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Validating risk factor and chronic disease projections in the Future Adult Model

  1. Bryan Tysinger  Is a corresponding author
  1. University of Southern California, California
Research article
Volume 13(3) Winter 2020
Cite this article as: B. Tysinger; 2020; Validating risk factor and chronic disease projections in the Future Adult Model; International Journal of Microsimulation; 13(3); 54-69. doi: 10.34196/ijm.00225
12 figures and 6 tables

Figures

Figure 1
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Receiver Operating Characteristic for BMI <= 25 - Females
Figure 2
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Receiver Operating Characteristic for BMI > 30 - Females
Figure 3
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Receiver Operating Characteristic for BMI > 40 - Females
Figure 4
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Receiver Operating Characteristic for BMI <= 25 - Males
Figure 5
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Receiver Operating Characteristic for BMI > 30 - Males
Figure 6
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Receiver Operating Characteristic for BMI > 40 - Males
Figure 7
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Receiver Operating Characteristic for Incident Diabetes - Females
Figure 8
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Receiver Operating Characteristic for Incident Diabetes - Males
Figure 9
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BMI distribution for those 35 and older - Females
Figure 10
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Relative cumulative distribution and density of BMI - Females
Figure 11
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BMI distribution for those 35 and older - Males
Figure 12
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Relative cumulative distribution and density of BMI - Males

Tables

Table 1
Variables directly impacted by BMI and diabetes in FAM.
Domain Category Measure
Health Chronic conditions Cancer1, diabetes1, heart disease, hypertension, lung disease1, stroke
Functional limitations Activities of daily living, instrumental activities of daily living
Mental distress Kessler 6
Mortality Death2
Risk factors BMI1, start smoking, stop smoking
Economic Employment status Full-/part-time, labor force participation
Health insurance Health insurance type2
Income and assets Capital income2, earnings2, wealth
Public program participation OASI2, DI2
Medical cost and use Individual Drug $2, out of pocket $2
Medicaid $2
Medicare Total $2, Part A $2, Part B $2
Total expenditures $2
Utilization Doctors visits2, hospital encounters2, hospital nights2
Subjective well-being Life satisfaction2, quality-adjusted life years2, self-reported health2

  1. 1 BMI model only

  2. 2 Diabetes model only

Table 2
Two-year BMI transition estimates used in FAM, 1999-2007 PSID.
(1)Log(BMI)-Females (2)Log(BMI)-Males
Non-Hispanic Black 0.00838*** 0.00168
Hispanic 0.00403 0.000181
Less than HS 0.00421 -0.000211
Bachelors -0.00887*** -0.00585***
Masters or higher -0.00741* -0.00460
Non-Hispanic Black × Less than HS -0.00920* -0.00877*
Non-Hispanic Black × Bachelors 0.0114* 0.00670
Non-Hispanic Black × Masters or higher -0.00390 0.0210
Hispanic × Less than HS -0.00298 -0.00431
Hispanic Bachelors 0.00193 -0.000211
Hispanic × Masters or higher -0.00810 -0.00361
Poor child SES 0.00103 0.00121
Well-off child SES -0.00154 -0.00146
Fair child health 0.00489 -0.000600
Good child health 0.000692 0.000749
Very good child health 0.00254 -0.000955
Excellent child health 0.000864 -0.00229
Age spline, less than 35 -0.000382 -0.0000346
Age spline, 35 to 44 -0.000155 -0.000609*
Age spline, 45 to 54 0.0000296 -0.000446
Age spline, 55 to 64 -0.000515 0.000165
Age spline, 65 to 74 -0.00130** -0.00147***
Age spline, more than 75 -0.00202*** -0.00117*
Lag of Log(BMI) spline, BMI less than 20 0.769*** 0.327***
Lag of Log(BMI) spline, BMI 20 to 25 0.945*** 0.929***
Lag of Log(BMI) spline, BMI 25 to 30 0.898*** 0.905***
Lag of Log(BMI) spline, BMI 30 to 35 0.987*** 0.945***
Lag of Log(BMI) spline, BMI 35 to 40 0.805*** 0.872***
Lag of Log(BMI) spline, BMI over 40 0.895*** 0.830***
Cohabiting -0.00124 0.00256
Married -0.00480** 0.000316
Constant 0.738*** 2.057***
Observations   20942   16454
R2 0.836 0.810
  1. ***

