Background
Methods
Study design
Data collection
Definition of variable and outcome
Machine learning
Statistical analyses
Results
Baseline characteristics
Total (N = 5937) | With APP-assisted self-care (N = 4454) | Without APP-assisted self-care (N = 1483) | P value | |
---|---|---|---|---|
Age, y | 66.2 ± 10.8 | 66.5 ± 10.2 | 65.5 ± 12.4 | 0.004 |
Gender, n (%) | 0.018 | |||
Male | 2829(47.6) | 2083(46.8) | 746(50.3) | |
Female | 3108(52.4) | 2371(53.2) | 737(49.7) | |
Marriage status, n (%) | < 0.001 | |||
Married | 5238(88.2) | 3888(87.3) | 1350(91.0) | |
Single/divorced/widowed | 699(11.8) | 566(12.7) | 133(9.0) | |
Native resident, n (%) | < 0.001 | |||
No | 250(4.2) | 117(2.6) | 133(9.0) | |
Yes | 5687(95.8) | 4337(97.3) | 1350(91.0) | |
Population composition, n (%) | < 0.001 | |||
Urban | 5914(99.6) | 4444(99.8) | 1470(99.1) | |
Rural | 23(0.4) | 10(0.2) | 13(0.9) | |
Comorbidity, n (%) | ||||
Diabetes | 2447(41.2) | 1892(42.5) | 555(37.4) | 0.001 |
Coronary artery disease | 1995(33.6) | 1530(34.4) | 425(28.7) | < 0.001 |
Stroke | 958(16.1) | 744(16.7) | 214(14.4) | 0.039 |
Height,cm | 163.6 ± 8.6 | 163.4 ± 8.6 | 164.5 ± 8.6 | < 0.001 |
Weight, Kg | 69.3 ± 11.7 | 69.3 ± 11.5 | 69.5 ± 12.0 | 0.565 |
Body Mass Index, kg/m2 | 25.8 ± 3.5 | 25.9 ± 3.5 | 25.6 ± 3.6 | 0.052 |
Waist, cm | 88.5 ± 9.5 | 88.8 ± 9.5 | 87.6 ± 9.2 | < 0.001 |
Hip, cm | 98.0 ± 9.2 | 98.4 ± 9.2 | 96.9 ± 9.2 | < 0.001 |
Waist-hip ratio | 0.9 ± 0.1 | 0.9 ± 0.1 | 0.90 ± 0.1 | 0.300 |
Fasting blood-glucose | 6.3 ± 1.0 | 6.3 ± 1.1 | 6.3 ± 0.9 | 0.117 |
Total cholesterol | 4.9 ± 1.0 | 4.8 ± 1.0 | 4.9 ± 0.9 | 0.589 |
Systolic BP, mmHg | ||||
Baseline | 128.7 ± 7.2 | 128.0 ± 7.3 | 130.8 ± 6.6 | < 0.001 |
Follow-up | 124.1 ± 13.8 | 122.6 ± 13.6 | 128.5 ± 13.5 | < 0.001 |
Difference | -4.6 ± 15.6 | -5.4 ± 15.5 | -2.3 ± 15.9 | < 0.001 |
Diastolic BP, mmHg | ||||
Baseline | 77.0 ± 5.7 | 76.8 ± 5.6 | 77.6 ± 5.7 | < 0.001 |
Follow-up | 73.5 ± 10.6 | 72.6 ± 10.7 | 76.2 ± 9.5 | < 0.001 |
Difference | -3.5 ± 11.9 | -4.2 ± 12.0 | -1.3 ± 11.1 | < 0.001 |
Follow-up BP control, n (%) | ||||
Systolic | 3886(65.4) | 3000(67.4) | 886(59.7) | < 0.001 |
Diastolic | 4720(79.5) | 3596(80.7) | 1124(75.8) | < 0.001 |
Overall | 3661(61.6) | 2827(63.4) | 834(56.2) | < 0.001 |
Detecting predictors for BP control levels
