Diabetes Metab J > Epub ahead of print
Cardiovascular Risk/Epidemiology
DOI: https://doi.org/10.4093/dmj.2021.0054    [Epub ahead of print]
Published online September 9, 2021.
Performance of Diabetes and Kidney Disease Screening Scores in Contemporary United States and Korean Populations
Liela Meng1  , Keun-Sang Kwon2, Dae Jung Kim3, Yong-ho Lee4, Jeehyoung Kim5, Abhijit V. Kshirsagar6, Heejung Bang7,8
1Graduate Group of Biostatistics, Department of Statistics, University of California, Davis, CA, USA
2Department of Preventive Medicine, Jeonbuk National University Medical School, Jeonju, Korea
3Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
4Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
5Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
6University of North Carolina Kidney Center & Division of Nephrology and Hypertension, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
7Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA
8Clinical and Translational Science Center & Center for Healthcare Policy and Research, Davis School of Medicine, University of California, Sacramento, CA, USA
Correspondence:  Liela Meng,
Email: mzcmeng@ucdavis.edu
Received: 22 March 2021   • Accepted: 28 May 2021
Risk assessment tools have been actively studied, and they summarize key predictors with relative weights/importance for a disease. Currently, standardized screening scores for type 2 diabetes mellitus (DM) and chronic kidney disease (CKD)—two key global health problems—are available in United States and Korea. We aimed to compare and evaluate screening scores for DM (or combined with prediabetes) and CKD, and assess the risk in contemporary United States and Korean populations.
Four (2×2) models were evaluated in the United States-National Health and Nutrition Examination Survey (NHANES 2015–2018) and Korea-NHANES (2016–2018)—8,928 and 16,209 adults. Weighted statistics were used to describe population characteristics. We used logistic regression for predictors in the models to assess associations with study outcomes (undiagnosed DM and CKD) and diagnostic measures for temporal and cross-validation.
Korean adult population (mean age 47.5 years) appeared to be healthier than United States counterpart, in terms of DM and CKD risks and associated factors, with exceptions of undiagnosed DM, prediabetes and prehypertension. Models performed well in own country and external populations regarding predictor-outcome association and discrimination. Risk tests (high vs. low) showed area under the curve >0.75, sensitivity >84%, specificity >45%, positive predictive value >8%, and negative predictive value >99%. Discrimination was better for DM, compared to the combined outcome of DM and prediabetes, and excellent for CKD due to age.
Four easy-to-use screening scores for DM and CKD are well-validated in contemporary United States and Korean populations. Prevention of DM and CKD may serve as first-step in public health, with these self-assessment tools as basic tools to help health education and disparity.
Key Words: Diabetes mellitus, type 2, Prediabetic state, Renal insufficiency, chronic, Risk factors, Self-assessment
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Liela Meng

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