Classification rule for ten year MACE Risk in primary care tarragona older adults with type2 diabetes: a CHAID decision-tree analysis

• Published in: BMC family practice Vol. 26; no. 1; pp. 129 - 11
• Main Authors: Ribas Seguí, D., Forcadell, MJosé, Vila-Córcoles, Angel, de Diego-Cabanes, Cinta, Ochoa-Gondar, Olga, Lujan, Francisco Martin, Gracia, Eva Satué
• Format: Journal Article
• Language: English
• Published: London BioMed Central 25.04.2025; BMC
• Subjects: Age Factors; Aged; Aged, 80 and over; Blood pressure; Cardiovascular disease; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Cardiovascular Diseases - mortality; CHAID; Chi-square test; Cholesterol; Chronic illnesses; Clinical medicine; Decision tree; Decision Trees; Diabetes; Diabetes in primary care; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - epidemiology; Family Medicine; Female; General Practice; Heart attacks; High density lipoprotein; Humans; Laboratories; MACE; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Myocardial Infarction - epidemiology; Older people; Population; Primary care; Primary Care Medicine; Primary Health Care; Retrospective Studies; Risk Assessment - methods; Risk Factors; Stroke; Stroke - epidemiology; Variables; Spain; Diabetes; MACE; Decision tree; CHAID
• ISSN: 2731-4553; 2731-4553; 1471-2296
• DOI: 10.1186/s12875-025-02826-w

Background Cardiovascular disease is the leading cause of mortality among individuals with Type 2 Diabetes Mellitus (T2DM). This study developed a simple tool to predict the 10-year risk of major adverse cardiovascular events (MACE) in T2DM patients over 60 years within primary care. Methods A retrospective cohort study was conducted on patients with T2DM who were over 60 years old in Tarragona, spanning from 01/01/2009–31/12/2018. Primary outcome was MACE, which included acute myocardial infarction (AMI), stroke, and cardiovascular death, all of which were identified using ICD-9 diagnostic codes. Other variables were age, sex, comorbidities, risk factors, as well as clinical and laboratory parameters. A Chi-Square Automatic Interaction Detector (CHAID) decision tree classification was utilized to assess the 10-year risk of developing a new MACE. Results Five thousand five hundred fifty-four patients with T2DM were identified. Among the 4,666 with T2DM and without previous MACE, 779 patients went on to develop a new MACE. The CHAID model categorizes individuals into three risk groups based on the primary predictor variable, which is age. For patients under the age of 71 with hypertension, having HDL-c levels less than 39 mg/dL increases the risk of developing a new MACE to 19.9%. Among individuals aged 71 to 75 years, having fasting glucose levels greater than 177 mg/dL elevates the risk to 27.2%. Conclusion Classification trees based on CHAID allow for the development of decision rules and simplify the stratification of cardiovascular risk in patients with T2DM, making it a valuable tool for risk assessment within a primary care setting.