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Alberto Zucchelli Roma – SIGG 2019
A “genetic algorithm” to optimizethe construction of a frailty index in a population-based studyAlberto Zucchelli
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Alberto Zucchelli Roma – SIGG 2019
Long story short…
A “genetic algorithm” to optimizethe construction of a frailty index in a population-based study
Engineering
Solution
Epidemiologic
al
Challenge
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Alberto Zucchelli Roma – SIGG 2019
Introduction
The Frailty Index:
𝐹𝐼 =𝑛. 𝒅𝒆𝒇𝒊𝒄𝒊𝒕𝒔 𝒆𝒙𝒉𝒊𝒃𝒊𝒕𝒆𝒅 𝑏𝑦 𝑡ℎ𝑒 𝑠𝑢𝑏𝑗𝑒𝑐𝑡
𝑛. 𝒅𝒆𝒇𝒊𝒄𝒊𝒕𝒔 𝒄𝒐𝒏𝒔𝒊𝒅𝒆𝒓𝒆𝒅 𝑏𝑦 𝑡ℎ𝑒 𝑟𝑒𝑠𝑒𝑎𝑟𝑐ℎ𝑒𝑟
Signs, symptoms, Diseases, Cognitive and functional measures,
Biomarkers, Instrumental examinations results, Low self reported
quality of life
*(30-40 deficits minimum)
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Alberto Zucchelli Roma – SIGG 2019
Zucchelli A; Vetrano DL – BMC; 2019
< 78
Years
old
* Imputed data
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Alberto Zucchelli Roma – SIGG 2019
N = 3363
108 “potential deficits”
AIM: to build a FI with a
“balanced accuracy” in the
prediction of mortality.
3.2 × 1032 possible FIs
Methods
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Alberto Zucchelli Roma – SIGG 2019
John Henry
Holland
Genetic algorithm
A search strategy that helps to find «better»
solutions to problems that are not
analytically solvable
Main advantages1) Users set criteria for “solutions”
• FI with 30-70 deficits
• FIs with a high number of missing values are
excluded
2) Users define what a “good solution” is
• Average AUC from non-parametric ROC
analyses for 3-year and 6-year mortality in
whole study population, sex and age subsamples
N = 3363
Train
dataset
70%
Test dataset
30%
GA GA-FI
Test and
compare
accuracy
c-FI
Methods
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Alberto Zucchelli Roma – SIGG 2019
1100 randomly
generated FIs*
Test accuracy
Recombine the
best ones
Replace the
worse ones
Best GA-
generated FI
*70% random sample
Methods
New FIs
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Alberto Zucchelli Roma – SIGG 2019
Best GA-generated FI
- gamma-distributed
- Max FI < 0.7
- 40 deficits included:
• 18 chronic conditions
• 14 physical function tests
• 5 socio-economic status
• 3 cognitive performance
Results
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Alberto Zucchelli Roma – SIGG 2019Best GA-generated FI Clinical FI
p = 0.006 p < 0.001
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Alberto Zucchelli Roma – SIGG 2019Best GA-generated FI Clinical FI
* **
** **
*
*
* p < 0.05
** p < 0.001
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Alberto Zucchelli Roma – SIGG 2019
Conclusion:- Optimization algorithms are feasible ways to
build a highly performant and accuracy-
balanced FI
- GAs offer different advantages:
• Users set criteria for solutions and goodness
• Results are data-based
• Inference is possible
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Alberto Zucchelli Roma – SIGG 2019
Co-authors:
Amaia Calderon-
LarrañagaLaura Fratiglioni
Alessandra Marengoni
Graziano Onder
Debora Rizzuto
Davide Liborio Vetrano
THANK YOU!Thanks to:
• All SNAC-K participants
• SNAC-K data collection and
data management teams
• ARC team
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Alberto Zucchelli Roma – SIGG 2019
supplementary
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Alberto Zucchelli Roma – SIGG 2019
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Alberto Zucchelli Roma – SIGG 2019
inactive
stick
MMSE_cat
Anemia
Heart_failure
widowed_cat
Dementia
COPD
Other_neurological_dis
Solid_neoplasms
Blindness_visual_loss
IADL_Transport
ADL_toiletting
ADL_transferring
education_cat
Deafness_hearing_loss
institution0
Other_CV
Other_psychia
WS_cat
Atrial_fibrillation
