Implementation of a mortality risk predictive analytics model.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 211-211
Author(s):  
Stephanie Broadnax Broussard ◽  
John Russell Hoverman ◽  
Lalan S. Wilfong ◽  
Sabrina Q. Mikan ◽  
Holly Books ◽  
...  
Keyword(s):  
High Risk ◽  
End Of Life ◽  
Mortality Risk ◽  
Predictive Analytics ◽  
Risk Identification ◽  
Close Monitoring ◽  
Network Analytics ◽  
Risk Of Mortality ◽  
Before And After ◽  
Very High

211 Background: Improving the quality of End of Life (EOL) care continues to be a challenge. Enhanced prognostic awareness is critical for all members of the clinical team. In December 2020, The McKesson Advance Care Planning Enrollment eXtended (APEX) mortality risk predictive analytics model was implemented to improve prognostic awareness in OCM population and improve the timing of initiation of end of life care. (See ASCO 2021 abstract #1560). Methods: The APEX tool was provided in collaboration with the McKesson/US Oncology network analytics team. A process was established for dissemination of the report information. In the pilot, 12 practice locations with varying community landscapes, socio-cultural dynamics, and site clinical personnel resources were selected. At each site clinical leads and physician champions were selected. Education was provided on the tool, prognostic variables, and appropriate interventions. Biweekly, each site was provided a list of stratified patients based on their risk of mortality within the next 90 days. Patients that were identified as “very high” or “high” risk were reviewed by the clinical teams and discussed in routine huddles. Physicians and teams reported their planned interventions before and after mortality risk identification. Results: In the pilot, 105 patients were identified as very high or high risk. Reported interventions included the option to continue treatment, ACP Discussion, hospice referral/enrollment, palliative care referral, or continue close monitoring. Prior to the report, 14 identified patients were admitted to hospice and 30 patients had 1 or more advance directives documented. For 26 patients, treatment changes occurred including hospice enrollment, reduction in chemotherapy dosage, change in regimen, or initiating intensive monitoring. 23 patients indicated on the report expired in the interim between generation of the report and receipt by the clinic. No changes in treatment were made in 22 patients. There was physician reported disagreement with the mortality risk assessment in 4 patients. Conclusions: We describe implementation of a mortality predictive model in our practice. The care teams found the tool useful to identify patients at high risk of mortality. Interventions were varied and we will track the outcomes based on intervention. We are using the information from the pilot to continue refining the tool and implementation.

A Case–Control Study Evaluating the Impact of Dedicated Palliative Care Training on Critical Care Interventions at the end of Life

2021 ◽  
pp. 082585972110374
Author(s):  
Jee Y. You ◽  
Lie D. Ligasaputri ◽  
Adarsh Katamreddy ◽  
Kiran Para ◽  
Elizabeth Kavanagh ◽  
...  
Keyword(s):  
Palliative Care ◽  
Critical Care ◽  
High Risk ◽  
End Of Life ◽  
Poor Prognosis ◽  
Medical Interventions ◽  
Risk Of Death ◽  
Before And After ◽  
The Difference ◽  
The Impact

Many patients admitted to intensive care units (ICUs) are at high risk of dying. We hypothesize that focused training sessions for ICU providers by palliative care (PC) certified experts will decrease aggressive medical interventions at the end of life. We designed and implemented a 6-session PC training program in communication skills and goals of care (GOC) meetings for ICU teams, including house staff, critical care fellows, and attendings. We then reviewed charts of ICU patients treated before and after the intervention. Forty-nine of 177 (28%) and 63 of 173 (38%) patients were identified to be at high risk of death in the pre- and postintervention periods, respectively, and were included based on the study criteria. Inpatient mortality (45% vs 33%; P = .24) and need for mechanical ventilation (59% vs 44%, P = .13) were slightly higher in the preintervention population, but the difference was not statistically significant. The proportion of patients in whom the decision not to initiate renal replacement therapy was made because of poor prognosis was significantly higher in the postintervention population (14% vs 67%, P = .05). There was a nonstatistically significant trend toward earlier GOC discussions (median time from ICU admission to GOC 4 vs 3 days) and fewer critical care interventions such as tracheostomies (17% vs 4%, P = .19). Our study demonstrates that directed PC training of ICU teams has a potential to reduce end of life critical care interventions in patients with a poor prognosis.

