Framingham和SCORE风险评估对冠心病风险的预测因社会经济地位而异:一项针对英国男性的研究结果。

Sheena E Ramsay, Richard W Morris, Peter H Whincup, A Olia Papacosta, Mary C Thomas, S Goya Wannamethee
{"title":"Framingham和SCORE风险评估对冠心病风险的预测因社会经济地位而异:一项针对英国男性的研究结果。","authors":"Sheena E Ramsay,&nbsp;Richard W Morris,&nbsp;Peter H Whincup,&nbsp;A Olia Papacosta,&nbsp;Mary C Thomas,&nbsp;S Goya Wannamethee","doi":"10.1177/1741826710389394","DOIUrl":null,"url":null,"abstract":"<p><strong>Aim: </strong>Evidence is limited on performance of the Framingham risk score (FRS) in different socioeconomic groups; similar limitations apply to the Systematic Coronary Risk Evaluation (SCORE). We examined the performance of coronary risk prediction systems in different socioeconomic groups in British men.</p><p><strong>Methods and results: </strong>In a socially and geographically representative cohort of British men aged 40-59 between 1978 and 1980, predicted 10-year coronary heart disease (CHD) (fatal and non-fatal) risk was calculated using FRS, and CHD mortality using SCORE. Prevalent cardiovascular disease cases were excluded. Occupational social class ranged from I (professionals) to V (unskilled workers), and was summarized as non-manual (I, II, III non-manual) and manual (III manual, IV, V). Both FRS and SCORE over-estimated 10-year CHD risk; over-prediction by both was particularly marked in high social classes. With FRS, predicted/observed risk fell progressively from 2.30 in social class I to 1.19 in social class V. Sensitivity of FRS at a ≥20% threshold (27% of men) fell from 53% to 37% from social class I to V; specificity varied similarly. With SCORE, predicted/observed CHD mortality fell from 1.53 to 1.26 from social class I to V; sensitivity at a ≥5% threshold (29% of men) fell between non-manual (61%) and manual (57%) groups, as did specificity. However, including social class in FRS barely improved risk prediction (net reclassification improvement = 0.18%).</p><p><strong>Conclusions: </strong>Framingham and SCORE predictions varied between socioeconomic groups and are more likely to identify those at greater CHD risk in higher socioeconomic groups. To ensure equitable primary prevention, strategies to adequately estimate risk in lower socioeconomic groups (at increased CHD risk) should be developed.</p>","PeriodicalId":50492,"journal":{"name":"European Journal of Cardiovascular Prevention & Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1741826710389394","citationCount":"37","resultStr":"{\"title\":\"Prediction of coronary heart disease risk by Framingham and SCORE risk assessments varies by socioeconomic position: results from a study in British men.\",\"authors\":\"Sheena E Ramsay,&nbsp;Richard W Morris,&nbsp;Peter H Whincup,&nbsp;A Olia Papacosta,&nbsp;Mary C Thomas,&nbsp;S Goya Wannamethee\",\"doi\":\"10.1177/1741826710389394\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aim: </strong>Evidence is limited on performance of the Framingham risk score (FRS) in different socioeconomic groups; similar limitations apply to the Systematic Coronary Risk Evaluation (SCORE). We examined the performance of coronary risk prediction systems in different socioeconomic groups in British men.</p><p><strong>Methods and results: </strong>In a socially and geographically representative cohort of British men aged 40-59 between 1978 and 1980, predicted 10-year coronary heart disease (CHD) (fatal and non-fatal) risk was calculated using FRS, and CHD mortality using SCORE. Prevalent cardiovascular disease cases were excluded. Occupational social class ranged from I (professionals) to V (unskilled workers), and was summarized as non-manual (I, II, III non-manual) and manual (III manual, IV, V). Both FRS and SCORE over-estimated 10-year CHD risk; over-prediction by both was particularly marked in high social classes. With FRS, predicted/observed risk fell progressively from 2.30 in social class I to 1.19 in social class V. Sensitivity of FRS at a ≥20% threshold (27% of men) fell from 53% to 37% from social class I to V; specificity varied similarly. With SCORE, predicted/observed CHD mortality fell from 1.53 to 1.26 from social class I to V; sensitivity at a ≥5% threshold (29% of men) fell between non-manual (61%) and manual (57%) groups, as did specificity. However, including social class in FRS barely improved risk prediction (net reclassification improvement = 0.18%).</p><p><strong>Conclusions: </strong>Framingham and SCORE predictions varied between socioeconomic groups and are more likely to identify those at greater CHD risk in higher socioeconomic groups. To ensure equitable primary prevention, strategies to adequately estimate risk in lower socioeconomic groups (at increased CHD risk) should be developed.</p>\",\"PeriodicalId\":50492,\"journal\":{\"name\":\"European Journal of Cardiovascular Prevention & Rehabilitation\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2011-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1177/1741826710389394\",\"citationCount\":\"37\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Journal of Cardiovascular Prevention & Rehabilitation\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/1741826710389394\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2011/1/28 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Cardiovascular Prevention & Rehabilitation","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/1741826710389394","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2011/1/28 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 37

