基于罕见且不确定诊断的自杀风险生存建模
Survival Modeling of Suicide Risk with Rare and Uncertain Diagnoses
AI总结：
针对医疗理赔中自杀未遂识别存在不确定性、生存分析含严重删失的问题，提出带正则化的整合Cox治愈模型，应用于青少年和年轻成人人群研究，识别出高可解释性风险因素并为自杀事件识别提供新见解。
摘要：
受通过改善行为医疗保健推进自杀预防的迫切需求驱动，我们利用医疗理赔数据，研究因自杀未遂住院后出院患者的后续自杀未遂风险。理解这类高自杀风险患者的风险行为，是迈向“零自杀”目标的重要一步。\n一个直接且非常规的挑战是，从医疗理赔中识别自杀未遂存在很大不确定性：近20%的“疑似”自杀未遂，是通过表明伤害和中毒外部原因但意图未明的诊断代码识别的。因此，研究这些未明确事件中哪些更可能是真实的自杀未遂，以及如何在存在严重删失的生存分析中合理利用它们，具有重要意义。\n为解决这些相互关联的问题，我们开发了带正则化的整合Cox治愈模型，用于处理含不确定事件和潜在治愈比例的生存回归。我们使用康涅狄格州的医疗理赔数据，将所提方法应用于青少年和年轻成人人群自杀相关住院后后续自杀未遂风险的研究。识别出的风险因素具有高度可解释性；更值得关注的是，我们的方法区分了对评估后续未遂的易感性或发生时机最有帮助的风险因素。我们进一步研究了不确定未遂的预测状态，为自杀事件识别带来了若干新见解。
英文摘要：
Motivated by the pressing need for suicide prevention through improving behavioral healthcare, we use medical claims data to study the risk of subsequent suicide attempts for patients who were hospitalized due to suicide attempts and later discharged. Understanding the risk behaviors of such patients at elevated suicide risk is an important step toward the goal of "Zero Suicide." An immediate and unconventional challenge is that the identification of suicide attempts from medical claims contains substantial uncertainty: almost 20% of "suspected" suicide attempts are identified from diagnosis codes indicating external causes of injury and poisoning with undermined intent. It is thus of great interest to learn which of these undetermined events are more likely actual suicide attempts and how to properly utilize them in survival analysis with severe censoring. To tackle these interrelated problems, we develop an integrative Cox cure model with regularization to perform survival regression with uncertain events and a latent cure fraction. We apply the proposed approach to study the risk of subsequent suicide attempts after suicide-related hospitalization for the adolescent and young adult population, using medical claims data from Connecticut. The identified risk factors are highly interpretable; more intriguingly, our method distinguishes the risk factors that are most helpful in assessing either susceptibility or timing of subsequent attempts. The predicted statuses of the uncertain attempts are further investigated, leading to several new insights on suicide event identification.
机构、总结、中文摘要均由AI分析而来，可能存在错误，请以论文正文为准。
