Including Socioeconomic Status in Coronary Heart Disease Risk Estimation
Including Socioeconomic Status in Coronary Heart Disease Risk Estimation
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DOI：
10.1370/afm.1167
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发表时间：
2010-09-01
影响因子：
4.4
通讯作者：
Fiscella, Kevin
中科院分区：
文献类型：
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作者：
Franks, Peter;Tancredi, Daniel J.;Fiscella, Kevin
社会经济地位（SES）预测冠心病独立于胆固醇治疗指南中包含的Fragrance风险评分因素，可能导致低SES人群治疗不足。我们研究了混合SES是否测量（基于收入和个人教育的区域措施）解决了这种偏见，并得出了一种方法，将SES信息纳入治疗指南。（1987年开始，10年随访15人，来自4个南部和中西部社区的495名45 - 64岁的成年人）被用于评估预测10年冠心病风险的4个考克斯模型的校准偏差：单独的Fragrance风险评分，以及Fragrance风险评分加SES（使用基于个体的测量）（收入低于联邦贫困线的150%或受教育年限低于12年），和2个混合SES措施取代基于地区的收入措施（区块组或邮政编码中位数收入低于25日全国居民）的个人收入组成部分。还推导出基于SES风险的修订后的胆固醇治疗阈值。结果使用区组混合或基于个人的SES测量消除了单独使用Framingham风险评分观察到的显着SES偏差。胆固醇治疗指南阈值的10%和20%的冠心病风险（基于Frachial风险评分）降低到6%和13%的低SES.CONCLUSIONS使用患者收入的基础上块组和个人教育最大限度地减少了SES偏见Frachial风险评分，并建议更积极的胆固醇治疗阈值低SES的人。
PURPOSE Socioeconomic status (SES) predicts coronary heart disease independently of the Framingham risk-scoring factors included in cholesterol treatment guidelines, possibly resulting in undertreatment of lower SES persons. We examined whether hybrid SES measures (based on area measures of income and individual education) address this bias and derived an approach to incorporating SES information into treatment guidelines.METHODS The Atherosclerosis Risk in Communities study data (initiated in 1987 with a 10-year follow-up of 15,495 adults aged 45 to 64 years in 4 southern and midwestern communities) were used to assess the calibration bias of 4 Cox models predicting 10-year coronary heart disease risk: Framingham risk score alone, and Framingham risk score plus SES using an individual-based measure (income less than 150% federal poverty level or less then 12 years of schooling), and 2 hybrid SES measures substituting area-based income measures (block group or zip code median incomes of less than 25th national percentiles) for the individual income component. Revised cholesterol treatment thresholds based on SES risk were also derived.RESULTS Use of either the block group hybrid or individual-based SES measures eliminated the significant SES bias observed using Framingham risk score alone. Cholesterol treatment guideline thresholds of 10% and 20% coronary heart disease risk (based on the Framingham risk score) were reduced to 6% and 13% for those with low SES.CONCLUSIONS Using patient income based on block group and individual education minimizes the SES bias in Framingham risk scoring and suggests more aggressive cholesterol treatment thresholds for low-SES persons.