Hippisley-Cox Julia, Coupland Carol, Robson John, Sheikh Aziz, Brindle Peter
Division of Primary Care, Tower Building, University Park, Nottingham NG2 7RD.
BMJ. 2009 Mar 17;338:b880. doi: 10.1136/bmj.b880.
To develop and validate a new diabetes risk algorithm (the QDScore) for estimating 10 year risk of acquiring diagnosed type 2 diabetes over a 10 year time period in an ethnically and socioeconomically diverse population.
Prospective open cohort study using routinely collected data from 355 general practices in England and Wales to develop the score and from 176 separate practices to validate the score.
2 540 753 patients aged 25-79 in the derivation cohort, who contributed 16 436 135 person years of observation and of whom 78 081 had an incident diagnosis of type 2 diabetes; 1 232 832 patients (7 643 037 person years) in the validation cohort, with 37 535 incident cases of type 2 diabetes.
A Cox proportional hazards model was used to estimate effects of risk factors in the derivation cohort and to derive a risk equation in men and women. The predictive variables examined and included in the final model were self assigned ethnicity, age, sex, body mass index, smoking status, family history of diabetes, Townsend deprivation score, treated hypertension, cardiovascular disease, and current use of corticosteroids; the outcome of interest was incident diabetes recorded in general practice records. Measures of calibration and discrimination were calculated in the validation cohort.
A fourfold to fivefold variation in risk of type 2 diabetes existed between different ethnic groups. Compared with the white reference group, the adjusted hazard ratio was 4.07 (95% confidence interval 3.24 to 5.11) for Bangladeshi women, 4.53 (3.67 to 5.59) for Bangladeshi men, 2.15 (1.84 to 2.52) for Pakistani women, and 2.54 (2.20 to 2.93) for Pakistani men. Pakistani and Bangladeshi men had significantly higher hazard ratios than Indian men. Black African men and Chinese women had an increased risk compared with the corresponding white reference group. In the validation dataset, the model explained 51.53% (95% confidence interval 50.90 to 52.16) of the variation in women and 48.16% (47.52 to 48.80) of that in men. The risk score showed good discrimination, with a D statistic of 2.11 (95% confidence interval 2.08 to 2.14) in women and 1.97 (1.95 to 2.00) in men. The model was well calibrated.
The QDScore is the first risk prediction algorithm to estimate the 10 year risk of diabetes on the basis of a prospective cohort study and including both social deprivation and ethnicity. The algorithm does not need laboratory tests and can be used in clinical settings and also by the public through a simple web calculator (www.qdscore.org).
开发并验证一种新的糖尿病风险算法（QDScore），用于估计在10年时间内，不同种族和社会经济背景人群患2型糖尿病的10年风险。
前瞻性开放队列研究，利用从英格兰和威尔士355家全科诊所常规收集的数据来开发该评分，并从176家独立诊所收集数据以验证该评分。
推导队列中有2540753名年龄在25 - 79岁的患者，他们提供了16436135人年的观察数据，其中78081人被确诊为2型糖尿病；验证队列中有1232832名患者（7643037人年），有37535例2型糖尿病新发病例。
采用Cox比例风险模型估计推导队列中危险因素的作用，并得出男性和女性的风险方程。最终模型中所检验并纳入的预测变量包括自我认定的种族、年龄、性别、体重指数、吸烟状况、糖尿病家族史、汤森德贫困评分、高血压治疗情况、心血管疾病以及当前使用皮质类固醇情况；感兴趣的结局是全科医疗记录中记录的糖尿病新发病例。在验证队列中计算校准和鉴别指标。
不同种族之间2型糖尿病风险存在4至5倍的差异。与白人参照组相比，孟加拉女性的调整后风险比为4.07（95%置信区间3.24至5.11），孟加拉男性为4.53（3.67至5.59），巴基斯坦女性为2.15（1.84至2.52），巴基斯坦男性为2.54（2.20至2.93）。巴基斯坦和孟加拉男性的风险比显著高于印度男性。与相应的白人参照组相比，非洲黑人男性和中国女性的风险增加。在验证数据集中，该模型解释了女性中51.53%（95%置信区间50.90至52.16）的变异以及男性中48.16%（47.52至48.80）的变异。风险评分显示出良好的鉴别能力，女性的D统计量为2.11（95%置信区间2.08至2.14），男性为1.97（1.95至2.00）。该模型校准良好。
QDScore是首个基于前瞻性队列研究、纳入社会剥夺和种族因素来估计糖尿病10年风险的风险预测算法。该算法无需实验室检测，可用于临床环境，也可供公众通过一个简单的网络计算器（www.qdscore.org）使用。
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