Development and Use of Prediction Models for Classification of Cardiovascular Risk of Remote Indigenous Australians

An Tran-Duy, Robyn McDermott, Josh Knight, Xinyang Hua, Elizabeth L.M. Barr, Kerry Arabena, Andrew Palmer, Philip M. Clarke

    Research output: Contribution to journalArticle

    Abstract

    Background: Cardiovascular disease (CVD) is the leading cause of death for Indigenous Australians. There is widespread belief that current tools have deficiencies for assessing CVD risk in this high-risk population. We sought to develop a 5-year CVD risk score using a wide range of known risk factors to further improve CVD risk prediction in this population.

    Methods: We used clinical and demographic information on Indigenous people aged between 30 and 74 years without a history of CVD events who participated in the Well Person's Health Check (WPHC), a community-based survey. Baseline assessments were conducted between 1998 and 2000, and data were linked to administrative hospitalisation and death records for identification of CVD events. We used Cox proportional hazard models to estimate the 5-year CVD risk, and the Harrell's c-statistic and the modified Hosmer-Lemeshow (mH-L) χ 2 statistic to assess the model discrimination and calibration, respectively.

    Results: The study sample consisted of 1,583 individuals (48.1% male; mean age 45.0 year). The risk score consisted of sex, age, systolic blood pressure, diabetes mellitus, waist circumference, triglycerides, and albumin creatinine ratio. The bias-corrected c-statistic was 0.72 and the bias-corrected mH-L χ2 statistic was 12.01 (p-value, 0.212), indicating good discrimination and calibration, respectively. Using our risk score, the CVD risk of the Indigenous Australians could be stratified to a greater degree compared to a recalibrated Framingham risk score.

    Conclusions: A seven-factor risk score could satisfactorily stratify 5-year risk of CVD in an Indigenous Australian cohort. These findings inform future research targeting CVD risk in Indigenous Australians.

    Original languageEnglish
    JournalHeart Lung and Circulation
    DOIs
    Publication statusE-pub ahead of print - 22 Feb 2019

    Fingerprint

    Cardiovascular Models
    Cardiovascular Diseases
    Calibration
    Blood Pressure
    Death Certificates
    Waist Circumference
    Proportional Hazards Models
    Population
    Cause of Death
    Albumins

    Cite this

    Tran-Duy, An ; McDermott, Robyn ; Knight, Josh ; Hua, Xinyang ; Barr, Elizabeth L.M. ; Arabena, Kerry ; Palmer, Andrew ; Clarke, Philip M. / Development and Use of Prediction Models for Classification of Cardiovascular Risk of Remote Indigenous Australians. In: Heart Lung and Circulation. 2019.
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    title = "Development and Use of Prediction Models for Classification of Cardiovascular Risk of Remote Indigenous Australians",
    abstract = "Background: Cardiovascular disease (CVD) is the leading cause of death for Indigenous Australians. There is widespread belief that current tools have deficiencies for assessing CVD risk in this high-risk population. We sought to develop a 5-year CVD risk score using a wide range of known risk factors to further improve CVD risk prediction in this population. Methods: We used clinical and demographic information on Indigenous people aged between 30 and 74 years without a history of CVD events who participated in the Well Person's Health Check (WPHC), a community-based survey. Baseline assessments were conducted between 1998 and 2000, and data were linked to administrative hospitalisation and death records for identification of CVD events. We used Cox proportional hazard models to estimate the 5-year CVD risk, and the Harrell's c-statistic and the modified Hosmer-Lemeshow (mH-L) χ 2 statistic to assess the model discrimination and calibration, respectively. Results: The study sample consisted of 1,583 individuals (48.1{\%} male; mean age 45.0 year). The risk score consisted of sex, age, systolic blood pressure, diabetes mellitus, waist circumference, triglycerides, and albumin creatinine ratio. The bias-corrected c-statistic was 0.72 and the bias-corrected mH-L χ2 statistic was 12.01 (p-value, 0.212), indicating good discrimination and calibration, respectively. Using our risk score, the CVD risk of the Indigenous Australians could be stratified to a greater degree compared to a recalibrated Framingham risk score. Conclusions: A seven-factor risk score could satisfactorily stratify 5-year risk of CVD in an Indigenous Australian cohort. These findings inform future research targeting CVD risk in Indigenous Australians.",
    keywords = "Aboriginal, Cardiovascular disease, Coronary heart disease, Prediction model, Risk score, Torres Strait Islanders",
    author = "An Tran-Duy and Robyn McDermott and Josh Knight and Xinyang Hua and Barr, {Elizabeth L.M.} and Kerry Arabena and Andrew Palmer and Clarke, {Philip M.}",
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    Development and Use of Prediction Models for Classification of Cardiovascular Risk of Remote Indigenous Australians. / Tran-Duy, An; McDermott, Robyn; Knight, Josh; Hua, Xinyang; Barr, Elizabeth L.M.; Arabena, Kerry; Palmer, Andrew; Clarke, Philip M.

