Time Estimation of Occurrence of Diabetes-Related Cardiovascular Complications by Ching-Yuan Hu Master of Science 2011 Institute of Chinese Medical Sciences University of Macau
Time Estimation of Occurrence of Diabetes-Related Cardiovascular Complications by Ching-Yuan Hu A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science Institute of Chinese Medical Sciences University of Macau 2011 Approved by Supervisor Date
i
ii
Abstract The prevalence of type 2 diabetes mellitus has been increasing with the changes of diet and lifestyle in Asia. Further, diabetes is manifested itself in the form of association between different types of complications. These complications are contributing to huge impact on healthcare utilization, societal productivity, quality of life and survival rate. This requires accurate understanding and description of diabetes progression and its complications. Mathematical models thus offer an opportunity to provide data on long-term health, economic and quality of life outcomes for decision making. In this study, four sub-models will be constructed to simulate major diabetes-related cardiovascular complications and estimate time-to-occurrence and probability of diabetes-related complications. Semi-Markov model serves as the major modeling tool in this study. The prevalence and mortality of diabetic cardiovascular complication were estimated by different status using survival analysis. The interdependence relation between MI and stroke is significant. The mortality rate of patients with MI, CHF and stroke at the same time is highest (93.3%). By contrast, those patient with IHD have the lowest mortality rate-1.71%. This model can let us clearly understand the mortality rate of diabetes patients and the progression of diabetes-related cardiovascular diseases. Furthermore, not only diabetic patients can get more target treatment, but also those medical providers can make management strategies more efficiently based on the results of those estimations. Key words: type 2 diabetes mellitus, cardiovascular complications, transition probability. iii
!"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""#!!"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!##! $%&'()*'!"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!###!!""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!+!!"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!+!!""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!,!!"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!-!!!""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!-!!""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!.!!"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!/!!"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!++!!""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!+0!!""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!+0!!""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!+0!!""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!,,!!""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!-1!!"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!-,!!"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!-,!!""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!--!!""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!22!!""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!22!!""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!20! iv
!"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!20!!""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!20!!""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!2/! v
!"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!-!!""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!0!!""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!/!!"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!,/!!"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!,3!!"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!-0!!""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!-0!!"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!-/!!"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!-3!!"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!-4!!"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!21!!""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!2+! vi
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!3!!""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!+4!!""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!+4!!""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!,1!!""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!,+!!"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!,0!!"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!,4!!"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!2,!!"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!2,!!"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""!2-! vii