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Development of an Australian cardiovascular disease mortality risk score using multiple imputation and recalibration from national statistics

Backholer, Kathryn, Hirakawa, Yoichiro, Tonkin, Andrew, Giles, Graham, Magliano, Dianna J, Colagiuri, Stephen, Harris, Mark, Mitchell, Paul, Nelson, Mark, Shaw, Jonathan E, Simmons, David, Simons, Leon, Taylor, Anne, Harding, Jessica, Gopinath, Bamini and Woodward, Mark 2017, Development of an Australian cardiovascular disease mortality risk score using multiple imputation and recalibration from national statistics, BMC cardiovasular disorders, vol. 17, pp. 1-9, doi: 10.1186/s12872-016-0462-5.

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Title Development of an Australian cardiovascular disease mortality risk score using multiple imputation and recalibration from national statistics
Author(s) Backholer, Kathryn
Hirakawa, Yoichiro
Tonkin, Andrew
Giles, Graham
Magliano, Dianna J
Colagiuri, Stephen
Harris, Mark
Mitchell, Paul
Nelson, Mark
Shaw, Jonathan E
Simmons, David
Simons, Leon
Taylor, Anne
Harding, Jessica
Gopinath, Bamini
Woodward, Mark
Journal name BMC cardiovasular disorders
Volume number 17
Article ID 17
Start page 1
End page 9
Total pages 9
Publisher BioMed Central
Place of publication London, Eng.
Publication date 2017
ISSN 1471-2261
Keyword(s) Cardiovascular disease
Imputation
Recalibration
Risk assessment
Adult
Age Factors
Aged
Cardiovascular Diseases
Female
Follow-Up Studies
Forecasting
Health Status Indicators
Health Surveys
Humans
Male
Middle Aged
New South Wales
Proportional Hazards Models
Risk Factors
Survival Rate
Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Summary Objective
To develop and recalibrate an Australian 5-year cardiovascular disease (CVD) mortality risk score to produce contemporary predictions of risk.

Methods
Data were pooled from six Australian cohort studies (n = 54,829), with baseline data collected between 1989 and 2003. Participants included were aged 40–74 years and free of CVD at baseline. Variables were harmonised across studies and missing data were imputed using multiple imputation. Cox proportional hazards models were used to estimate the risk of CVD mortality associated with factors mutually independently predictive (p < 0.05) and a 5-year risk prediction algorithm was constructed. This algorithm was recalibrated to reflect contemporary national levels of CVD mortality and risk factors using national statistics.

Results
Over a mean 16.6 years follow-up, 1375 participants in the six studies died from CVD. The prediction model included age, sex, smoking, diabetes, systolic blood pressure, total and high-density lipoprotein cholesterol (HDLC), a social deprivation score, estimated glomerular filtration rate and its square and interactions of sex with diabetes, HDLC and deprivation score, and of age with systolic blood pressure and smoking. This model discriminated well when applied to a Scottish study population (c-statistic (95% confidence interval): 0.751 (0.709, 0.793)). Recalibration generally increased estimated risks, but well below those predicted by the European SCORE models.

Conclusions
The resulting risk score, which includes markers of both chronic kidney disease and socioeconomic deprivation, is the first CVD mortality risk prediction tool for Australia to be derived using Australian data. The primary model, and the method of recalibration, is applicable elsewhere.
Language eng
DOI 10.1186/s12872-016-0462-5
Field of Research 110299 Cardiorespiratory Medicine and Haematology not elsewhere classified
1102 Cardiovascular Medicine And Haematology
Socio Economic Objective 920103 Cardiovascular System and Diseases
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2017, The Authors
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30092732

Document type: Journal Article
Collections: Faculty of Health
Population Health
Open Access Collection
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.