Development and use of prediction models for classification of cardiovascular risk of remote Indigenous Australians

Tran-Duy, An, McDermott, Robyn, Knight, Josh, Xinyang, Hua, Barr, Elizabeth L.M., Arabena, Kerry, Palmer, Andrew, and Clarke, Philip M. (2020) Development and use of prediction models for classification of cardiovascular risk of remote Indigenous Australians. Heart, Lung and Circulation, 29 (3). pp. 374-383.

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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) χ2 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.

Item ID: 58887
Item Type: Article (Research - C1)
ISSN: 1444-2892
Keywords: Aboriginal, Torres Strait Islanders, Prediction model, Risk score, Cardiovascular disease, Coronary heart disease
Copyright Information: © 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license.
Funders: National Health and Medical Research Council of Australia (NHMRC)
Projects and Grants: NHMRC project number 1107140
Date Deposited: 10 Jul 2019 04:23
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3201 Cardiovascular medicine and haematology > 320101 Cardiology (incl. cardiovascular diseases) @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920103 Cardiovascular System and Diseases @ 100%
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