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 journalArticleResearchpeer-review

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

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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",
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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 journalArticleResearchpeer-review

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

JO - Heart Lung and Circulation

JF - Heart Lung and Circulation

SN - 1444-2892

ER -