Patients | Difference in SBP, mmHg | Difference in DBP, mmHg | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Mean (95% CI) | B | P value | Ba0 | P value* | Mean (95% CI) | B | P value | Ba | P value* | ||
Age (years), n (%) | -2.30 | < 0.001 | -0.53 | 0.124 | -2.09 | 0.497 | -0.34 | 0.215 | |||
≤ 65 | 2902(48.8) | -3.42(-3.97,-2.88) | -3.36(-3.77,-2.95) | ||||||||
> 65 | 3035(51.2) | -5.73(-6.28,-5.14) | -3.57(-4.01,-3.05) | ||||||||
Male, n (%) | 0.36 | 0.379 | 0.61 | 0.081 | 0.04 | 0.904 | 0.30 | 0.276 | |||
No | 3108(52.4) | -4.77(-5.35,-4.28) | -3.49(-3.93,-3.07) | ||||||||
Yes | 2829(47.6) | -4.41(-4.97,-3.86) | -3.45(-3.90,-3.06) | ||||||||
Marriage status, n (%) | 0.94 | 0.133 | -0.41 | 0.428 | -0.17 | 0.719 | -0.17 | 0.675 | |||
Married | 5238(88.2) | -4.49(-4.95,-4.08) | -3.49(-3.82,-3.17) | ||||||||
Single/divorced/widowed | 699(11.8) | -5.43(-6.56,-4.34) | -3.32(-4.19,-2.42) | ||||||||
Native resident, n (%) | 1.04 | 0.303 | -0.16 | 0.847 | 0.57 | 0.456 | -0.35 | 0.870 | |||
No | 5687(95.8) | -4.65(-5.07,-4.24) | -3.50(-3.83,-3.18) | ||||||||
Yes | 250(4.2) | -3.60(-5.30,-1.97) | -2.92(-4.10,-1.74) | ||||||||
Population composition, n (%) | -1.93 | 0.555 | -2.01 | 0.453 | 0.65 | 0.794 | -0.72 | 0.291 | |||
Urban | 5914(99.6) | -4.59(-5.00,-4.19) | -3.47(-3.77,-3.20) | ||||||||
Rural | 23(0.4) | -6.52(-13.25,1.57) | -2.83(-8.93,2.81) | ||||||||
Obesity, n (%) | -0.56 | 0.196 | 0.02 | 0.965 | -0.25 | 0.452 | 0.01 | 0.993 | |||
No | 4028(67.8) | -4.42(-4.93,-3.92) | -3.39(-3.77,-3.02) | ||||||||
Yes | 1909(32.2) | -4.98(-5.68,-4.31) | -3.64(-4.15,-3.09) | ||||||||
Increased Waist-hip ratio, n (%) | -0.83 | 0.046 | -0.37 | 0.289 | -0.74 | 0.018 | -0.40 | 0.146 | |||
No | 3578(60.2) | -4.27(-4.77,-3.78) | -3.18(-3.55,-2.81) | ||||||||
Yes | 2359(39.8) | -5.10(-5.71,-4.48) | -3.92(-4.39,-3.42) | ||||||||
Diabetes, n (%) | -1.29 | 0.002 | -1.52 | < 0.001 | -0.91 | 0.004 | -1.06 | < 0.001 | |||
No | 3490(58.8) | -4.07(-4.59,-3.56) | -3.10(-3.47,-2.69) | ||||||||
Yes | 2447(41.2) | -5.36(-6.02,-4.77) | -4.01(-4.54,-3.54) | ||||||||
Coronary artery disease, n (%) | -0.05 | 0.909 | 0.34 | 0.342 | 0.35 | 0.285 | 0.39 | 0.176 | |||
No | 3982(67.0) | -4.59(-5.07,-4.08) | -3.59(-3.97,-3.23) | ||||||||
Yes | 1955(33.0) | -4.63(-5.35,-3.93) | -3.24(-3.81,-2.69) | ||||||||
Stroke, n (%) | -1.16 | 0.035 | -0.12 | 0.784 | -0.01 | 0.993 | 0.12 | 0.741 | |||
No | 4979(83.8) | -4.41(-4.89,-4.01) | -3.47(-3.79,-3.16) | ||||||||
