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      Forecasting cardiovascular disease mortality using artificial neural networks in Sindh, Pakistan

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          Abstract

          Cardiovascular disease (CVD) is a leading cause of death and disability worldwide, and its incidence and prevalence are increasing in many countries. Modeling of CVD plays a crucial role in understanding the trend of CVD death cases, evaluating the effectiveness of interventions, and predicting future disease trends. This study aims to investigate the modeling and forecasting of CVD mortality, specifically in the Sindh province of Pakistan. The civil hospital in the Nawabshah area of Sindh province, Pakistan, provided the data set used in this study. It is a time series dataset with actual cardiovascular disease (CVD) mortality cases from 1999 to 2021 included. This study analyzes and forecasts the CVD deaths in the Sindh province of Pakistan using classical time series models, including Naïve, Holt-Winters, and Simple Exponential Smoothing (SES), which have been adopted and compared with a machine learning approach called the Artificial Neural Network Auto-Regressive (ANNAR) model. The performance of both the classical time series models and the ANNAR model has been evaluated using key performance indicators such as Root Mean Square Deviation Error, Mean Absolute Error (MAE), and Mean Absolute Percentage Error (MAPE). After comparing the results, it was found that the ANNAR model outperformed all the selected models, demonstrating its effectiveness in predicting CVD mortality and quantifying future disease burden in the Sindh province of Pakistan. The study concludes that the ANNAR model is the best-selected model among the competing models for predicting CVD mortality in the Sindh province. This model provides valuable insights into the impact of interventions aimed at reducing CVD and can assist in formulating health policies and allocating economic resources. By accurately forecasting CVD mortality, policymakers can make informed decisions to address this public health issue effectively.

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          Most cited references47

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          Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1·25 million people

          Summary Background The associations of blood pressure with the different manifestations of incident cardiovascular disease in a contemporary population have not been compared. In this study, we aimed to analyse the associations of blood pressure with 12 different presentations of cardiovascular disease. Methods We used linked electronic health records from 1997 to 2010 in the CALIBER (CArdiovascular research using LInked Bespoke studies and Electronic health Records) programme to assemble a cohort of 1·25 million patients, 30 years of age or older and initially free from cardiovascular disease, a fifth of whom received blood pressure-lowering treatments. We studied the heterogeneity in the age-specific associations of clinically measured blood pressure with 12 acute and chronic cardiovascular diseases, and estimated the lifetime risks (up to 95 years of age) and cardiovascular disease-free life-years lost adjusted for other risk factors at index ages 30, 60, and 80 years. This study is registered at ClinicalTrials.gov, number NCT01164371. Findings During 5·2 years median follow-up, we recorded 83 098 initial cardiovascular disease presentations. In each age group, the lowest risk for cardiovascular disease was in people with systolic blood pressure of 90–114 mm Hg and diastolic blood pressure of 60–74 mm Hg, with no evidence of a J-shaped increased risk at lower blood pressures. The effect of high blood pressure varied by cardiovascular disease endpoint, from strongly positive to no effect. Associations with high systolic blood pressure were strongest for intracerebral haemorrhage (hazard ratio 1·44 [95% CI 1·32–1·58]), subarachnoid haemorrhage (1·43 [1·25–1·63]), and stable angina (1·41 [1·36–1·46]), and weakest for abdominal aortic aneurysm (1·08 [1·00–1·17]). Compared with diastolic blood pressure, raised systolic blood pressure had a greater effect on angina, myocardial infarction, and peripheral arterial disease, whereas raised diastolic blood pressure had a greater effect on abdominal aortic aneurysm than did raised systolic pressure. Pulse pressure associations were inverse for abdominal aortic aneurysm (HR per 10 mm Hg 0·91 [95% CI 0·86–0·98]) and strongest for peripheral arterial disease (1·23 [1·20–1·27]). People with hypertension (blood pressure ≥140/90 mm Hg or those receiving blood pressure-lowering drugs) had a lifetime risk of overall cardiovascular disease at 30 years of age of 63·3% (95% CI 62·9–63·8) compared with 46·1% (45·5–46·8) for those with normal blood pressure, and developed cardiovascular disease 5·0 years earlier (95% CI 4·8–5·2). Stable and unstable angina accounted for most (43%) of the cardiovascular disease-free years of life lost associated with hypertension from index age 30 years, whereas heart failure and stable angina accounted for the largest proportion (19% each) of years of life lost from index age 80 years. Interpretation The widely held assumptions that blood pressure has strong associations with the occurrence of all cardiovascular diseases across a wide age range, and that diastolic and systolic associations are concordant, are not supported by the findings of this high-resolution study. Despite modern treatments, the lifetime burden of hypertension is substantial. These findings emphasise the need for new blood pressure-lowering strategies, and will help to inform the design of randomised trials to assess them. Funding Medical Research Council, National Institute for Health Research, and Wellcome Trust.
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            Time series regression studies in environmental epidemiology

