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研究生:Grace Sambo
研究生(外文):Grace Sambo
論文名稱:花蓮縣老人之死亡風險預測分數系統之建構
論文名稱(外文):Development of a risk scoring system for predicting mortality among older people in Hualien
指導教授:謝宗成謝宗成引用關係
指導教授(外文):Tsung-Cheng Hsieh
口試委員:李子奇林志榮
口試委員(外文):Zi-Qi LiZhi-Rong Lin
口試日期:2022-06-17
學位類別:碩士
校院名稱:慈濟大學
系所名稱:公共衛生學系碩士班
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2022
畢業學年度:110
語文別:英文
論文頁數:103
外文關鍵詞:Agingolder adultsscoring systemsshort- and long-term mortality
相關次數:
  • 被引用被引用:0
  • 點閱點閱:79
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  Background: Health behaviors and comorbidities could largely contribute to mortality risk, especially among older adults. An accurate risk scoring system is key in identifying potential high-risk factors that predict mortality, hence facilitating decision-making in clinical and policy interventions. To our knowledge, no study has sought to develop a scoring system to predict mortality among older adults in Hualien. This study aims to identify risk factors for mortality and develop a risk scoring system to predict short-term and mid-term mortality among the older population in Hualien, Taiwan.
  Material and Methods: This study analyzed secondary data from the National Health Agency; Hualien County health bureau conducted between 2013 to 2019. We randomly selected and categorized the participants into a training and validation datasets. Of 33021 older adults who attended health examinations, 16081 were eligible for inclusion into the study and randomly selected to develop and validate the scoring system. Descriptive statistics, mean and standard deviation, were used for quantitative variables and frequencies and percentages for qualitative variables. In addition, paired t-test and chi-square or fishers' exact test were used to compare quantitative variables and categorical variables. Finally, Cox proportional hazards model with stepwise forward selection was employed to identify the potential associated factors. The risk scoring system for predicting mortality for each of the four-year periods was constructed based on five steps (step 1 to 4 for the development phase and step 5 for validation).
  Results: In the development dataset, approximately 262 (2%) expired within one year of observation, 611 (5.4%), 837 (8.5%) and 960 (11.8%) expired during the second, third and fourth years, respectively. Overall, age, gender, smoking, diabetes, stroke, and Hepatitis B and C significantly increased short- and long-term mortality risk. However, consuming alcohol and physical activity were associated with decreased mortality risk. In general, the developed risk scoring system indicated good performance at second (AUROC = 0.768), third (0.747) and fourth (0.721) year mortality in contrast to (AUROC= 0.549) at first-year mortality.
  Conclusion: This study’s findings showed that a scoring system that uses health behaviors and comorbidities could measure mortality risk, particularly when used at intermittent and longterm.

Table of Contents
Acknowledgement ...................................................................................................................... ii
Abstract........................................................................................................................................ i
List of Tables............................................................................................................................. v
CHAPTER ONE........................................................................................................................ 1
INTRODUCTION..................................................................................................................... 1
1.1 Background ...................................................................................................................... 1
1.2 Aim of the study.................................................................................................................... 5
1.2.1 Objectives .......................................................................................................................... 5
CHAPTER TWO ....................................................................................................................... 6
LITERATURE REVIEW ........................................................................................................ 6
2.1. Definition of Older adults.................................................................................................... 6
2.2 Determinants of Health behaviours ...................................................................................... 6
2.2.1 Alcohol consumption......................................................................................................... 7
2.2.2 Smoking ............................................................................................................................. 8
2.2.3 Betel nuts Chewing............................................................................................................ 9
2.2.4 Physical activity............................................................................................................... 10
2.3 Mortality and associated risk factors .................................................................................. 11
2.4 Importance of a risk scoring system ................................................................................... 12
CHAPTER THREE................................................................................................................ 14
MATERIALS AND METHODS ........................................................................................... 14
3.1 Study design......................................................................................................................... 14
3.2 Data source.......................................................................................................................... 16
iii
3.3. Study Variables.................................................................................................................. 16
3.4 Outcomes Variables............................................................................................................ 16
3.4.1 One-year mortality........................................................................................................... 16
3.4.1.2 Two-year mortality ....................................................................................................... 17
3.4.1.3 Three-year mortality ..................................................................................................... 17
3.4.1.4 Four-year mortality ....................................................................................................... 17
3.4.2 Independent variables .................................................................................................... 17
3.5 Statistical analysis.............................................................................................................. 18
3.6 IRB approval....................................................................................................................... 19
CHAPTER FOUR .................................................................................................................................20
RESULTS ................................................................................................................................ 20
4.1 One-year mortality.............................................................................................................................20
4.1.1 Characteristics of the study participants.........................................................................................20
4.1.2 Description of alive and expired older people in Hualien (One-year mortality)............. 23
4.1.3 Development of the scoring system................................................................................................25
4.1.4 Validation of the scoring system ....................................................................................................30
4.2. Two-year mortality ...........................................................................................................................31
4.2.1 Characteristics of the participants...................................................................................................31
4.2.2. Description of alive and expired older people ...............................................................................33
4.2.3 Development of a scoring system...................................................................................................35
4.2.4 Validation of the scoring system ....................................................................................................39
4.3 Three-year mortality ..........................................................................................................................41
4.3.1 Characteristics of the study participants.........................................................................................41
4.3.2 Description of alive and expired older adults in Hualien ...............................................................43
iv
4.3.3 Development of the scoring system................................................................................................45
4.3.4 Validation of the scoring system ....................................................................................................50
4.4 Fourth-year mortality.........................................................................................................................52
4.4.1 Characteristics of the study participants.........................................................................................52
4.4.2 Description of alive and expired older people in Hualien (four-year mortality) ............................54
4.4.3. Development of the scoring system...............................................................................................56
4.4.4 Validation of the scoring system...................................................................................... 61
CHAPTER FIVE...................................................................................................................................62
DISCUSSION AND CONCLUSION ...................................................................................................62
5.1 Determinants of mortality risk...........................................................................................................62
5.2 Predictive ability of the scoring systems ............................................................................. 67
5.3 Predicted differences between rural and urban areas in the urban and rural area................ 68
5.4. Study contributions, strengths, and limitations.................................................................. 69
5.5 Conclusion ........................................................................................................................... 70
References................................................................................................................................. 72
Appendix 1 Research schedule ................................................................................................ 103


