Medication-based mortality prediction in COPD using machine learning and conventional statistical methods
Bibliographic record
Abstract
BACKGROUND: Predicting mortality in chronic obstructive pulmonary disease (COPD) patients supports clinical decision-making and resource allocation. While most existing prediction models rely on clinical, physiological, imaging, or biological measures which are not frequently collected in clinical practice, drug claims data may be electronically accessible during routine visits. METHODS: We conducted a retrospective cohort study of COPD patients aged ≥40 years in Quebec with ≥2 years of public drug coverage and ≥1 dispensation of maintenance COPD medication. Predictors included sociodemographic characteristics, medication use and adherence for COPD and, in some models, for other chronic conditions. We compared logistic regression to six machine learning (ML) methods and assessed their performance in predicting 5-year all-cause mortality on a separate test dataset. RESULTS: Among 179,168 COPD patients (mean age 70.2 years; 47.4 % male), five-year mortality rate was 24.3 %. Logistic regression achieved an area under the receiver-operator characteristics curve (AUC-ROC) of 0.749 using only COPD medications, rising to 0.778 when adding medications for other chronic conditions. Most ML methods slightly outperformed logistic regression, with deep artificial neural networks (D-ANN) yielding the best performance (AUC-ROC = 0.787; p < 0.001). SHapley Additive exPlanations (SHAP) analysis highlighted non-inhaled anticholinergics, diuretics, antidepressants, and lipid-lowering agents as top predictors. CONCLUSIONS: Models using medication-based predictors can predict a substantial part of five-year all-cause mortality in COPD patients and may serve as a useful proxy for clinical, physiological, laboratory, and imaging predictors, which are often unavailable in medico-administrative databases and/or inaccessible to physicians in routine practice; they may also yield additional gains in predictive discrimination when combined with these other sources. While ML approaches, especially D-ANN, showed improved performance, gains over logistic regression were modest.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".