Development and validation of questionnaire-based machine learning models for predicting all-cause mortality in a representative population of China

Abstract

Background: Considering that the previously developed mortality prediction models have limited applications to the Chinese population, a questionnaire-based prediction model is of great importance for its accuracy and convenience in clinical practice.

Methods: Two national cohort, namely, the China Health and Nutrition Survey (8,355 individual older than 18) and the China Health and Retirement Longitudinal Study (12,711 individuals older than 45) were used for model development and validation. One hundred and fifty-nine variables were compiled to generate predictions. The Cox regression model and six machine learning (ML) models were used to predict all-cause mortality. Finally, a simple questionnaire-based ML prediction model was developed using the best algorithm and validated.

Results: In the internal validation set, all the ML models performed better than the traditional Cox model in predicting 6-year mortality and the random survival forest (RSF) model performed best. The questionnaire-based ML model, which only included 20 variables, achieved a C-index of 0.86 (95%CI: 0.80-0.92). On external validation, the simple questionnaire-based model achieved a C-index of 0.82 (95%CI: 0.77-0.87), 0.77 (95%CI: 0.75-0.79), and 0.79 (95%CI: 0.77-0.81), respectively, in predicting 2-, 9-, and 11-year mortality.

Conclusions: In this prospective population-based study, a model based on the RSF analysis performed best among all models. Furthermore, there was no significant difference between the prediction performance of the questionnaire-based ML model, which only included 20 variables, and that of the model with all variables (including laboratory variables). The simple questionnaire-based ML prediction model, which needs to be further explored, is of great importance for its accuracy and suitability to the Chinese general population.

Keywords: machine learning; mortality; personalized prediction; prediction model; questionnaire-based.

Figure 1

Receiver operating characteristic curves of different models for predicting 6-year all-cause mortality in Internal Validation Cohort. (A) Models with all variables. (B) Models with variables excluding laboratory variables. (C) Models with only laboratory variables. COX, Cox proportional hazards regression model; Lasso, least absolute shrinkage and selection operator regression model; GLMBoost, boosted generalized linear model; ST, survival tree model; CIF, conditional inference forest model; RSF, random forest survival analysis model; GBM, gradient boosting model.