List of Tables
Table 4.1.2 Characteristics of alive and expired older adults (One-year mortality)..................... 24
Table 4.1.3.1 Results of ROC Analysis and the optimal cut-off point for age............................. 25
Table 4.1.3.2 Cox proportional analysis based on the determined risk score .............................. 27
Table 4.1.3.3 The determined risk scoring system and the corresponding optimal cut-off point 29
Table 4.1.4. Results of the validation of the developed scoring system....................................... 30
Table 4.1.4.1 Comparison of accuracy of the score between rural and urban.............................. 30
Table 4.2.1 Characteristics of the study participants (Two-year mortality) ................................. 32
Table 4.2.3 Characteristics of alive and expired older adults (Two-year mortality).................... 34
Table 4.2.3.1 Results of ROC Analysis and the optimal cut-off point for age............................. 35
Table 4.2.3.2 Cox proportional analysis with stepwise selection based on the determined risk score
(Two-year mortality)..................................................................................................................... 37
Table 4.2.3.3 The determined risk scoring system and the corresponding optimal cut-off point 38
Table 4.2.4.1 Results of the validation of the determined scoring system ................................... 39
Table 4.2.4.2 Results of the validation of the determined scoring system ................................... 40
Table 4.3.1 Characteristics of the study participants (three-year mortality)................................. 42
Table 4.3.2 Characteristics of alive and expired older adults (three-year mortality) ................... 44
Table 4.3.3 Results of ROC Analysis and the optimal cut-off point for age................................ 45
Table 4.3.3.1 Cox proportional analysis based on the determined risk score............................... 47
Table 4.3.3.2 The determined risk scoring system and the corresponding optimal cut-off point 49
Table 4.3.4. Results of the validation of the determined scoring system ..................................... 51
vi
Table 4.3.4.1 Comparison of accuracy of the score between rural and urban.............................. 51
Table 4.4.1 Characteristics of the study participants (Four-year mortality)................................. 53
Table 4.4.2 Characteristics of alive and expired older adults (four-year mortality)..................... 55
Table 4.4.3 Results of ROC Analysis and the optimal cut-off point for age................................ 56
Table 4.4.3.1 Cox proportional analysis based on the determined risk score .............................. 58
Table 4.4.3.2 The determined risk scoring system and the corresponding optimal cut-off point 60
Table 4.4.4.1 Results of the validation of the developed scoring system (four-year mortality)... 61
Table 4.4.4.2 Comparison of accuracy of the score between rural and urban areas..................... 61


List of Figures
Figure 4.1.3.3 the ROC curve of the developed scoring system (One-year mortality) ................ 29
Figure 4.2.3.3 The ROC curve for the developed scoring system................................................ 39
Figure 4.3.3.2 the ROC curve of the developed scoring system................................................... 50
Figure 4.4.3.2 the ROC curve of the developed scoring system................................................... 60



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