Yes | 958(16.2) | -5.57(-6.49,-4.74) | -3.47(-4.22,-2.73) | ||||||||
Baseline date, n (%) | -3.39 | < 0.001 | -2.91 | < 0.001 | -2.44 | < 0.001 | -2.39 | < 0.001 | |||
2014–2017 | 3822(64.4) | -4.05(-4.52,-3.68) | -3.05(-3.38,-2.72) | ||||||||
2018–2021 | 2115(35.6) | -5.50(-5.98,-5.03) | -3.75(-4.21,-3.29) | ||||||||
APP-assisted self-care, n (%) | -3.11 | < 0.001 | -4.59 | < 0.001 | -2.88 | < 0.001 | -2.91 | < 0.001 | |||
No | 1483(25.0) | -2.27(-3.12,-1.49) | -1.31(-1.89,-0.72) | ||||||||
Yes | 4454(75.0) | -5.38(-5.86,-4.94) | -4.19(-4.59,-3.84) | ||||||||
Antihypertensive medication adherence, n (%) | -13.47 | < 0.001 | -13.04 | < 0.001 | -6.95 | < 0.001 | -6.86 | < 0.001 | |||
No | 846(14.2) | 6.95(5.82,8.14) | 2.49(1.68,3.26) | ||||||||
Yes | 5091(85.8) | -6.52(-6.96,-6.12) | -4.46(-4.78,-4.15) | ||||||||
Follow-up time, n (%) | -2.04 | < 0.001 | 0.55 | 0.219 | -1.15 | 0.001 | 0.68 | 0.057 | |||
≤ 1 year | 1443(24.4) | -3.05(-3.74,-2.27) | -2.60(-3.13,-2.05) | ||||||||
> 1 year | 4494(75.6) | -5.10(-5.57,-4.64) | -3.75(-4.10,-3.36) |
Detecting predictors for BP control rates
Total (N = 5937) | Good control (N = 3661) | Poor control (N = 2276) | Univariate analysis | Multivariable analysis | |||
---|---|---|---|---|---|---|---|
OR(95%CI) | P value | OR(95%CI) | P value | ||||
Age (years), n (%) | 1.06(0.96,1.18) | 0.251 | 0.89(0.78, 1.02) | 0.091 | |||
≤ 65 | 2902(48.8) | 1811(49.5) | 1091(47.9) | ||||
> 65 | 3035(51.2) | 1850(50.5) | 1185(52.1) | ||||
Male, n(%) | 1.03(0.93,1.14) | 0.612 | 0.99(0.87, 1.13) | 0.893 | |||
No | 3108(52.4) | 1926(52.6) | 1182(51.9) | ||||
Yes | 2829(47.6) | 1735(47.4) | 1094(48.1) | ||||
Marriage status, n (%) | 0.92(0.78,1.08) | 0.281 | 1.00(0.83, 1.21) | 0.986 | |||
Married | 5238(88.2) | 3243(88.6) | 1995(87.7) | ||||
Single/divorced/widowed | 699(11.8) | 418(11.4) | 281(12.3) | ||||
Native resident, n (%) | 0.44(0.32, 0.60) | < 0.001 | 0.50(0.34, 0.74) | < 0.001 | |||
No | 250(4.2) | 195(5.3) | 55(2.4) | ||||
Yes | 5687(95.8) | 3466(94.7) | 2221(97.6) | ||||
Population composition, n (%) | 1.03(0.45,2.39) | 0.937 | 1.76(0.62, 4.97) | 0.285 | |||
Urban | 5914(99.6) | 3647(99.6) | 2267(99.6) | ||||
Rural | 23(0.4) | 14(0.4) | 9(0.4) | ||||
Obesity, n (%) | 1.09(0.98, 1.22) | 0.121 | 0.98(0.86, 1.11) | 0.724 | |||
No | 4028(67.8) | 2511(68.6) | 1517(66.6) | ||||
Yes | 1909(32.2) | 1150(31.4) | 759(33.4) | ||||
