Prediction of first cardiovascular disease event in 2.9 million individuals using Danish administrative healthcare data:a nationwide, registry-based derivation and validation study

AIMS: The aim of this study was to derive and validate a risk prediction model with nationwide coverage to predict the individual and population-level risk of cardiovascular disease (CVD). METHODS AND RESULTS: All 2.98 million Danish residents aged 30–85 years free of CVD were included on 1 January 2014 and followed through 31 December 2018 using nationwide administrative healthcare registries. Model predictors and outcome were pre-specified. Predictors were age, sex, education, use of antithrombotic, blood pressure-lowering, glucose-lowering, or lipid-lowering drugs, and a smoking proxy of smoking-cessation drug use or chronic obstructive pulmonary disease. Outcome was 5-year risk of first CVD event, a combination of ischaemic heart disease, heart failure, peripheral artery disease, stroke, or cardiovascular death. Predictions were computed using cause-specific Cox regression models. The final model fitted in the full data was internally-externally validated in each Danish Region. The model was well-calibrated in all regions. Area under the receiver operating characteristic curve (AUC) and Brier scores ranged from 76.3% to 79.6% and 3.3 to 4.4. The model was superior to an age-sex benchmark model with differences in AUC and Brier scores ranging from 1.2% to 1.5% and −0.02 to −0.03. Average predicted risks in each Danish municipality ranged from 2.8% to 5.9%. Predicted risks for a 66-year old ranged from 2.6% to 25.3%. Personalized predicted risks across ages 30–85 were presented in an online calculator (https://hjerteforeningen.shinyapps.io/cvd-risk-manuscript/). CONCLUSION: A CVD risk prediction model based solely on nationwide administrative registry data provided accurate prediction of personal and population-level 5-year first CVD event risk in the Danish population. This may inform clinical and public health primary prevention efforts

Tájékoztató jelentés az őszi mezőgazdasági munkákról (2015. november 16-i operatív jelentések alapján)

A kiadvány a statisztikáról szóló 1993. évi XLVI. törvény (Stt.) 8.§ (2) bekezdése alapján készült el. Az adatszolgáltatás a Stt. felhatalmazása alapján kiadott Országos Statisztikai Adatgyűjtési Program keretein belül történt. A Nemzeti Agrárkamara (NAK) közreműködésével begyűjtött adatok a őszi mezőgazdasági munkák állásáról adnak tájékoztatást

Constructing whole of population cohorts for health and social research using the New Zealand Integrated Data Infrastructure

Abstract Objectives: To construct and compare a 2013 New Zealand population derived from Statistics New Zealand’s Integrated Data Infrastructure (IDI) with the 2013 census population and a 2013 Health Service Utilisation population, and to ascertain the differences in cardiovascular disease prevalence estimates derived from the three cohorts. Methods: We constructed three national populations through multiple linked administrative data sources in the IDI and compared the three cohorts by age, gender, ethnicity, area‐level deprivation and District Health Board. We also estimated cardiovascular disease prevalence based on hospitalisations using each of the populations as denominators. Results: The IDI population was the largest and most informative cohort. The percentage differences between the IDI and the other two populations were largest for males and for those aged 15–34 years. The percentage differences between the IDI and Census cohorts were largest for people living in the most deprived areas. The ethnic distribution varied across the three cohorts. Using the IDI population as a reference, the Health Service Utilisation population generally overestimated cardiovascular disease prevalence, while the Census population generally underestimated it. Conclusions and implications: The New Zealand IDI population is the most comprehensive and appropriate national cohort for use in health and social research

Performance of a Framingham cardiovascular risk model among Indians and Europeans in New Zealand and the role of body mass index and social deprivation

Objectives To evaluate a Framingham 5-year cardiovascular disease (CVD) risk score in Indians and Europeans in New Zealand, and determine whether body mass index (BMI) and socioeconomic deprivation were independent predictors of CVD risk. Methods We included Indians and Europeans, aged 30–74 years without prior CVD undergoing risk assessment in New Zealand primary care during 2002–2015 (n=256 446). Risk profiles included standard Framingham predictors (age, sex, systolic blood pressure, total cholesterol/high-density lipoprotein ratio, smoking and diabetes) and were linked with national CVD hospitalisations and mortality datasets. Discrimination was measured by the area under the receiver operating characteristics curve (AUC) and calibration examined graphically. We used Cox regression to study the impact of BMI and deprivation on the risk of CVD with and without adjustment for the Framingham score. Results During follow-up, 8105 and 1156 CVD events occurred in Europeans and Indians, respectively. Higher AUCs of 0.76 were found in Indian men (95% CI 0.74 to 0.78) and women (95% CI 0.73 to 0.78) compared with 0.74 (95% CI 0.73 to 0.74) in European men and 0.72 (95% CI 0.71 to 0.73) in European women. Framingham was best calibrated in Indian men, and overestimated risk in Indian women and in Europeans. BMI and deprivation were positively associated with CVD, also after adjustment for the Framingham risk score, although the BMI association was attenuated. Conclusions The Framingham risk model performed reasonably well in Indian men, but overestimated risk in Indian women and in Europeans. BMI and socioeconomic deprivation could be useful predictors in addition to a Framingham score

To move or not to move? Exploring the relationship between residential mobility, risk of cardiovascular disease and ethnicity in New Zealand

Residential mobility can have negative impacts on health, with some studies finding that residential mobility can contribute to widening health gradients in the population. However, ethnically differentiated experiences of residential mobility and the relationship with health are neglected in the literature. To examine the relationship between residential mobility, risk of cardiovascular disease (CVD) and ethnicity, we constructed a cohort of 2,077,470 participants aged 30 + resident in New Zealand using encrypted National Health Index (eNHI) numbers linked to individual level routinely recorded data. Using binary logistic regression, we model the risk of CVD for the population stratified by ethnic group according to mover status, baseline deprivation and transitions between deprivation statuses. We show that the relationship between residential mobility and CVD varies between ethnic groups and is strongly influenced by the inter-relationship between residential mobility and deprivation mobility. Whilst residential mobility is an important determinant of CVD, much of the variation between ethnic groups is explained by contrasting deprivation experiences. To reduce inequalities in CVD within New Zealand, policies must focus on residentially mobile Māori, Pacific and South Asian populations who already have a heightened risk of CVD living in more deprived areas