Evaluating the risk of hypertension using an artificial neural network method in rural residents over the age of 35 years in a Chinese area

Hypertension (HTN) has been proven to be associated with an increased risk of cardiovascular diseases. The purpose of the study was to examine risk factors for HTN and to develop a prediction model to estimate HTN risk for rural residents over the age of 35 years. This study was based on a cross-sectional survey of 3054 rural community residents (N=3054). Participants were divided into two groups: a training set (N1=2438) and a validation set (N2=616). The differences between the training set and validation set were not statistically significant. The predictors of HTN risk were identified from the training set using logistic regression analysis. Some risk factors were significantly associated with HTN, such as a high educational level (EL) (odds ratio (OR)=0.744), a predominantly sedentary job (OR=1.090), a positive family history of HTN (OR=1.614), being overweight (OR=1.525), dysarteriotony (OR=1.101), alcohol intake (OR=0.760), a salty diet (OR=1.146), more vegetable and fruit intake (OR=0.882), meat consumption (OR=0.787) and regular physical exercise (OR=0.866). We established the predictive models using logistic regression model (LRM) and artificial neural network (ANN). The accuracy of the models was compared by receiver operating characteristic (ROC) when the models were applied to the validation set. The ANN model (area under the curve (AUC)=0.900±0.014) proved better than the LRM (AUC=0.732±0.026) in terms of evaluating the HTN risk because it had a larger area under the ROC curve.

[1]  R. Detrano,et al.  The accelerating epidemic of hypertension among rural Chinese women: results from Liaoning Province. , 2008, American journal of hypertension.

[2]  Jing Chen,et al.  Prevalence, Awareness, Treatment, and Control of Hypertension in China , 2002, Hypertension.

[3]  Xiao-dong Zhu,et al.  Prediction of radiation induced liver disease using artificial neural networks. , 2006, Japanese journal of clinical oncology.

[4]  Enzo Grossi,et al.  BMC Cardiovascular Disorders BioMed Central Debate , 2006 .

[5]  A M Walker,et al.  Epidemiologic interpretation of artificial neural networks. , 1998, American journal of epidemiology.

[6]  D. Gu,et al.  Alcohol intake and hypertension subtypes in Chinese men , 2005, Journal of hypertension.

[7]  Bei-fan Zhou Predictive values of body mass index and waist circumference for risk factors of certain related diseases in Chinese adults--study on optimal cut-off points of body mass index and waist circumference in Chinese adults. , 2002, Biomedical and environmental sciences : BES.

[8]  John T. Wei,et al.  Artificial neural networks for prostate carcinoma risk assessment , 2000, Cancer.

[9]  X. Zhang,et al.  Epidemiology of hypertension in China and Japan , 2000, Journal of Human Hypertension.

[10]  J. Weiner,et al.  Practical human biology , 1981 .

[11]  M. Gail,et al.  Community intervention trial for smoking cessation (COMMIT): II. Changes in adult cigarette smoking prevalence. , 1995, American journal of public health.

[12]  Daniel Levy,et al.  Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham Heart Study: a cohort study , 2001, The Lancet.

[13]  E. Ding,et al.  Alcohol consumption, physical activity, and chronic disease risk factors: a population-based cross-sectional survey , 2006, BMC public health.

[14]  K. Stronks,et al.  Ethnic differences in the effect of environmental stressors on blood pressure and hypertension in the Netherlands , 2007, BMC public health.

[15]  Gustavo Santos-García,et al.  Prediction of postoperative morbidity after lung resection using an artificial neural network ensemble , 2004, Artif. Intell. Medicine.

[16]  B. Popkin,et al.  Understanding the role of mediating risk factors and proxy effects in the association between socio-economic status and untreated hypertension. , 2004, Social science & medicine.

[17]  Sudha Seshadri,et al.  Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study. , 2002, JAMA.

[18]  Kevin N. Gurney,et al.  An introduction to neural networks , 2018 .

[19]  Shiro Baba,et al.  Artificial neural network analysis for predicting pathological stage of clinically localized prostate cancer in the Japanese population. , 2002, Japanese journal of clinical oncology.

[20]  E. Vartiainen,et al.  Fifteen-year follow-up of smoking prevention effects in the North Karelia youth project. , 1998, American journal of public health.

[21]  G. Grunkemeier,et al.  Receiver operating characteristic curve analysis of clinical risk models. , 2001, The Annals of thoracic surgery.

[22]  T. Ninomiya,et al.  Development and validation of a cardiovascular risk prediction model for Japanese: the Hisayama study , 2009, Hypertension Research.

[23]  Xiaohui Hou Urban-rural disparity of overweight, hypertension, undiagnosed hypertension, and untreated hypertension in China. , 2008 .

[24]  E. Vartiainen,et al.  Trends in cardiovascular disease risk factor clustering in eastern Finland: results of 15-year follow-up of the North Karelia Project. , 1994, Preventive medicine.

[25]  J. Chiong Controlling hypertension from a public health perspective. , 2008, International journal of cardiology.

[26]  Yutaka Shimada,et al.  Prediction of survival in patients with esophageal carcinoma using artificial neural networks , 2005, Cancer.

[27]  E. Hill With the WHO in China , 1948 .

[28]  N. Kaplan,et al.  Anxiety-induced hyperventilation. A common cause of symptoms in patients with hypertension. , 1997, Archives of internal medicine.

[29]  G. Mensah,et al.  Cardiovascular risk factors and confounders among nondrinking and moderate-drinking U.S. adults. , 2005, American journal of preventive medicine.

[30]  T. Harris,et al.  Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. , 2006, The New England journal of medicine.

[31]  T. Cheng,et al.  Impact of dysglycemia, body mass index, and waist-to-hip ratio on the prevalence of systemic hypertension in a lean Chinese population. , 2006, American Journal of Cardiology.

[32]  D. Hu,et al.  Body mass index and the prevalence of prehypertension and hypertension in a Chinese rural population. , 2008, Internal medicine.

[33]  S. Pocock,et al.  Identification of risk factors in hypertensive patients: contribution of randomized controlled trials through an individual patient database. , 1999, Circulation.

[34]  E. Vartiainen,et al.  Socio-economic status and serum lipids: a cross-sectional study in a Chinese urban population. , 2002, Journal of clinical epidemiology.

[35]  Konrad Jamrozik Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies , 2002 .

[36]  J. Allenberg,et al.  Profound influence of different methods for determination of the ankle brachial index on the prevalence estimate of peripheral arterial disease , 2007, BMC public health.

[37]  H. Blackburn,et al.  Cardiovascular survey methods. , 1969, Monograph series. World Health Organization.

[38]  D. Hu,et al.  Predictors of progression from prehypertension to hypertension among rural Chinese adults: results from Liaoning Province , 2010, European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology.

[39]  Massimo Buscema,et al.  Recognition of patients with cardiovascular disease by artificial neural networks , 2004, Annals of medicine.