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Development and use of prediction models for classification of cardiovascular risk of remote indigenous Australians

Citation

Tran-Duy, A and McDermott, R and Knight, J and Hua, X and Barr, ELM and Arabena, K and Palmer, AJ and Clarke, PM, Development and use of prediction models for classification of cardiovascular risk of remote indigenous Australians, Heart Lung and Circulation pp. 1-10. ISSN 1443-9506 (2019) [Refereed Article]


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Copyright Statement

Copyright 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) https://creativecommons.org/licenses/by-nc-nd/4.0/

DOI: doi:10.1016/j.hlc.2019.02.005

Abstract

Background: 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.

Methods: 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) χ2 statistic to assess the model discrimination and calibration, respectively.

Results: 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.

Conclusions: 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.

Item Details

Item Type:Refereed Article
Keywords:aboriginal, cardiovascular disease, coronary heart disease, prediction model, risk score, Torres Strait Islanders
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Indigenous Health
Objective Field:Aboriginal and Torres Strait Islander Health - Health System Performance (incl. Effectiveness of Interventions)
UTAS Author:Palmer, AJ (Professor Andrew Palmer)
ID Code:132298
Year Published:2019
Deposited By:Menzies Institute for Medical Research
Deposited On:2019-05-02
Last Modified:2019-06-06
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