Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Vic, Australia.
Centre for Chronic Disease Prevention, James Cook University, Cairns, Qld, Australia; School of Health Sciences, University of South Australia, Adelaide, SA, Australia.
Heart Lung Circ. 2020 Mar;29(3):374-383. doi: 10.1016/j.hlc.2019.02.005. Epub 2019 Feb 22.
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.
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 statistic to assess the model discrimination and calibration, respectively.
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.
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.
心血管疾病（CVD）是导致澳大利亚原住民死亡的主要原因。人们普遍认为，目前的工具在评估这一高危人群的 CVD 风险方面存在缺陷。我们试图开发一种 5 年 CVD 风险评分，使用广泛的已知风险因素，以进一步提高该人群的 CVD 风险预测。
我们使用了参加“健康人健康检查”（WPHC）的 30 至 74 岁无 CVD 病史的原住民的临床和人口统计学信息，这是一项基于社区的调查。基线评估于 1998 年至 2000 年进行，数据与行政住院和死亡记录相关联，以确定 CVD 事件。我们使用 Cox 比例风险模型来估计 5 年 CVD 风险，并用 Harrell 的 c 统计量和改良的 Hosmer-Lemeshow（mH-L）χ 统计量分别评估模型的区分度和校准度。
研究样本包括 1583 人（48.1%为男性；平均年龄 45.0 岁）。风险评分包括性别、年龄、收缩压、糖尿病、腰围、甘油三酯和白蛋白肌酐比。校正偏倚后的 c 统计量为 0.72，校正偏倚后的 mH-L χ2统计量为 12.01（p 值为 0.212），分别表示良好的区分度和校准度。与重新校准的 Framingham 风险评分相比，使用我们的风险评分可以更精确地对澳大利亚原住民的 CVD 风险进行分层。
一个七因素风险评分可以满意地对澳大利亚原住民的 CVD 5 年风险进行分层。这些发现为针对澳大利亚原住民 CVD 风险的未来研究提供了信息。
