BACKGROUNDDiabetes and hypertension are among top public health priorities, particularly in low and middle-income countries where their health and socioeconomic impact is exacerbated by the quality and accessibility of health care. Moreover, their connection with severe or deadly COVID-19 illness has further increased their societal relevance. Tools for early detection of these chronic diseases enable interventions to prevent high-impact complications, such as loss of sight and kidney failure. Similarly, prognostic tools for COVID-19 help stratify the population to prioritize protection and vaccination of high-risk groups, optimize medical resources and tests, and raise public awareness.METHODSWe developed and validated state-of-the-art risk models for the presence of undiagnosed diabetes, hypertension, visual complications associated with diabetes and hypertension, and the risk of severe COVID-19 illness (if infected). The models were estimated using modern methods from the field of statistical learning (e.g., gradient boosting trees), and were trained on publicly available data containing health and socioeconomic information representative of the Mexican population. Lastly, we assembled a short integrated questionnaire and deployed a free online tool for massifying access to risk assessment.RESULTSOur results show substantial improvements in accuracy and algorithmic equity (balance of accuracy across population subgroups), compared to established benchmarks. In particular, the models: i) reached state-of-the-art sensitivity and specificity rates of 90% and 56% (0.83 AUC) for diabetes, 80% and 64% (0.79 AUC) for hypertension, 90% and 56% (0.84 AUC) for visual diminution as a complication, and 90% and 60% (0.84 AUC) for development of severe COVID disease; and ii) achieved substantially higher equity in sensitivity across gender, indigenous/non-indigenous, and regional populations. In addition, the most relevant features used by the models were in line with risk factors commonly identified by previous studies. Finally, the online platform was deployed and made accessible to the public on a massive scale.CONCLUSIONSThe use of large databases representative of the Mexican population, coupled with modern statistical learning methods, allowed the development of risk models with state-of-the-art accuracy and equity for two of the most relevant chronic diseases, their eye complications, and COVID-19 severity. These tools can have a meaningful impact on democratizing early detection, enabling large-scale preventive strategies in low-resource health systems, increasing public awareness, and ultimately raising social well-being.
Integrated Care for Chronic Diseases – State of the Art