Tack Reinier W P, Senff Jasper R, Kimball Tamara N, Prapiadou Savvina, Tan Benjamin Y Q, Yechoor Nirupama, Rosand Jonathan, Singh Sanjula D, Anderson Christopher D
McCance Center for Brain Health Massachusetts General Hospital Boston MA USA.
Department of Neurology Massachusetts General Hospital Boston MA USA.
J Am Heart Assoc. 2025 Apr;14(7):e038730. doi: 10.1161/JAHA.124.038730. Epub 2025 Mar 21.
Stroke and dementia are leading causes of mortality and can be prevented through risk factor management. Risk factor assessment requires laboratory or physical measurements. We aimed to determine whether self-reported risk factors serve as reliable proxies and predict stroke- and dementia-related mortality.
We used cross-sectional data from the NHANES (National Health and Nutrition Examination Survey) from 1999 to 2018 linked to National Death Index records. We included participants with available data on self-reported and measured hypertension, hypercholesterolemia, diabetes, kidney disease, hearing impairment and overweight. Reliability was assessed using F1 scores, and used survey-weighted Cox-proportional hazards models evaluated associations with stroke- or dementia-related mortality. Reliability of self-reported risk factors was highest in overweight (F1 score 0.81, sensitivity 76%, specificity 77%) and diabetes (F1 score 0.71, sensitivity 77%, specificity 97%) and lowest for kidney disease (F1 score 0.25, sensitivity 16%, specificity 98%). Self-reported hypertension (hazard ratio [HR], 1.49 [95% CI, 1.14-1.94]) and diabetes (HR, 1.58 [95% CI, 1.18-2.12]) were associated with stroke-related mortality, comparable to measured risk factors. For dementia-related mortality, only measured hearing impairment (all dementia cases had hearing impairment at baseline) and both self-reported (HR, 0.50 [95% CI, 0.37-0.68]) and measured overweight (HR, 0.70 [95% CI, 0.52-0.93]) were associated.
In conclusion, the reliability and validity of self-reported risk factors for stroke and dementia differ between risk factors. Although self-reported measures vary in their reliability, they perform equally as well as objective metrics for evaluating the risk of stroke- and dementia-related mortality.
中风和痴呆是主要的死亡原因，可通过危险因素管理加以预防。危险因素评估需要进行实验室检查或体格测量。我们旨在确定自我报告的危险因素是否可作为可靠的替代指标，并预测与中风和痴呆相关的死亡率。
我们使用了1999年至2018年美国国家健康与营养检查调查（NHANES）的横断面数据，并将其与国家死亡指数记录相链接。我们纳入了具有自我报告和测量的高血压、高胆固醇血症、糖尿病、肾病、听力障碍和超重等可用数据的参与者。使用F1分数评估可靠性，并使用调查加权的Cox比例风险模型评估与中风或痴呆相关死亡率的关联。自我报告的危险因素在超重（F1分数0.81，敏感性76%，特异性77%）和糖尿病（F1分数0.71，敏感性77%，特异性97%）方面可靠性最高，而在肾病方面可靠性最低（F1分数0.25，敏感性16%，特异性98%）。自我报告的高血压（风险比[HR]，1.49[95%置信区间，1.14 - 1.94]）和糖尿病（HR，1.58[95%置信区间，1.18 - 2.12]）与中风相关死亡率相关，与测量的危险因素相当。对于与痴呆相关的死亡率，仅测量的听力障碍（所有痴呆病例在基线时均有听力障碍）以及自我报告的（HR，0.50[95%置信区间，0.37 - 0.68]）和测量的超重（HR，0.70[95%置信区间，0.52 - 0.93]）与之相关。
总之，中风和痴呆自我报告危险因素的可靠性和有效性因危险因素而异。尽管自我报告的测量方法可靠性各不相同，但在评估中风和痴呆相关死亡率风险方面，它们与客观指标的表现相当。