    p < 0:05, *p < 0:01, **p < 0:001

Table 3
Two-year diabetes incidence estimates used in FAM, 1999-2007 PSID.
(1)Diabetes incidence (marginal effects)
Non-Hispanic Black 0.00167
Hispanic 0.00505
Less than HS 0.00331
Bachelors -0.000224
Masters or higher -0.00235
Male 0.00268*
Poor child SES 0.00322*
Well-off child SES 0.00150
Fair child health -0.000465
Good child health -0.00240
Very good child health 0.00184
Excellent child health 0.00175
Age spline, less than 35 0.0000936
Age spline, 35 to 44 0.00117***
Age spline, 45 to 54 0.000778**
Age spline, 55 to 64 0.000295
Age spline, 65 to 74 0.000269
Age spline, more than 75 -0.000564
Lag of former smoker 0.00141
Lag of current smoker 0.00550**
Lag of any exercise -0.00394*
Lag of Log(BMI) spline, BMI less than 25 0.0485**
Lag of Log(BMI) spline, BMI 25 to 30 0.0733***
Lag of Log(BMI) spline, BMI 30 to 35 0.0382*
Lag of Log(BMI) spline, BMI 35 to 40 0.0666**
Lag of Log(BMI) spline, BMI over 40 -0.0235
Observations   35264
Pseudo R2 0.117
  1. ***

    p < 0:05, *p < 0:01, **p < 0:001

Table 4
Out-of-sample validation - 2017 FAM vs. 2017 PSID.
Females Males
FAM (2017) PSID (2017) FAM (2017) PSID (2017)
BMI
1st pctl 16.6 [ 16.2, 16.9] 17.2 [ 16.7, 17.8] 19.2 [ 19.0, 19.5] 19.0 [ 18.5, 19.5]
5th pctl 18.7 [ 18.5, 19.0] 19.5 [ 19.2, 19.8] 21.2 [ 21.0, 21.4] 21.6 [ 21.3, 21.9]
10th pctl 20.1 [ 20.0, 20.3] 20.5 [ 20.4, 20.7] 22.5 [ 22.2, 22.7] 22.8 [ 22.5, 23.0]
25th pctl 22.9 [ 22.8, 23.0] 22.8 [ 22.5, 23.1] 24.9 [ 24.7, 25.0] 24.9 [ 24.7, 25.1]
Mean 27.7 [ 27.6, 27.9] 27.6 [ 27.4, 27.9] 28.5 [ 28.3, 28.7] 28.3 [ 28.1, 28.6]
75th pctl 31.5 [ 31.3, 31.8] 30.9 [ 30.5, 31.3] 31.5 [ 31.2, 31.8] 30.9 [ 30.5, 31.3]
90th pctl 36.7 [ 36.3, 37.0] 36.6 [ 35.9, 37.2] 35.3 [ 34.8, 35.7] 35.1 [ 34.6, 35.6]
95th pctl 40.0 [ 39.4, 40.5] 40.8 [ 40.1, 41.4] 37.7 [ 37.1, 38.2] 37.8 [ 37.3, 38.4]
99th pctl 46.9 [ 45.5, 48.2] 50.5 [ 48.1, 52.9] 42.4 [ 41.3, 43.6] 46.4 [ 44.6, 48.1]
Diabetes prevalence 12.4 [ 11.5, 13.3] 14.6 [ 13.2, 15.9] 14.9 [ 13.6, 16.3] 16.7 [ 15.2, 18.2]

  1. Notes: Confidence intervals for FAM reflect 50 sets of bootstrapped transition models, each simulated 100 times. Confidence intervals for PSID reflect the complex survey design.