Increased Waist-hip ratio, n (%) | 1.09(0.98,1.20) | 0.131 | 1.07(0.94, 1.22) | 0.279 | |||
No | 3578(60.2) | 2234(61.0) | 1344(59.1) | ||||
Yes | 2359(39.8) | 1427(39.0) | 932(40.9) | ||||
Diabetes, n (%) | 1.91(1.71,2.12) | < 0.001 | 1.50(1.33, 1.70) | < 0.001 | |||
No | 3490(58.8) | 2372(64.8) | 1118(49.1) | ||||
Yes | 2447(41.2) | 1289(35.2) | 1158(50.9) | ||||
Coronary artery disease, n (%) | 1.54(1.38, 1.71) | < 0.001 | 1.35(1.19, 1.53) | < 0.001 | |||
No | 3982(67.0) | 2590(70.7) | 1392(61.2) | ||||
Yes | 1955(33.0) | 1071(29.3) | 884(38.8) | ||||
Stroke, n (%) | 1.27(1.11, 1.46) | 0.001 | 1.20(1.02, 1.41) | 0.026 | |||
No | 4979(83.8) | 3117(85.1) | 1862(81.8) | ||||
Yes | 958(16.2) | 544(14.9) | 414(18.2) | ||||
Baseline date, n(%) | 0.63(0.56–0.70) | < 0.001 | 0.72(0.62, 0.83) | < 0.001 | |||
2014–2017 | 3822(64.4) | 2210(60.4) | 1612(70.8) | ||||
2018–2021 | 2115(35.6) | 1451(39.6) | 664 (29.2) | ||||
APP-assisted self-care, n (%) | 0.74(0.66–0.83) | < 0.001 | 0.51(0.44, 0.59) | < 0.001 | |||
No | 1483(25.0) | 834(22.8) | 649(28.5) | ||||
Yes | 4454(75.0) | 2827(77.2) | 1627(71.5) | ||||
Antihypertensive medication adherence, n (%) | 0.16(0.14–0.20) | < 0.001 | 0.14(0.11, 0.16) | < 0.001 | |||
No | 846(14.2) | 218(6.0) | 628(27.6) | ||||
Yes | 5091(85.8) | 3443(94.0) | 1648 (72.4) | ||||
Follow-up time, n (%) | 1.96(1.72–2.24) | < 0.001 | 2.02(1.70, 2.40) | < 0.001 | |||
≤ 1 year | 1443(24.4) | 1055(28.8) | 388(17.0) | ||||
> 1 year | 4494(75.6) | 2606(71.2) | 1888(83.0) |
Testing prediction accuracy of predictors in machine learning algorithm
Cross-validation | Algorithm | Performance evaluation parameters | |||||
---|---|---|---|---|---|---|---|
ACC(%) | SE(%) | SPE(%) | PPV (%) | NPV (%) | AUC | ||
K2 | DT | 70.12 | 42.10 | 87.52 | 67.66 | 70.86 | 0.6712 |
SVM | 70.95 | 44.36 | 87.46 | 68.75 | 71.66 | 0.6642 | |
NB | 66.33 | 45.00 | 79.60 | 57.83 | 69.95 | 0.6874 | |
RF | 71.03 | 34.88 | 91.01 | 70.88 | 69.20 | 0.7291 | |
K5 | DT | 70.14 | 42.09 | 87.50 | 67.57 | 70.89 | 0.6788 |
SVM | 70.96 | 44.46 | 87.46 | 68.77 | 71.71 | 0.6601 | |
NB | 66.32 | 44.99 | 79.56 | 57.79 | 69.93 | 0.6885 | |
RF | 71.96 | 35.35 | 91.03 | 71.45 | 69.31 | 0.7316 | |
K10 | DT | 70.11 | 42.11 | 87.56 | 67.76 | 70.90 | 0.6686 |
SVM | 70.94 | 44.45 | 87.43 | 68.78 | 71.68 | 0.6619 | |
NB | 70.92 | 44.40 | 87.46 | 68.83 | 71.64 | 0.6774 | |
RF | 71.37 | 33.53 | 91.63 | 71.34 | 68.91 | 0.7286 |