Abstract:
ABSTRACT
Background: Hypertension and Diabetes mellitus are the chronic non communicable diseases
(CNCDs) which have emerged as a leading global health problem. They are also known risk
factors for different complications, like blindness, vascular brain diseases, renal failure etc.
This complication mostly facilitated on peoples with both diabetes and hypertension. Thus, the
aim of this study was modeling the longitudinal multivariate effect of fasting blood pressure
,systolic blood pressure and diastolic blood pressure on time to complication of hypertensive
diabetic patients ,
Methods: Hospital based retrospective study was conducted among hypertensive diabetic
patients attending a follow-up treatment between 2017 G.C and 2019 G.C at Finoteselam
Hospital, Amhara region, Ethiopia. A sample of 206 hypertensive diabetic patients screened
who were under follow up at finoteselam hospital. The longitudinal outcomes and the time to
event (i.e. complication) data with the separate and joint modeling approach were fitted.
Multivariate joint models typically combine multivariate linear mixed effect model for repeated
measurements and cox model for time to event out comes.
Results: The mean baseline age of hypertensive diabetic patients was 57.23 years. Out of 206
hypertensive diabetic patients 109(53.1%) were females and 97(46.9% males) from 109
females and 97 males 45(21.8%) and 34(17%) were complicated from female and male
respectively. Generally 80(38.8%) patients were complicated at any complication..
Multivariate joint model was the best model in the research.in this study economic status
,baseline fasting blood sugar, Residenc place and sex were found to significant effect with log
FBS, age place of Residenc and smoking status was found to be a significant effect with log
SBP. And age, sex, observation time and place of residence were found to be a significant
factor for log diastolic blood pressure.
Conclusions: When evaluating the overall performance of both the separate and joint models
in terms of model parsimony, goodness of fit, smaller standard error of coefficients , smaller
total AIC, and the statistical significance of both the association parameters, the multivariate
joint model performs better. Thus, authors concluded that the multivariate joint model was
preferred for simultaneous analyses of multiple repeated measurement and survival data in this
study. The relationship between the three longitudinal outcomes and the hazard rate of
complication was statistically significant Complication is more likely to occur in patients with
higher fasting blood sugar, systolic bled pressure and diastolic blood pressure.
Key words: complication, hypertensive diabetic patients, multivariate Joint Model,
Longitudinal Data, Survival analysis, Cox PH model.