Table 5
Host and external data comparison - 2007 PSID vs. 2007 BRFSS.
Females Males
PSID (2007) BRFSS (2007) PSID (2007) BRFSS (2007)
BMI
1st pctl 17.5 [ 17.2, 17.8] 17.6 [ 17.5, 17.7] 19.4 [ 18.8, 19.9] 19.2 [ 19.0, 19.3]
5th pctl 19.1 [ 19.0, 19.3] 19.5 [ 19.5, 19.6] 21.7 [ 21.5, 21.9] 21.5 [ 21.4, 21.6]
10th pctl 20.3 [ 20.1, 20.4] 20.5 [ 20.5, 20.6] 22.8 [ 22.6, 23.0] 22.6 [ 22.6, 22.7]
25th pctl 22.3 [ 22.2, 22.5] 22.7 [ 22.7, 22.7] 24.7 [ 24.5, 24.9] 24.6 [ 24.4, 24.7]
Mean 26.9 [ 26.7, 27.1] 27.2 [ 27.1, 27.2] 27.9 [ 27.8, 28.1] 28.1 [ 28.1, 28.2]
75th pctl 30.0 [ 29.7, 30.2] 30.2 [ 30.1, 30.2] 30.1 [ 29.9, 30.4] 30.6 [ 30.5, 30.7]
90th pctl 35.3 [ 34.7, 35.8] 35.5 [ 35.4, 35.6] 34.2 [ 33.8, 34.5] 34.5 [ 34.4, 34.6]
95th pctl 39.3 [ 38.6, 40.0] 39.2 [ 39.1, 39.4] 36.8 [ 36.3, 37.4] 37.4 [ 37.2, 37.6]
99th pctl 48.4 [ 46.2, 50.6] 47.9 [ 47.5, 48.4] 43.8 [ 42.2, 45.3] 45.0 [ 44.6, 45.5]
Diabetes prevalence 7.3 [ 6.5, 8.2] 9.2 [ 9.0, 9.4] 8.7 [ 7.8, 9.7] 9.9 [ 9.7, 10.2]

  1. Notes: Confidence intervals for PSID and BRFSS reflect the complex survey design.

Table 6
External validation - 2017 FAM vs. 2017 BRFSS.
Females Males
FAM (2017) BRFSS (2017) FAM (2017) BRFSS (2017)
BMI
1st pctl 16.6 [ 16.2, 16.9] 17.7 [ 17.6, 17.8] 19.2 [ 19.0, 19.5] 18.8 [ 18.7, 19.0]
5th pctl 18.7 [ 18.5, 19.0] 19.8 [ 19.7, 19.9] 21.2 [ 21.0, 21.4] 21.6 [ 21.5, 21.7]
10th pctl 20.1 [ 20.0, 20.3] 21.0 [ 20.9, 21.0] 22.5 [ 22.2, 22.7] 23.0 [ 22.9, 23.0]
25th pctl 22.9 [ 22.8, 23.0] 23.4 [ 23.4, 23.5] 24.9 [ 24.7, 25.0] 25.1 [ 25.1, 25.1]
Mean 27.7 [ 27.6, 27.9] 28.2 [ 28.1, 28.3] 28.5 [ 28.3, 28.7] 28.8 [ 28.7, 28.9]
75th pctl 31.5 [ 31.3, 31.8] 31.6 [ 31.5, 31.8] 31.5 [ 31.2, 31.8] 31.6 [ 31.5, 31.7]
90th pctl 36.7 [ 36.3, 37.0] 36.9 [ 36.7, 37.1] 35.3 [ 34.8, 35.7] 35.9 [ 35.7, 36.0]
95th pctl 40.0 [ 39.4, 40.5] 40.7 [ 40.5, 41.0] 37.7 [ 37.1, 38.2] 39.0 [ 38.8, 39.3]
99th pctl 46.9 [ 45.5, 48.2] 49.9 [ 49.3, 50.5] 42.4 [ 41.3, 43.6] 46.8 [ 46.2, 47.4]
Diabetes prevalence 12.4 [ 11.5, 13.3] 14.0 [ 13.7, 14.4] 14.9 [ 13.6, 16.3] 15.7 [ 15.3, 16.1]

  1. Notes: Confidence intervals for FAM reflect 50 sets of bootstrapped transition models, each simulated 100 times. Confidence intervals for BRFSS reflect the complex survey design.

Data and code availability

The data used in FAM are available for scientific research upon registration.

1. Panel Study of Income Dynamics is available at https://psidonline.isr.umich.edu/

2. Behavioral Risk Factor Surveillance System is available at https://www.cdc.gov/brfss/index.html

3. Health and Retirement Study is available at http://hrsonline.isr.umich.edu/

4. Medical Expenditure Panel Survey is available at https://meps.ahrq.gov/mepsweb/

5. Medicare Current Beneficiary Survey is available at https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/MCBS

6. National Health Interview Survey is available at https://www.cdc.gov/nchs/nhis/index.htm

7. National Health and Nutrition Examination Survey is available at https://www.cdc.gov/nchs/nhanes/index.htm

8. AmericanCommunitySurvey is available at https://www.census.gov/programs-surveys/acs

9. CensusPopulation Projections is available at https://www.census.gov/programs-surveys/popproj.html

The source code for FAM is available via a publicly accessible Subversion code repository at https://schweb.lahrc.lahealthresearchcloud.org/svn/PublicFutureElderlyModel/trunk. It is suggested that users contact Bryan Tysinger for guidance in getting started.

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