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. 2025 Apr 25;26(1):129.
doi: 10.1186/s12875-025-02826-w.

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

D Ribas Seguí  1   2 , MJosé Forcadell  3   4 , Angel Vila-Córcoles  5   3 , Cinta de Diego-Cabanes  5   3 , Olga Ochoa-Gondar  5   3 , Francisco Martin Lujan  5   3   6 , Eva Satué Gracia  5   3
Affiliations

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

D Ribas Seguí et al. BMC Prim Care. .

Abstract

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.

Keywords: CHAID; Decision tree; Diabetes; MACE.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All the authors: D Ribas Seguí, M José Forcadell, Angel Vila-Córcoles, Cinta de Diego, Olga Ochoa-Gondar, Francisco Martin Lujan and Eva Satué consent to participate in the manuscript. Consent for publication: This study was conducted in accordance with the principles of the Declaration of Helsinki and the guidelines of good clinical practice. Due to the retrospective nature of the study, the Ethics Committee for Clinical Research (CEIC) of the Instituto de Investigación en Atención Primaria (IDIAP) Jordi Gol waived the need to obtain informed consent. This study was conducted within the framework of the CAPAMIS project, (Evaluation of the effectiveness of the pneumococcal 23-valent vaccine to prevent pneumonia and acute vascular events in the population over 60 years) project,which was reviewed and approved by the IDIAP Jordi Gol ethics committee in 2009 (file 4R09/019). The protocol of the project was published in BMC Public Health Journal (https://doi.org/10.1186/1471 - 2458 - 10 - 25). Also received a grant from the"Instituto de Salud Carlos III"(file PI09/0043) whose budget has already been exhausted. The project included a follow-up of the cohort with the update of monitoring variables and study events. This information was provided to the research team in pseudonym by a member of the institutional Information and Communication Technology Unit. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
MACE tree 10-year risk in total T2DM without previous MACE. Basal control values. MACE: major adverse cardiovascular events; T2DM: Type 2 Diabetes Mellitus; HDL: high-density lipoprotein
Fig. 2
Fig. 2
MACE tree 10-year risk in total T2DM without previous MACE. Baseline values MACE: major adverse cardiovascular events; T2DM: Type 2 Diabetes Mellitus; LDL: low-density lipoprotein; HDL: high-density lipoprotein
See this image and copyright information in PMC

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