PREDICTING DEATH FROM CORONARY HEART-DISEASE USING A QUESTIONNAIRE
PREDICTING DEATH FROM CORONARY HEART-DISEASE USING A QUESTIONNAIRE
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DOI：
10.1093/ije/19.4.899
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发表时间：
1990-12-01
影响因子：
7.7
通讯作者：
ROSE, G
中科院分区：
文献类型：
--
作者：
BULPITT, CJ;SHIPLEY, MJ;ROSE, G
根据白厅研究开始时的问卷调查，报告了18 322名40岁至的男性公务员的十年冠心病死亡率。总共有1714人死亡，其中723人死于冠心病。对问卷的预测能力进行了审查，以期将其用作人口研究中的一种筛查工具。在预测冠心病死亡方面，有心绞痛(A)和严重胸痛史(可能是心肌梗死，PMI)的男性获得了最大的特异度(真阴性率)。这一策略(A加PMI)获得了99%的特异度，但灵敏度(真阳性率)仅为7%。相比之下，在报告心绞痛和/或PMI的男性中，特异性为90%，敏感性为29%。如果将这种“和/或”算法扩展到包括呼吸困难、糖尿病和/或去看患有心脏病或高血压的初级保健医生的报告，那么特异度仍然是85%，但敏感度提高到44%。因此，建议将此组合(共11个问题)用于筛选目的。利用天气对呼吸的影响等问题，找出并排除那些喜欢正面答案的人(肯定回答者)，导致特异性略有增加，但敏感度相对较大地下降。在报告胸痛的受试者中，那些也抱怨非特定症状的人的死亡率只有那些没有这些额外主诉的人的一半。
The ten-year coronary heart disease (CHD) mortality is reported for 18 322 male civil servants aged 40 to 64 according to questionnaire responses at entry into the Whitehall study. In all 1714 died, 723 from CHD. The predictive power of the questionnaire was examined with a view to its use as a screening tool in population studies. In predicting death from coronary heart disease the greatest specificity (true negative rate) was achieved with men reporting both angina (A) and a history of severe chest pain (possible myocardial infarction, PMI). This strategy (A plus PMI) achieved a specificity of 99% but a sensitivity (true positive rate) of only 7%. In contrast, in men reporting angina and/or PMI, specificity was 90% and sensitivity 29%. If this 'and/or' algorithm was extended to include the report of dyspnoea, diabetes, and/or attending a primary care physician with heart disease or hypertension, then specificity was still 85%, but sensitivity increased to 44%. This combination (11 questions in all) is therefore recommended for screening purposes. Identifying and excluding those who favour positive answers ('yes-set' responders), using questions such as the effect of weather on breathing, led to small increases in specificity but relatively large falls in sensitivity. Among subjects reporting chest pain, those who also complained of non-specific symptoms experienced only half the mortality of those with none of these additional complaints.