scholarly journals Mortality of site-specific cancer in patients with schizophrenia: A systematic review and meta-analysis

2019 ◽  
Author(s):  
Liwei Ni ◽  
Yuming Long ◽  
Xuya Yuan ◽  
Jianhao Xu ◽  
Jialong Tao ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lung Cancer ◽  
Colon Cancer ◽  
High Risk ◽  
Mortality Rate ◽  
Mortality Risk ◽  
Meta Analysis ◽  
Site Specific ◽  
Risk Of Mortality ◽  
Male Patients

Abstract Background: Numerous studies have reported contradicting results on the relationship between cancer mortality and schizophrenia. Our aim is to quantify the mortality rate of common site-specific cancers among patients with schizophrenia and to synthesize the available research evidence. Method: We performed a systemic search of the PubMed, EMBASE and Web of Science databases. Studies reporting the mortality rate of different cancer in patients with schizophrenia were included. A random-effects model was applied to calculate the pooled relative risks (RRs) with 95% confidence intervals (95%CIs). Results: Seven studies consisting of a total of 1,162,971 participants with schizophrenia were included in this meta-analysis. Data regarding mortality risk of breast, colon, lung and prostate cancer among schizophrenia patients were subjected to quantitative analysis. Pooled results showed significant increases in mortality risk of breast cancer (RR = 1.97, 95%CI 1.38–2.83), lung cancer (RR = 1.93, 95%CI 1.46–2.54) and colon cancer (RR = 1.69, 95%CI 1.60–1.80) in patients with schizophrenia compared with those in the general population or control group. The mortality risk of prostate cancer increased in male patients, although no significant difference was detected (RR = 1.58, 95% CI 0.79–3.15). Increased risks of mortality from lung and colon cancer were observed in female patients (RR = 2.49, 95%CI 2.40–2.59 and RR = 2.42, 95%CI 1.39–4.22, respectively) and elevated risks of mortality from lung and colon cancer in male patients (RR = 2.40, 95%CI 2.30–2.50 and RR = 1.90, 95%CI 1.71–2.11, respectively) were detected. Conclusions: Individuals with schizophrenia have a significantly high risk of mortality from breast, colon, and lung cancer and a high risk of mortality from prostate cancer.

Abstract 11056: Hospitals Accepting Greater Proportions of High Risk Transfer-In STEMI Patients Do Not Have Higher Risk-Adjusted Hospital Mortality: A Report From the AHA Mission: Lifeline Program

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Michael C Kontos ◽  
Tracy Y Wang ◽  
Anita Y Chen ◽  
Laine Thomas ◽  
Eric Bates ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
High Risk ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Mortality Risk ◽  
Risk Adjustment ◽  
Risk Model ◽  
Risk Transfer ◽  
Before And After

Background: Mortality is an important quality measure for acute MI hospital care. There is concern that, despite risk adjustment, PCI receiving hospitals receiving a disproportionate volume of high risk STEMI transfers may have their reported mortality adversely affected. Methods: All STEMI patients from April 2011 to December 2013 in the ACTION Registry®-GWTG™ were included. High risk was defined as pts with either cardiogenic shock or cardiac arrest on admission. Hospitals were divided into tertiles based on the proportion of high risk STEMI patients who were transferred relative to the total number of STEMI patients treated. Adjusting for covariates in the ACTION mortality risk model, the differences in risk-adjusted in-hospital mortality in each tertile were determined before and after excluding high risk STEMI transfer pts. Results: Among 119,680 STEMI pts treated at 539 primary PCI hospitals, 37,028 (31%) pts were transfers, of whom 4,500 (4%) were high risk. The proportion of high risk STEMI transfers ranged from 0-12% across hospitals. Times from initial hospital presentation to PCI were similar across tertiles: Low 107 min; Middle, 100 min; High 106 min. The ACTION mortality risk model, which includes cardiogenic shock but not cardiac arrest, slightly underestimated mortality for high-risk STEMI transfer pts (observed in-hospital mortality rate: 26%, predicted mortality rate: 24%). While differences in observed hospital mortality were present among hospitals with a greater proportion of high-risk transfers, risk-adjusted mortality was unaffected by the inclusion or exclusion of high-risk transfer patients across all tertiles (TABLE). Conclusions: Receiving PCI hospitals accepting greater proportions of high risk STEMI transfer pts did not have a higher risk-adjusted in-hospital mortality when a clinical mortality risk model was used for risk adjustment.

