重新校准印度西部农村人口的非传染性疾病风险预测工具。
Recalibrating the Non-Communicable Diseases risk prediction tools for the rural population of Western India.
作者信息
Gupta Manoj Kumar, Raghav Pankaja, Tanvir Tooba, Gautam Vaishali, Mehto Amit, Choudhary Yachana, Mittal Ankit, Singh Gyanendra, Singh Garima, Baskaran Pritish, Rehana V R, Jabbar Shaima Abdul, Sridevi S, Goel Akhil Dhanesh, Bhardwaj Pankaj, Saurabh Suman, Srikanth S, Naveen K H, Prasanna T, Rustagi Neeti, Sharma Prem Prakash
机构信息
Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Veer Chandra Singh Garhwali Govt. Institute of Medical Science & Research, Srinagar, Uttarakhand, India.
出版信息
BMC Public Health. 2022 Feb 22;22(1):376. doi: 10.1186/s12889-022-12783-z.
BACKGROUND
The aim of the present study was to recalibrate the effectiveness of Indian Diabetes Risk Score (IDRS) and Community-Based Assessment Checklist (CBAC) by opportunistic screening of Diabetes Mellitus (DM) and Hypertension (HT) among the people attending health centres, and estimating the risk of fatal and non-fatal Cardio-Vascular Diseases (CVDs) among them using WHO/ISH charts.
METHODS
All the people aged ≥ 30 years attending the health centers were screened for DM and HT. Weight, height, waist circumference, and hip circumferences were measured, and BMI and Waist-Hip Ratio (WHR) were calculated. Risk categorization of all participants was done using IDRS, CBAC, and WHO/ISH risk prediction charts. Individuals diagnosed with DM or HT were started on treatment. The data was recorded using Epicollect5 and was analyzed using SPSS v.23 and MedCalc v.19.8. ROC curves were plotted for DM and HT with the IDRS, CBAC score, and anthropometric parameters. Sensitivity (SN), specificity (SP), Positive Predictive Value (PPV), Negative Predictive Value (NPV), Accuracy and Youden's index were calculated for different cut-offs of IDRS and CBAC scores.
RESULTS
A total of 942 participants were included for the screening, out of them, 9.2% (95% CI: 7.45-11.31) were diagnosed with DM for the first time. Hypertension was detected among 25.7% (95% CI: 22.9-28.5) of the participants. A total of 447 (47.3%) participants were found with IDRS score ≥ 60, and 276 (29.3%) with CBAC score > 4. As much as 26.1% were at moderate to higher risk (≥ 10%) of developing CVDs. Area Under the Curve (AUC) for IDRS in predicting DM was 0.64 (0.58-0.70), with 67.1% SN and 55.2% SP (Youden's Index 0.22). While the AUC for CBAC was 0.59 (0.53-0.65). For hypertension both the AUCs were 0.66 (0.62-0.71) and 0.63 (0.59-0.67), respectively.
CONCLUSIONS
IDRS was found to have the maximum AUC and sensitivity thereby demonstrating its usefulness as compared to other tools for screening of both diabetes and hypertension. It thus has the potential to expose the hidden NCD iceberg. Hence, we propose IDRS as a useful tool in screening of Diabetes and Hypertension in rural India.
背景
本研究的目的是通过对前往健康中心的人群进行糖尿病（DM）和高血压（HT）的机会性筛查，重新校准印度糖尿病风险评分（IDRS）和基于社区的评估清单（CBAC）的有效性，并使用世界卫生组织/国际高血压学会（WHO/ISH）图表评估其中致命和非致命心血管疾病（CVD）的风险。
方法
对所有年龄≥30岁前往健康中心的人群进行DM和HT筛查。测量体重、身高、腰围和臀围，并计算体重指数（BMI）和腰臀比（WHR）。使用IDRS、CBAC和WHO/ISH风险预测图表对所有参与者进行风险分类。被诊断为DM或HT的个体开始接受治疗。数据使用Epicollect5记录，并使用SPSS v.23和MedCalc v.19.8进行分析。绘制DM和HT与IDRS、CBAC评分及人体测量参数的ROC曲线。针对IDRS和CBAC评分的不同临界值计算敏感性（SN）、特异性（SP）、阳性预测值（PPV）、阴性预测值（NPV）、准确性和尤登指数。
结果
总共942名参与者纳入筛查，其中9.2%（95%CI：7.45 - 11.31）首次被诊断为DM。25.7%（95%CI：22.9 - 28.5）的参与者检测出患有HT。总共447名（47.3%）参与者的IDRS评分≥60，276名（29.3%）参与者的CBAC评分>4。高达26.1%的人发生CVD的风险为中度至高度（≥10%）。IDRS预测DM的曲线下面积（AUC）为0.64（0.58 - 0.70），SN为67.1%，SP为55.2%（尤登指数0.22）。而CBAC的AUC为0.59（0.53 - 0.65）。对于高血压，两个AUC分别为0.66（0.62 - 0.71）和0.63（0.59 - 0.67）。
结论
发现IDRS具有最大的AUC和敏感性，因此与其他用于筛查糖尿病和高血压的工具相比，证明了其有用性。因此，它有可能揭示隐藏的非传染性疾病冰山。因此，我们建议将IDRS作为印度农村地区筛查糖尿病和高血压的有用工具。
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