Socio-Economic Factors and Clinical Context Can Predict Adherence to Incidental Pulmonary Nodule Follow-up via Machine Learning Models
- PMID: 38461910
- DOI: 10.1016/j.jacr.2024.02.031
Socio-Economic Factors and Clinical Context Can Predict Adherence to Incidental Pulmonary Nodule Follow-up via Machine Learning Models
Abstract
Objective: To quantify the relative importance of demographic, contextual, socio-economic, and nodule-related factors that influence patient adherence to incidental pulmonary nodule (IPN) follow-up visits and evaluate the predictive performance of machine learning models utilizing these features.
Methods: We curated a 1,610-subject patient data set from electronic medical records consisting of 13 clinical and socio-economic predictors and IPN follow-up adherence status (timely, delayed, or never) as the outcome. Univariate analysis and multivariate logistic regression were performed to quantify the predictors' contributions to follow-up adherence. Three additional machine learning models (random forests, neural network, and support vector machine) were fitted and cross-validated to examine prediction performance across different model architectures and evaluate intermodel concordance.
Results: On univariate basis, all 13 predictors except comorbidity were found to have a significant association with follow-up. In multiple logistic regression, inpatient or emergency clinical context (odds ratio favoring never following up: 7.28 and 8.56 versus outpatient, respectively) and high nodule risk (odds ratio: 0.25 versus low risk) are the most significant predictors of follow-up, and sex, race, and marital status become additionally significant if clinical context is removed from the model. Clinical context itself is associated with sex, race, insurance, employment, marriage, income, nodule risk, and smoking status, suggesting its role in mediating socio-economic inequities. On cross-validation, all four machine learning models demonstrated comparable and good predictive performances, with mean area under the curve ranging from 0.759 to 0.802, with sensitivity 0.641 to 0.660 and specificity 0.768 to 0.840.
Conclusion: Socio-economic factors and clinical context are predictive of IPN follow-up adherence, with clinical context being the most significant contributor and likely representing uncaptured socio-economic determinants.
Keywords: Adherence; follow-up; incidental pulmonary nodule; machine learning.
Copyright © 2024 American College of Radiology. Published by Elsevier Inc. All rights reserved.
Similar articles
-
Statistical modeling can determine what factors are predictive of appropriate follow-up in patients presenting with incidental pulmonary nodules on CT.Eur J Radiol. 2020 Jul;128:109062. doi: 10.1016/j.ejrad.2020.109062. Epub 2020 May 13. Eur J Radiol. 2020. PMID: 32422551
-
Can Predictive Modeling Tools Identify Patients at High Risk of Prolonged Opioid Use After ACL Reconstruction?Clin Orthop Relat Res. 2020 Jul;478(7):0-1618. doi: 10.1097/CORR.0000000000001251. Clin Orthop Relat Res. 2020. PMID: 32282466 Free PMC article.
-
Demographics and socioeconomic determinants of health predict continued participation in a CT lung cancer screening program.Curr Probl Diagn Radiol. 2024 Sep-Oct;53(5):552-559. doi: 10.1067/j.cpradiol.2024.04.004. Epub 2024 Apr 21. Curr Probl Diagn Radiol. 2024. PMID: 38658287
-
Development and validation of machine learning models to identify high-risk surgical patients using automatically curated electronic health record data (Pythia): A retrospective, single-site study.PLoS Med. 2018 Nov 27;15(11):e1002701. doi: 10.1371/journal.pmed.1002701. eCollection 2018 Nov. PLoS Med. 2018. PMID: 30481172 Free PMC article.
-
Predicting the risk of emergency admission with machine learning: Development and validation using linked electronic health records.PLoS Med. 2018 Nov 20;15(11):e1002695. doi: 10.1371/journal.pmed.1002695. eCollection 2018 Nov. PLoS Med. 2018. PMID: 30458006 Free PMC article.
LinkOut - more resources
Full Text Sources