scholarly journals Association of predicted 10 years cardiovascular mortality risk with duration of HIV infection and antiretroviral therapy among HIV-infected individuals in Durban, South Africa

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Olamide O. Todowede ◽  
Benn Sartorius ◽  
Nombulelo Magula ◽  
Aletta E. Schutte
Keyword(s):  
Metabolic Syndrome ◽  
High Risk ◽  
Hiv Infection ◽  
Mortality Risk ◽  
Low Risk ◽  
Metabolic Risk ◽  
Cvd Risk ◽  
Cardiovascular Mortality Risk ◽  
Very High ◽  
Cvd Mortality

Abstract Background South Africa has the largest population of human immunodeficiency virus (HIV) infected patients on antiretroviral therapy (ART) realising the benefits of increased life expectancy. However, this population may be susceptible to cardiovascular disease (CVD) development, due to the chronic consequences of a lifestyle-related combination of risk factors, HIV infection and ART. We predicted a 10-year cardiovascular mortality risk in an HIV-infected population on long-term ART, based on their observed metabolic risk factor profile. Methods We extracted data from hospital medical charts for 384 randomly selected HIV-infected patients aged ≥ 30 years. We defined metabolic syndrome (MetS) subcomponents using the International Diabetes Federation definition. A validated non-laboratory-based model for predicting a 10-year CVD mortality risk was applied and categorised into five levels, with the thresholds ranging from very low-risk (< 5%) to very high-risk scores (> 30%). Results Among the 384 patients, with a mean (± standard deviation) age of 42.90 ± 8.20 years, the proportion of patients that were overweight/obese was 53.3%, where 50.9% had low high-density lipoprotein (HDL) cholesterol and 21 (17.5%) had metabolic syndrome. A total of 144 patients with complete data allowed a definitive prediction of a 10-year CVD mortality risk. 52% (95% CI 44–60) of the patients were stratified to very low risk (< 5%) compared to 8% (95% CI 4–13) that were at a very high risk (> 30%) of 10-year CVD mortality. The CVD risk grows with increasing age (years), 57.82 ± 6.27 among very high risk and 37.52 ± 4.50; p < 0.001 in very low risk patients. Adjusting for age and analysing CVD risk mortality as a continuous risk score, increasing duration of HIV infection (p = 0.002) and ART (p = 0.007) were significantly associated with increased predicted 10 year CVD mortality risk. However, there was no association between these factors and categorised CVD mortality risk as per recommended scoring thresholds. Conclusions Approximately 1 in 10 HIV-infected patients is at very high risk of predicted 10-year CVD mortality in our study population. Like uninfected individuals, our study found increased age as a major predictor of 10-year mortality risk and high prevalence of metabolic syndrome. Additional CVD mortality risk due to the duration of HIV infection and ART was seen in our population, further studies in larger and more representative study samples are encouraged. It recommends an urgent need for early planning, prevention and management of metabolic risk factors in HIV populations, at the point of ART initiation.

scholarly journals Kidney Disease Symptoms Before and After Kidney Transplantation

2021 ◽  
pp. CJN.19031220
Author(s):  
Kathryn Taylor ◽  
Nadia Chu ◽  
Xiaomeng Chen ◽  
Zhan Shi ◽  
Eileen Rosello ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Symptom Score ◽  
Mortality Risk ◽  
Symptom Burden ◽  
Post Transplantation ◽  
Before And After ◽  
Transplant Candidates ◽  
Mental Stressors ◽  
Waitlist Mortality ◽  
Very High

