A Markov chain model to assess the efficacy of screening for non-insulin dependent diabetes mellitus (NIDDM)

被引:45
作者
Kuo, HS
Chang, HJ
Chou, P
Teng, L
Chen, THH
机构
[1] Natl Taiwan Univ, Coll Publ Hlth, Grad Inst Epidemiol, Taipei 10764, Taiwan
[2] Natl Yang Ming Univ, Coll Med, Grad Inst Publ Hlth, Taipei 112, Taiwan
关键词
NIDDM screening; Markov chain model;
D O I
10.1093/ije/28.2.233
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background The high prevalence and severe consequences of non-insulin dependent diabetes mellitus (NIDDM) in Taiwan calls for urgent measures to detect this disease in the asymptomatic phase. However, the efficacy of early detection of NIDDM is highly dependent on its natural history from the disease-free state, through the asymptomatic to the symptomatic phase and death from NIDDM or other causes. Methods In order to project the above progression, a five-state illness-and-death Markov chain model was proposed to estimate these transition parameters using data from two rounds of a blood sugar screening programme for NIDDM in Puli, in central Taiwan. Results showed that the annual incidence for asymptomatic NIDDM was 10.67 per 1000 (95% CI : 8.26-13.79) and the average duration between the asymptomatic and symptomatic phases (the sojourn time) was 8 years (95% CI: 5.74-11.29). The 10-year survival rate for asymptomatic NIDDM (79.35%) was better than that for symptomatic NIDDM (69.45%). Prediction of deaths from NIDDM was performed to assess how the efficacy of screening for NIDDM varied by different screening frequencies (annual, biennial, 4-yearly and the control group). Results indicated there is no substantial difference in mortality reduction from NIDDM among the annual, biennial and 4-yearly screening regimens. However, a 4-yearly screening regimen significantly reduced deaths from NIDDM by 40% (95% CI: 26-51%). Conclusions A long sojourn time and the substantial reduction in mortality suggest that a 4-yearly screening regime for NIDDM would be most effective and feasible in Taiwan. The proposed five-state Markov chain model can be applied to other similar NIDDM screening projects.
引用
收藏
页码:233 / 240
页数:8
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