Addition of Social Determinants of Health to Coronary Heart Disease Risk Prediction: The Multi-Ethnic Study of Atherosclerosis

被引:1
作者
Murphy, Brittany Saldivar [1 ]
Nam, Yunbi [2 ]
McClelland, Robyn L. [2 ]
Acquah, Isaac [3 ]
Cainzos-Achirica, Miguel [4 ]
Nasir, Khurram [5 ]
Post, Wendy S. [6 ]
Aldrich, Melinda C. [1 ]
DeFilippis, Andrew P. [7 ]
机构
[1] Vanderbilt Univ, Med Ctr, Dept Med, Nashville, TN USA
[2] Univ Washington, Dept Biostat, Seattle, WA USA
[3] MedStar Union Mem Hosp, Dept Med, Baltimore, MD USA
[4] IMIM, Dept Cardiol, Parc Salut Mar, Barcelona, Spain
[5] Houston Methodist DeBakey Heart & Vasc Ctr, Dept Cardiol, Div Cardiovasc Prevent & Wellness, Houston, TX USA
[6] Johns Hopkins Univ, Dept Med, Div Cardiol, Baltimore, MD USA
[7] Vanderbilt Univ, Med Ctr, Div Cardiovasc Med, 1215 21st Ave S,MCE 5th Floor North Tower, Nashville, TN 37250 USA
来源
JOURNAL OF THE AMERICAN HEART ASSOCIATION | 2024年 / 13卷 / 14期
关键词
coronary disease; risk; social determinants; POOLED COHORT EQUATIONS; CARDIOVASCULAR-DISEASE; SOCIOECONOMIC-STATUS; ETHNIC-DIFFERENCES; ARTERY CALCIUM; VALIDATION; IMPACT; SCORE;
D O I
10.1161/JAHA.123.033651
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND Social determinants of health (SDoH) are associated with cardiovascular risk factors and outcomes; however, they are absent from risk prediction models. We aimed to assess if the addition of SDoH improves the predictive ability of the MESA (Multi-Ethnic Study of Atherosclerosis) Risk Score. METHOD AND RESULTS This was a community-based prospective population cohort study that enrolled 6286 men and women, ages 45-84 years, who were free of clinical coronary heart disease (CHD) at baseline. Data from 10-year follow-up were examined for CHD events, defined as myocardial infarction, fatal CHD, resuscitated cardiac arrest, and revascularization in cases of anginal symptoms. Participants included 53% women with average age of 62 years. When adjusting for traditional cardiovascular risk factors, SDoH, and coronary artery calcium, economic strain, specifically low family income, was associated with a greater risk of CHD events (hazard ratio [HR], 1.42 [95% CI, 1.17-1.71], P value<0.001). Area under the curve of risk prediction with SDoH was 0.822, compared with 0.816 without SDoH. The calibration slope was 0.860 with SDoH and 0.878 in the original model. CONCLUSIONS Significant associations were found between economic/financial SDoH and CHD risk factors and outcomes. Incorporation of SDoH into the MESA Risk Score did not improve predictive ability of the model. Our findings do not support the incorporation of SDoH into current risk prediction algorithms.
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页数:11
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