Background and Objectives: Kidney failure patients report a high symptom burden, which likely increase while on dialysis due to physical and mental stressors and decrease after kidney transplantation due to restoration of kidney function. Design, Setting, Participants, and Measurements: We leveraged a 2-center prospective study of 1,298 kidney transplant candidates and 521 recipients (5/2014-3/2020). Symptom scores (0-100) at evaluation and admission for transplantation were calculated using KDQOL-SF, where lower scores represent greater burden, and burden was categorized as: very high: 0.0-71.0; high: 71.1-81.0; medium: 81.1-91.0; low: 91.1-100.0. We estimated adjusted waitlist mortality risk (competing risks regression), change in symptoms between evaluation and transplantation (n=190), and post-transplantation symptom score trajectories (mixed-effects models). Results: At evaluation, candidates reported being moderately to extremely bothered by fatigue (32%), xeroderma (27%), muscle soreness (26%), and pruritus (25%); 16% reported high and 21% reported very high symptom burden. Candidates with very high symptom burden were at greater waitlist mortality risk (aSHR=1.67, 95%CI:1.06,2.62). By transplantation, 34% experienced an increased symptom burden while 42% remained unchanged. The estimated overall symptom score was 82.3 points at transplantation, 90.6 points at 3 months (10% improvement); the score increased 2.75 points/month (95%CI:2.38,3.13) during 0-3 months, and plateaued (-0.06 points/month, 95%CI:-0.30,0.18) from 3 months through 12 months post-transplantation. There were early (first 3 months) improvements in 9 of 11 symptoms; pruritus (23% improvement) and fatigue (21% improvement) had the greatest improvements. Conclusions: Among candidates, very high symptom burden was associated with waitlist mortality, but for those surviving and undergoing kidney transplantation, symptoms improved.

KUAUTAS MIKROBIOLOGI UDARA RUANG OPERASI RSUD dr. M. SOEWANDHIE SURABAYATAHUN 2014

2014 ◽  
Vol 12 (2) ◽  
Author(s):  
Nada Awang Abdillah ◽  
Erna Tri Astuti ◽  
Sudjarwo .
Keyword(s):  
Air Quality ◽  
High Risk ◽  
Disease Transmission ◽  
Microbiological Quality ◽  
Bacterial Count ◽  
Quality Standard ◽  
Operating Rooms ◽  
Ceramic Tiles ◽  
Before And After ◽  
Very High

One of the rooms with very high risk of disease transmission in a hospital is the operatingroom.The government through the Minister of Health Decree No. 1204/MENKES/SK/X/2004on HospitalEnvironmental Health Requirements, has placed operating rooms as a very high risk zone. Among otherthings, air quality (bacterial count) is very important to note since the rooms are used for surgicalprocedures requiring extremely sterile conditions. This study was aimed at determining the air quality(bacterial count) in operating rooms at Dr. M. Soewandhie Hospital of Surabaya in 2014.This was a descriptive study, conducted in Dr. M. Soewandhie hospital. Samples were taken fromall operating rooms, RO 1 (one), RO 2 (two), RO 3 (three), RO4 (four) and RO 5 (five). Variables to beexamined induded air microbiological quality as reflected in the bacterial count, temperature and humiditymeasurements, assessment of building and construction cleaning and sterilization processes on operatingrooms.The results showed, that bacterial counts in RO 1 was 14 cfu/m3, RO 2 63 cfu/m3, RO 3 23cfu/m3, RO4 19 cfu/m3, these four rooms did not meet the requirement, the only room that satisfied therequirement was RO 5 as much as 5 cfu/m3. Temperature and humidity in RO 1 to RO 3 were at thesame value of 200e and 68%, RO4 was 21.50e and 59%, RO 5 was 210e and 60%. In terms of roomtemperature, all rooms were satisfactory, but in term of humidity, only RO4 was satisfactory. Results ofbuilding and room assessment were: RO 1 80%, RO 2 80%, RO3 84%, RO4 74% and RO 5 70%. Itcan be conduded that RO4 and RO 5 did not satisfy the standard. In terms of cleaning processes, RO 1to RO 3 were found equal at the percentage of 75%, while RO 4 and RO 5 was also equal at thepercentage of 65%.Among the five operating rooms at Soewandhie hospital of Surabaya, four of them have exceededthe bacterial count designated as the air quality standard . It is therefore recommended to performsterilization with UV(ultraviolet) before and after each surgery; to provide an exhaust fan in RO4 and RO5, to ensure conical meeting between the floors and walls of the ROs, installation of ceramic tiles on thewall of RO 5, keeping the operating room doors closed at all times, maintenance of air conditioning unitsand exhaust fans at least every 6 months to check up on the condition of the utilities and to develop andimplement standard operational procedures for cleaning and sterilization of process of cleaning theoperating rooms.