patellar_refl
decisions
smoke_cat
Peripheral_vascular_dis
IADL_med
ADL_dressing
Parkinson_parkinsonism
hosp_y_before_cat
Other_respiratory_dis
fatigue
BMI_18
IADL_Housekeeping
Other_eye_dis
social_net_cat
Cerebrovascular_dis
IADL_Telefon
Bradycardias
IADL_Laundry
ADL_bathing
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Alberto Zucchelli Roma – SIGG 2019
Hypertension
Thyroid disorders
Anaemia
Atrial Fibrillation
Blindness and other visual impairments
Cerebrovascular diseases
Chronic kidney disease
Chronic Obstructive Pulmonary Disease, emphysema and chronic bronchitis
Deafness and other hearing impairments
Dementia
Depression and other mood disorders
Diabetes
Heart failure
Inflammatory bowel diseases
Ischemic heart disease
Osteoporosis
Parkinson disease and parkinsonisms
Peripheral arterial diseases
Peripheral neuropathies
Sleep disorders
Solid neoplasm
Inability to autonomously take and prepare medications
Inability to autonomously shop
Inability to autonomously cook and prepare meals
Inability to autonomously do house chores
Inability to autonomously do the laundry
Inability to autonomously manage finances
Inability to autonomously use the telephone
Inability to autonomously use means of transportation
Minimental State Examination score
Inability to autonomously bath
Inability to autonomously dress
Inability to autonomously use the toilet
Incontinence
Inability to autonomously move in and out from bed or chair
Inability to autonomously feed him-/herself
Usage of stick during walking
Reporting dyspnoea
Evidence of swollen legs at physical examination
Reporting anxiety symptoms
Self-reporting appetite loss
Self-reporting sense of worthlessness
Reporting pain
Feeling older than actual age
Self-reporting low quality of life
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Alberto Zucchelli Roma – SIGG 2019
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Alberto Zucchelli Roma – SIGG 2019
DEF_inactive
DEF_stick
DEF_MMSE_cat
DEF_Anemia
DEF_Heart_failure
DEF_widowed_cat
DEF_Dementia
DEF_COPD
DEF_Other_neurological_dis
DEF_Solid_neoplasms
DEF_Blindness_visual_loss
DEF_IADL_Transport
DEF_ADL_toiletting
DEF_ADL_transferring
DEF_education_cat
DEF_Deafness_hearing_loss
DEF_institution0
DEF_Other_CV
DEF_Other_psychia
DEF_WS_cat
DEF_Atrial_fibrillation
DEF_patellar_refl
DEF_decisions
DEF_smoke_cat
DEF_Peripheral_vascular_dis
DEF_IADL_med
DEF_ADL_dressing
DEF_Parkinson_parkinsonism
DEF_hosp_y_before_cat
DEF_Other_respiratory_dis
DEF_fatigue
DEF_BMI_18
DEF_IADL_Housekeeping
DEF_Other_eye_dis
DEF_social_net_cat
DEF_Cerebrovascular_dis
DEF_IADL_Telefon
DEF_Bradycardias
DEF_IADL_Laundry
DEF_ADL_bathing
DEF_romberg_closed
DEF_finger_nose
DEF_tremor
DEF_dysphagia
DEF_smell_change
DEF_pain_cat
DEF_conc_diff_cat
DEF_low_QoF
DEF_paresis
DEF_Weight_loss
DEF_Cardiac_valve_dis
DEF_Colitis_related_dis
DEF_slowness
DEF_wheelchair
DEF_grip_cat
DEF_appeite_loss
DEF_Chronic_pancr
DEF_Ischemic_heart_dis
DEF_Osteoarthritis
DEF_Other_MSK_joint_dis
DEF_Sleep_dis
DEF_Thyroid_dis
DEF_ADL_continence
DEF_sadness
DEF_muscle_tonus
DEF_loneliness_cat
DEF_Allergy
DEF_Dorsopathies
DEF_InflamArthr
DEF_Migraine
DEF_Other_metabolic_dis
DEF_IADL_Finances
DEF_ADL_feeding
DEF_worth_cat
DEF_heart_rtm_cat
DEF_heart_mur_cat
DEF_swol_legs_cat
DEF_Autoimmune_dis
DEF_dyspnea_cat
DEF_IADL_Shopping
DEF_bluecollar
DEF_IADL_Food
DEF_Osteoporosis
DEF_bruit_carotid_cat
DEF_Cataract_lens_dis
DEF_Chronic_kidney_dis
DEF_Diabetes
DEF_EsopStomDu
DEF_Glaucoma
DEF_Hypertension
DEF_SomaticStress
DEF_Other_genitourinary_dis
DEF_disinhibition
DEF_suicide
DEF_dysartrhia
DEF_alcool_cat
DEF_Asthma
DEF_Depression_mood_dis
DEF_Dyslipidemia
DEF_Obesity
DEF_Peripheral_neuropathy
DEF_agitation
DEF_anxiety
DEF_hostile
DEF_sleep_prob
DEF_tired
DEF_stairs_walking_diff
DEF_tandem
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Alberto Zucchelli Roma – SIGG 2019