Public Health Ontario, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Public Health Ontario, Toronto, Ontario, Canada.
Prev Med. 2014 Jan;58:17-21. doi: 10.1016/j.ypmed.2013.10.007. Epub 2013 Oct 23.
To quantify the influence of type 2 diabetes risk distribution on prevention benefit and apply a method to optimally identify population targets.
We used data from the 2011 Canadian Community Health Survey (N=45,040) and the validated Diabetes Population Risk Tool to calculate 10-year diabetes risk. We calculated the Gini coefficient as a measure of risk dispersion. Intervention benefit was estimated using absolute risk reduction (ARR), number-needed-to-treat (NNT), and number of cases prevented.
There is a wide variation of diabetes risk in Canada (Gini=0.48) and with an inverse relation to risk (r=-0.99). Risk dispersion is lower among individuals meeting an empirically derived risk cut-off (Gini=0.18). Targeting prevention based on a risk cut-off (10-year risk ≥ 16.5%) resulted in a greater number of cases prevented (340 thousand), higher ARR (7.7%) and lower NNT (13) compared to targeting individuals based on risk factor targets.
This study provides empirical evidence to demonstrate that risk variability is an important consideration for estimating the prevention benefit. Prioritizing target populations using an empirically derived cut-off based on a multivariate risk score will result in greater benefit and efficiency compared to risk factor targets.
量化 2 型糖尿病风险分布对预防效果的影响，并采用一种方法来最优地确定目标人群。
我们使用了 2011 年加拿大社区健康调查的数据（N=45040）和经过验证的糖尿病人群风险工具来计算 10 年糖尿病风险。我们使用基尼系数作为风险分散的衡量标准。干预效果使用绝对风险降低（ARR）、需要治疗的人数（NNT）和预防的病例数来估计。
加拿大的糖尿病风险存在很大差异（基尼系数=0.48），并且与风险呈反比（r=-0.99）。在符合经验衍生风险临界值的个体中，风险分散度较低（基尼系数=0.18）。基于风险临界值（10 年风险≥16.5%）进行预防目标定位，可预防的病例数更多（34 万），ARR 更高（7.7%），NNT 更低（13），与基于危险因素目标定位相比。
本研究提供了实证证据，证明风险变异性是估计预防效果的一个重要考虑因素。与危险因素目标相比，使用基于多变量风险评分的经验衍生临界值对目标人群进行优先排序，将带来更大的效益和效率。
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