    In: Heart Lung and Circulation, 22.02.2019.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Development and Use of Prediction Models for Classification of Cardiovascular Risk of Remote Indigenous Australians

    AU - Tran-Duy, An

    AU - McDermott, Robyn

    AU - Knight, Josh

    AU - Hua, Xinyang

    AU - Barr, Elizabeth L.M.

    AU - Arabena, Kerry

    AU - Palmer, Andrew

    AU - Clarke, Philip M.

    PY - 2019/2/22

    Y1 - 2019/2/22

    N2 - Background: Cardiovascular disease (CVD) is the leading cause of death for Indigenous Australians. There is widespread belief that current tools have deficiencies for assessing CVD risk in this high-risk population. We sought to develop a 5-year CVD risk score using a wide range of known risk factors to further improve CVD risk prediction in this population. Methods: We used clinical and demographic information on Indigenous people aged between 30 and 74 years without a history of CVD events who participated in the Well Person's Health Check (WPHC), a community-based survey. Baseline assessments were conducted between 1998 and 2000, and data were linked to administrative hospitalisation and death records for identification of CVD events. We used Cox proportional hazard models to estimate the 5-year CVD risk, and the Harrell's c-statistic and the modified Hosmer-Lemeshow (mH-L) χ 2 statistic to assess the model discrimination and calibration, respectively. Results: The study sample consisted of 1,583 individuals (48.1% male; mean age 45.0 year). The risk score consisted of sex, age, systolic blood pressure, diabetes mellitus, waist circumference, triglycerides, and albumin creatinine ratio. The bias-corrected c-statistic was 0.72 and the bias-corrected mH-L χ2 statistic was 12.01 (p-value, 0.212), indicating good discrimination and calibration, respectively. Using our risk score, the CVD risk of the Indigenous Australians could be stratified to a greater degree compared to a recalibrated Framingham risk score. Conclusions: A seven-factor risk score could satisfactorily stratify 5-year risk of CVD in an Indigenous Australian cohort. These findings inform future research targeting CVD risk in Indigenous Australians.

    AB - Background: Cardiovascular disease (CVD) is the leading cause of death for Indigenous Australians. There is widespread belief that current tools have deficiencies for assessing CVD risk in this high-risk population. We sought to develop a 5-year CVD risk score using a wide range of known risk factors to further improve CVD risk prediction in this population. Methods: We used clinical and demographic information on Indigenous people aged between 30 and 74 years without a history of CVD events who participated in the Well Person's Health Check (WPHC), a community-based survey. Baseline assessments were conducted between 1998 and 2000, and data were linked to administrative hospitalisation and death records for identification of CVD events. We used Cox proportional hazard models to estimate the 5-year CVD risk, and the Harrell's c-statistic and the modified Hosmer-Lemeshow (mH-L) χ 2 statistic to assess the model discrimination and calibration, respectively. Results: The study sample consisted of 1,583 individuals (48.1% male; mean age 45.0 year). The risk score consisted of sex, age, systolic blood pressure, diabetes mellitus, waist circumference, triglycerides, and albumin creatinine ratio. The bias-corrected c-statistic was 0.72 and the bias-corrected mH-L χ2 statistic was 12.01 (p-value, 0.212), indicating good discrimination and calibration, respectively. Using our risk score, the CVD risk of the Indigenous Australians could be stratified to a greater degree compared to a recalibrated Framingham risk score. Conclusions: A seven-factor risk score could satisfactorily stratify 5-year risk of CVD in an Indigenous Australian cohort. These findings inform future research targeting CVD risk in Indigenous Australians.

    KW - Aboriginal

    KW - Cardiovascular disease

    KW - Coronary heart disease

    KW - Prediction model

    KW - Risk score

    KW - Torres Strait Islanders

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    U2 - 10.1016/j.hlc.2019.02.005

    DO - 10.1016/j.hlc.2019.02.005

    M3 - Article

    C2 - 30853523

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    JO - Heart Lung and Circulation

    JF - Heart Lung and Circulation

    SN - 1444-2892

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