Addition of Social Determinants of Health to Coronary Heart Disease Risk Prediction: The Multi-Ethnic Study of Atherosclerosis.
Addition of Social Determinants of Health to Coronary Heart Disease Risk Prediction: The Multi-Ethnic Study of Atherosclerosis.
- 2024
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. 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. METHODS 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.
English
2047-9980
*Coronary Disease
*Social Determinants of Health
Aged
Aged, 80 and over
Coronary Disease/di [Diagnosis]
Coronary Disease/eh [Ethnology]
Coronary Disease/ep [Epidemiology]
Ethnicity/sn [Statistics & Numerical Data]
Female
Heart Disease Risk Factors
Humans
Male
Middle Aged
Predictive Value of Tests
Prognosis
Prospective Studies
Risk Assessment
Risk Factors
Social Determinants of Health/eh [Ethnology]
United States/ep [Epidemiology]--Automated
MedStar Union Memorial Hospital
Internal Medicine Residency
Journal Article
Multicenter Study
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. 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. METHODS 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.
English
2047-9980
*Coronary Disease
*Social Determinants of Health
Aged
Aged, 80 and over
Coronary Disease/di [Diagnosis]
Coronary Disease/eh [Ethnology]
Coronary Disease/ep [Epidemiology]
Ethnicity/sn [Statistics & Numerical Data]
Female
Heart Disease Risk Factors
Humans
Male
Middle Aged
Predictive Value of Tests
Prognosis
Prospective Studies
Risk Assessment
Risk Factors
Social Determinants of Health/eh [Ethnology]
United States/ep [Epidemiology]--Automated
MedStar Union Memorial Hospital
Internal Medicine Residency
Journal Article
Multicenter Study