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Validation of a new predictive risk model for mortality using Framingham Heart Study data
Meeting Abstracts
Validation of a new predictive risk model for mortality using Framingham Heart Study data Joseph M Massaro, Joanne M Murabito, Rhoda Au, Emily Carnahan, Gregory R Kotzbauer, Julie P W Bynum, Eugene C Nelson, Stephen S Lim, Ralph B D’Agostino Sr
Abstract Background The Institute for Health Metrics and Evaluation (IHME) developed a risk model to estimate 10-year mortality risk compared with a population with optimum risk factors in adults aged 30 years and older. IHME used data on exposure distributions of 12 behavioural and biometric risks in the US population, mortality rates by cause, and estimates of the proportional hazards of risk factor exposure from systematic reviews. The model has been validated using National Health and Nutrition Examination Survey (NHANES) data collected during 1988–94 and 1999–2004 (n=8331). Methods We will use data from participants attending the Framingham Heart Study (FHS) Offspring Examination 7 (1998–2001) and the Original Cohort Examination 20 (1986–90) to further validate the 10-year mortality risk model. These examinations were chosen since risk factors used in the IHME development mortality risk model were measured in these examinations. FHS participants aged 30 years and older at the time of examination will be included. Model performance will be assessed by (a) area under the curve to assess the ability of the model to discriminate between FHS participants who did and did not die within 10 years; and (b) Hosmer-Lemeshow goodness-of-fit tests comparing the FHS-observed mortality rate with the model-predicted mortality risk. Findings The FHS validation cohort consists of 3500 participants (mean age 62∙4 years); 55% are women. Unlike NHANES, the FHS cohort sample is predominantly white. The FHS cohort is approximately 10·6 years (95% CI 10·1–11·1) older than NHANES, on average; FHS and NHANES have 55% and 53% females, respectively. The observed mortality rate is 14·3% (95% CI 13·2–15·5) in FHS and 8·4% (7·8–9·0) in NHANES cohort samples. We will present the findings of the validation on the FHS participants and compare with NHANES validation results.
Published Online June 17, 2013 School of Public Health (J M Massaro PhD, R B D’Agostino Sr PhD), School of Medicine, Boston University, Boston, MA, USA (J M Murabito MD, R Au PhD); Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA (E Carnahan BA, S S Lim PhD); and the Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, NH, USA (G R Kotzbauer BA, J P W Bynum MD, E C Nelson DSc) Correspondence to: Joseph M Massaro, Boston University, School of Public Health 801 Massachusetts Ave, Crosstown, 3rd Floor, Boston, MA, USA [email protected]
Interpretation Adequate performance of the risk model when applied to FHS, a sample with characteristics somewhat different from NHANES, will further support its validity and usefulness in the US population. Funding National Heart, Lungs and Blood Institute at the National Institutes of Health (2 N01-HC-25195-06). Contributors JMMass wrote the first draft of the abstract. All authors reviewed and revised. JMMass and RBD’A will perform the analysis and interpretation. RA, ECN, GRK, and JPWB conceived the notion to validate using FHS and are providing guidance. JMMur is providing guidance and interpretation. EC and SSL performed the original model development and the NHANES validation, and are providing guidance. Conflicts of interest We declare that we have no conflicts of interest.
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91
Validation of a new predictive risk model for mortality using Framingham Heart Study data Joseph M Massaro, Joanne M Murabito, Rhoda Au, Emily Carnahan, Gregory R Kotzbauer, Julie P W Bynum, Eugene C Nelson, Stephen S Lim, Ralph B D’Agostino Sr
Abstract Background The Institute for Health Metrics and Evaluation (IHME) developed a risk model to estimate 10-year mortality risk compared with a population with optimum risk factors in adults aged 30 years and older. IHME used data on exposure distributions of 12 behavioural and biometric risks in the US population, mortality rates by cause, and estimates of the proportional hazards of risk factor exposure from systematic reviews. The model has been validated using National Health and Nutrition Examination Survey (NHANES) data collected during 1988–94 and 1999–2004 (n=8331). Methods We will use data from participants attending the Framingham Heart Study (FHS) Offspring Examination 7 (1998–2001) and the Original Cohort Examination 20 (1986–90) to further validate the 10-year mortality risk model. These examinations were chosen since risk factors used in the IHME development mortality risk model were measured in these examinations. FHS participants aged 30 years and older at the time of examination will be included. Model performance will be assessed by (a) area under the curve to assess the ability of the model to discriminate between FHS participants who did and did not die within 10 years; and (b) Hosmer-Lemeshow goodness-of-fit tests comparing the FHS-observed mortality rate with the model-predicted mortality risk. Findings The FHS validation cohort consists of 3500 participants (mean age 62∙4 years); 55% are women. Unlike NHANES, the FHS cohort sample is predominantly white. The FHS cohort is approximately 10·6 years (95% CI 10·1–11·1) older than NHANES, on average; FHS and NHANES have 55% and 53% females, respectively. The observed mortality rate is 14·3% (95% CI 13·2–15·5) in FHS and 8·4% (7·8–9·0) in NHANES cohort samples. We will present the findings of the validation on the FHS participants and compare with NHANES validation results.
Published Online June 17, 2013 School of Public Health (J M Massaro PhD, R B D’Agostino Sr PhD), School of Medicine, Boston University, Boston, MA, USA (J M Murabito MD, R Au PhD); Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA (E Carnahan BA, S S Lim PhD); and the Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, NH, USA (G R Kotzbauer BA, J P W Bynum MD, E C Nelson DSc) Correspondence to: Joseph M Massaro, Boston University, School of Public Health 801 Massachusetts Ave, Crosstown, 3rd Floor, Boston, MA, USA [email protected]
Interpretation Adequate performance of the risk model when applied to FHS, a sample with characteristics somewhat different from NHANES, will further support its validity and usefulness in the US population. Funding National Heart, Lungs and Blood Institute at the National Institutes of Health (2 N01-HC-25195-06). Contributors JMMass wrote the first draft of the abstract. All authors reviewed and revised. JMMass and RBD’A will perform the analysis and interpretation. RA, ECN, GRK, and JPWB conceived the notion to validate using FHS and are providing guidance. JMMur is providing guidance and interpretation. EC and SSL performed the original model development and the NHANES validation, and are providing guidance. Conflicts of interest We declare that we have no conflicts of interest.
www.thelancet.com
91