            Time series regression studies have been widely used in environmental epidemiology, notably in investigating the short-term associations between exposures such as air pollution, weather variables or pollen, and health outcomes such as mortality, myocardial infarction or disease-specific hospital admissions. Typically, for both exposure and outcome, data are available at regular time intervals (e.g. daily pollution levels and daily mortality counts) and the aim is to explore short-term associations between them. In this article, we describe the general features of time series data, and we outline the analysis process, beginning with descriptive analysis, then focusing on issues in time series regression that differ from other regression methods: modelling short-term fluctuations in the presence of seasonal and long-term patterns, dealing with time varying confounding factors and modelling delayed (‘lagged’) associations between exposure and outcome. We finish with advice on model checking and sensitivity analysis, and some common extensions to the basic model.
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              Recurrent Neural Networks for Multivariate Time Series with Missing Values

              Multivariate time series data in practical applications, such as health care, geoscience, and biology, are characterized by a variety of missing values. In time series prediction and other related tasks, it has been noted that missing values and their missing patterns are often correlated with the target labels, a.k.a., informative missingness. There is very limited work on exploiting the missing patterns for effective imputation and improving prediction performance. In this paper, we develop novel deep learning models, namely GRU-D, as one of the early attempts. GRU-D is based on Gated Recurrent Unit (GRU), a state-of-the-art recurrent neural network. It takes two representations of missing patterns, i.e., masking and time interval, and effectively incorporates them into a deep model architecture so that it not only captures the long-term temporal dependencies in time series, but also utilizes the missing patterns to achieve better prediction results. Experiments of time series classification tasks on real-world clinical datasets (MIMIC-III, PhysioNet) and synthetic datasets demonstrate that our models achieve state-of-the-art performance and provide useful insights for better understanding and utilization of missing values in time series analysis.
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                Author and article information

                Contributors
                hasnain@stat.qau.edu.pk
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                4 January 2025
                4 January 2025
                2025
                : 25
                : 34
                Affiliations
                [1 ]Govt Degree College TangoJam, Hyderabad 70060, Sindh, Pakistan
                [2 ]Ibn-e-Sina Medical University Mirpurkhas, Sindh, Pakistan
                [3 ]Department of Statistics, Faculty of Computing, The Islamia University of Bahawalpur, ( https://ror.org/002rc4w13) Bahawalpur, Pakistan
                [4 ]Department of Statistics, Quaid-i-Azam University, 45320, ( https://ror.org/04s9hft57) Islamabad, Pakistan
                [5 ]Department of Finance, College of Business Administration, King Saud University, ( https://ror.org/02f81g417) P.O. Box 71115, Riyadh, 11587 Saudi Arabia
                [6 ]Al-Barkaat Institute of Management Studies, Aligarh 202122, Dr. A. P. J. Abdul Kalam Technical University, ( https://ror.org/03h56sg55) Lucknow 226010, India
                Article
                21187
                10.1186/s12889-024-21187-0
                11699765
                39754102
                6c047937-165b-4de7-9c07-c2d5ecb43673
                © The Author(s) 2025

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 10 May 2024
                : 23 December 2024
                Categories
                Research
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                © BioMed Central Ltd., part of Springer Nature 2025

                Public health
                cardiovascular disease,analyzing and forecasting,mortality,time series models,artificial neural network approach

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