Development, validation and comparison of multivariable risk scores for prediction of total stroke and stroke types in Chinese adults: a prospective study of 0.5 million adults

Stroke and Vascular Neurology

article

Matthew Chun¹  Robert Clarke¹  Tingting Zhu²  David Clifton²  Derrick A Bennett¹  Yiping Chen¹  Yu Guo⁵  Pei Pei⁶  Jun Lv⁷  Canqing Yu⁷  Ling Yang¹  Liming Li⁷  Zhengming Chen⁴  Benjamin J Cairns⁹ 

[1] Clinical Trial Service Unit and Epidemiological Studies, Nuffield Department of Population Health , University of Oxford;Department of Engineering Science , University of Oxford;Department of Biomedical Engineering , Oxford-Suzhou Centre for Advanced Research;Medical Research Council Health Research Unit, Nuffield Department of Population Health , University of Oxford;CKB Project Department , Fuwai Hospital Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases;CKB Project Department , Chinese Academy of Medical Sciences;Department of Epidemiology and Biostatistics , School of Public Health, Peking University;Department of Epidemiology , Peking University Center for Public Health and Epidemic Preparedness and Response;1 Clinical Trial Service Unit and Epidemiological Studies, Nuffield Department of Population Health , University of Oxford , Oxford , UK 2 Department of Engineering Science , University of Oxford , Oxford , UK 3 Department of Biomedical Engineering , Oxford-Suzhou Centre for Advanced Research , Suzhou , China 4 Medical Research Council Health Research Unit, Nuffield Department of Population Health , University of Oxford , Oxford , UK 5 CKB Project Department , Fuwai Hospital Chinese Academy of Medical Sciences, National Center for Cardiovascular Diseases , Beijing , China 6 CKB Project Department , Chinese Academy of Medical Sciences , Beijing , China 7 Department of Epidemiology and Biostatistics , School of Public Health, Peking University , Beijing , China 8 Department of Epidemiology , Peking University Center for Public Health and Epidemic Preparedness and Response

关键词: stroke;    risk factors;    prospective studies;    standard of care;   

DOI  :  10.1136/svn-2021-001251

学科分类：社会科学、人文和艺术（综合）

来源: BMJ Publishing Group

【 摘 要 】

Background and purpose Low-income and middle-income countries have the greatest stroke burden, yet remain understudied. This study compared the utility of Framingham versus novel risk scores for prediction of total stroke and stroke types in Chinese adults.Methods China Kadoorie Biobank (CKB) is a prospective study of 512 726 adults, aged 30–79 years, recruited from 10 areas in China in 2004–2008. By 1 January 2018, 43 234 incident first stroke cases (36 310 ischaemic stroke (IS); 8865 haemorrhagic stroke (HS)) were recorded in 503 842 participants with no history of stroke at baseline. We compared the predictive utility of the Framingham Stroke Risk Profile (FSRP) with novel CKB stroke risk scores and included recalibration, refitting, stratifying by study area and addition of other risk factors. Discrimination was assessed using area under the receiver operating characteristic curve (AUC) and calibration was assessed using Greenwood-Nam-D’Agostino χ2 statistics.Results Incidence of total stroke varied fivefold by area in China. The FSRP had good discrimination for total stroke (AUC (95% CI); men: 0.78 (0.77 to 0.79), women: 0.77 (95% CI 0.76 to 0.78)), but poor calibration (χ2; men: 1,825, women: 3,053), substantially underestimating absolute risks. Recalibration reduced χ280%, but did not improve discrimination. Refitting the FSRP did not materially improve discrimination, but further improved calibration. Stratification by area improved discrimination (AUC; men: 0.82 (0.82 to 0.83); women: 0.82 (0.82 to 0.83)), but not calibration. Adding other risk factors yielded modest, but statistically significant, improvements in the AUCs. The findings for IS and HS were similar to those for total stroke.Conclusions The FSRP reliably differentiated Chinese adults with incident stroke, but substantially underestimated the absolute risks of stroke. Novel local risk prediction equations that took account of differences in stroke incidence within China enhanced risk prediction of total stroke and major stroke pathological types.

【 授权许可】

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