scholarly journals P0184RISK PREDICTION FOR DEATH AND END-STAGE RENAL DISEASE DOES NOT PARALLEL REAL-LIFE TRAJECTORY OF OLDER PATIENTS WITH ADVANCED CHRONIC KIDNEY DISEASE - A ROMANIAN CENTER EXPERIENCE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Andra Nastasa ◽  
Mugurel Apetrii ◽  
Mihai Onofriescu ◽  
Ionut Nistor ◽  
Hani Hussien ◽  
...  
Keyword(s):  
High Risk ◽  
Mortality Risk ◽  
Kidney Failure ◽  
Older Patients ◽  
Real Life ◽  
Low Risk ◽  
Individual Risk ◽  
Failure Risk ◽  
Risk Of Mortality ◽  
Life Trajectory

Abstract Background and Aims In Europe, the share of the elderly (≥65 years of age) in the total population is estimated to increase from 19.2% in 2016 to 29.1% by 2080. In 2016, European Renal Best Practice (ERBP) group published a clinical practice guideline on management of older patients with CKD stage3b or higher (eGFR&lt;45ml/min/1.73 m2). Two risk stratifications scores were emphasized: Bansal score for prognosticating risk of death in medium term, and Kidney Failure Risk Equation (KFRE) for estimating progression of CKD stage 3b or 4 to ESRD. Our group, as part of the ERBP team, aimed to evaluate and apply the framework proposed by the guideline, consisting of risk prediction for both mortality and progression to ESRD in a cohort of elderly patients with advanced CKD. After dividing the population in groups of risk, we described their real-life trajectory in terms of either reaching ESRD/death. Method In this retrospective cohort study we included patients aged ≥65 years with CKD stage 3b-4, evaluated at the Outpatient Nephrology Department of Dr. C. I. Parhon Hospital from Iași, Romania, between October 2016 – October 2018. Individual risk for mortality was predicted using Bansal score, a nine-variable equation model. A total score of 7 (associated with a mortality risk of 53.82%) was established as cut-off value to differentiate between 2 groups: high risk of mortality (Bansal ≥ 7) and low risk of mortality (Bansal &lt; 7), given the fact that the ERBP guidelines don’t define a threshold for high risk in respect to mortality outcome. According to the algorithm proposed by the guideline, individual risk for progression to ESRD at 5 years was calculated in the low mortality risk group, using the 4-variable Kidney Failure Risk Equation (KFRE). Results The final cohort included 958 patients, with a mean age of 74 years (SD: 7), and with similar gender distribution (50.6% female vs. 49.4% male). Predicted trajectory in terms of reaching ESRD / death: When we applied Bansal score for mortality, the total study population (N=958) was divided in two groups: N1 with high risk of mortality, which comprised more than half of the cohort (548 patients, 57.2%) and N2 with low risk of mortality (410 patients, 42.8%). Individual risk of progression to ESRD was then estimated in N2 group, using 4-variable KFRE. Nearly ¾ of this group (75.4%, 309 subjects) presented a low-risk of progression and ¼ (24.6%, 101 subjects) had high-risk. Real-life trajectory in terms of reaching ESRD / death: From the entire cohort, 31 patients started renal replacement therapy (RRT) and 164 patients died as their first clinical event. The RRT initiation rate was 3.6% of N1 group (20 subjects) versus 2.7% of N2 group (11 subjects). The mortality rate was 15.5% of N1 group (85 deaths) versus 19.3% of N2 group (79 deaths). Figure 1 depicts the real-life trajectory of the population groups in terms of reaching ESRD / death. Conclusion In a large population from Eastern Europe, the application of the algorithm from the Clinical Practice Guideline on management of older patients with advanced CKD showed that risk prediction for death and end-stage renal disease does not parallel the real-life trajectory of the population. More than half of the subjects had a high risk of mortality, however we found similar death rates in the 2 groups (high versus low risk of mortality). Also, the RRT initiation rates were similar, irrespective of predicted mortality risk or kidney failure risk, suggesting that implementing the guideline in real-life settings is still a challenge.

scholarly journals Predicting 90-Day Mortality in Locoregionally Advanced Head and Neck Squamous Cell Carcinoma after Curative Surgery