摘要

目的:关于弗雷明汉风险评分(FRS)在不同社会经济群体中的表现的证据有限;类似的限制也适用于系统性冠状动脉风险评估(SCORE)。我们检查了冠状动脉风险预测系统在英国不同社会经济群体中的表现。方法和结果:在1978年至1980年间具有社会和地理代表性的40-59岁英国男性队列中,使用FRS计算预测10年冠心病(致命和非致命)风险,使用SCORE计算冠心病死亡率。排除流行心血管疾病病例。职业社会等级从I(专业人员)到V(非技术工人),归纳为非体力劳动(I、II、III非体力劳动)和体力劳动(III体力劳动、IV、V)。FRS和SCORE均高估了10年冠心病风险;两者的过度预测在上流社会尤为明显。对于FRS,预测/观察到的风险从社会阶层I的2.30逐渐下降到社会阶层V的1.19。在≥20%阈值时FRS的敏感性(27%的男性)从社会阶层I下降到社会阶层V的53%下降到37%;特异性也有类似的变化。使用SCORE,从社会I级到V级,预测/观察到的冠心病死亡率从1.53降至1.26;≥5%阈值的敏感性(29%的男性)在非手动组(61%)和手动组(57%)之间下降,特异性也是如此。然而,在FRS中纳入社会阶层几乎没有改善风险预测(净重分类改善= 0.18%)。结论:Framingham和SCORE的预测在不同的社会经济群体之间存在差异,在较高的社会经济群体中更有可能识别出冠心病风险更高的人群。为确保初级预防的公平性,应制定战略,充分评估社会经济地位较低群体(冠心病风险较高)的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prediction of coronary heart disease risk by Framingham and SCORE risk assessments varies by socioeconomic position: results from a study in British men.

Aim: Evidence is limited on performance of the Framingham risk score (FRS) in different socioeconomic groups; similar limitations apply to the Systematic Coronary Risk Evaluation (SCORE). We examined the performance of coronary risk prediction systems in different socioeconomic groups in British men.

Methods and results: In a socially and geographically representative cohort of British men aged 40-59 between 1978 and 1980, predicted 10-year coronary heart disease (CHD) (fatal and non-fatal) risk was calculated using FRS, and CHD mortality using SCORE. Prevalent cardiovascular disease cases were excluded. Occupational social class ranged from I (professionals) to V (unskilled workers), and was summarized as non-manual (I, II, III non-manual) and manual (III manual, IV, V). Both FRS and SCORE over-estimated 10-year CHD risk; over-prediction by both was particularly marked in high social classes. With FRS, predicted/observed risk fell progressively from 2.30 in social class I to 1.19 in social class V. Sensitivity of FRS at a ≥20% threshold (27% of men) fell from 53% to 37% from social class I to V; specificity varied similarly. With SCORE, predicted/observed CHD mortality fell from 1.53 to 1.26 from social class I to V; sensitivity at a ≥5% threshold (29% of men) fell between non-manual (61%) and manual (57%) groups, as did specificity. However, including social class in FRS barely improved risk prediction (net reclassification improvement = 0.18%).

Conclusions: Framingham and SCORE predictions varied between socioeconomic groups and are more likely to identify those at greater CHD risk in higher socioeconomic groups. To ensure equitable primary prevention, strategies to adequately estimate risk in lower socioeconomic groups (at increased CHD risk) should be developed.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信