACT）队列研究的数据进行内部验证。然后，我们使用 Framingham Heart Study、Rotterdam Study 和 Kaiser Permanente Northern California（KPNC）的数据对模型进行外部验证。我们使用平均绝对百分比误差（MAPE）和均方根误差（RMSE）比较了模型预测的 AAD 累积发病率和死亡率与已发表的队列数据。
在内部验证中，AgeD-Pol 模型在 16 年的随访后，对 65-69 岁初始年龄的人群的累积 AAD 发病率（MAPE，0.2%）和生存（MAPE，8.8%）具有良好的拟合度。在外部验证中，使用 Framingham 和 Rotterdam 队列的数据，模型预测的终生 AAD 累积发病率为 30.5%-32.4%（女性）和 16.7%-23.0%（男性），使用 KPNC 数据，AAD 累积发病率为 14 年 21.5%。模型预测结果与所有三个队列均具有良好的拟合度（MAPE，0.9%-9.0%）。同样，模型预测的生存也与 Rotterdam（RMSE，AAD 患者和无 AAD 患者分别为 1.9-3.6）和 KPNC 队列（RMSE，AAD 患者为 7.6-18.0）具有良好的拟合度。
当对 AgeD-Pol 模型进行验证以获得 AAD 累积发病率和死亡率的已发表数据时，该模型表现良好，并为美国卫生系统规划提供了一种预测 AAD 疾病负担的有用工具。