Cancers ◽  
2018 ◽  
Vol 10 (10) ◽  
pp. 392 ◽  
Author(s):  
Lei Qin ◽  
Tsung-Ming Chen ◽  
Yi-Wei Kao ◽  
Kuan-Chou Lin ◽  
Kevin Yuan ◽  
...  
Keyword(s):  
Overall Survival ◽  
Squamous Cell Carcinoma ◽  
High Risk ◽  
Mortality Rate ◽  
Cell Carcinoma ◽  
Mortality Risk ◽  
Survival Rates ◽  
Curative Surgery ◽  
Risk Patients ◽  
Very High

Purpose: To propose a risk classification scheme for locoregionally advanced (Stages III and IV) head and neck squamous cell carcinoma (LA-HNSCC) by using the Wu comorbidity score (WCS) to quantify the risk of curative surgeries, including tumor resection and radical neck dissection. Methods: This study included 55,080 patients with LA-HNSCC receiving curative surgery between 2006 and 2015 who were identified from the Taiwan Cancer Registry database; the patients were classified into two groups, mortality (n = 1287, mortality rate = 2.34%) and survival (n = 53,793, survival rate = 97.66%), according to the event of mortality within 90 days of surgery. Significant risk factors for mortality were identified using a stepwise multivariate Cox proportional hazards model. The WCS was calculated using the relative risk of each risk factor. The accuracy of the WCS was assessed using mortality rates in different risk strata. Results: Fifteen comorbidities significantly increased mortality risk after curative surgery. The patients were divided into low-risk (WCS, 0–6; 90-day mortality rate, 0–1.57%), intermediate-risk (7–11; 2.71–9.99%), high-risk (12–16; 17.30–20.00%), and very-high-risk (17–18 and >18; 46.15–50.00%) strata. The 90-day survival rates were 98.97, 95.85, 81.20, and 53.13% in the low-, intermediate-, high-, and very-high-risk patients, respectively (log-rank p < 0.0001). The five-year overall survival rates after surgery were 70.86, 48.62, 22.99, and 18.75% in the low-, intermediate-, high-, and very-high-risk patients, respectively (log-rank p < 0.0001). Conclusion: The WCS is an accurate tool for assessing curative-surgery-related 90-day mortality risk and overall survival in patients with LA-HNSCC.

What is the risk of mortality for people who are screen positive in a diabetes screening programme but who do not have diabetes on biochemical testing? Diabetes screening programmes from a public health perspective

2002 ◽  
Vol 9 (4) ◽  
pp. 187-190 ◽  
Author(s):  
A. Spijkerman ◽  
S. Griffin ◽  
J. Dekker ◽  
G. Nijpels ◽  
N.J. Wareham
Keyword(s):  
Public Health ◽  
High Risk ◽  
Mortality Risk ◽  
False Positive ◽  
True Positive ◽  
Negative Group ◽  
Diabetes Screening ◽  
True Negative ◽  
Risk Of Mortality ◽  
Biochemical Testing

OBJECTIVES: To assess mortality risk in people classified by the Cambridge risk score (CRS), a previously validated simple screening tool for undiagnosed type 2 diabetes that uses only information routinely available in primary care. SETTING: Random sample of the general population between 50 and 75 years of age in Hoorn, The Netherlands METHODS: The results of the CRS were compared with the gold standard for diabetes, the oral glucose tolerance test (OGTT) results classified according to the World Health Organisation (WHO) 1999 diagnostic criteria. Cox’s proportional hazards regression was used to assess the risk of mortality of screen positive and screen negative people. RESULTS: 154 people out of the total population of 2297 had previously undiagnosed diabetes and 113 (73%) of these would have been detected with the CRS (true positive). However, the CRS identified a much larger group (n=1037) who were positive for the score, but who did not have diabetes on biochemical testing (false positive). Unadjusted risk of mortality was highest in the true positive group (3.40 95% confidence interval (95% CI, 2.15 to 5.38)), intermediate in false positive people (2.62 (2.00 to 3.43)), and lowest in false negative people (1.50 (0.55 to 4.09)) with the true negative group as reference. Adjustment for age and sex resulted in similar risk estimates for all three groups, but mortality risk was significantly increased only in false positive and true positive groups compared with the true negative group. CONCLUSIONS: People who have a positive risk score are at high risk of mortality whether or not subsequent testing shows them to have diabetes. Direct public health interventions in this high risk population may be appropriate.

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