Development and temporal evaluation of sex-specific models to predict 4-year atherosclerotic cardiovascular disease risk based on age and neighbourhood characteristics in South Limburg, the Netherlands

Abstract

BackgroundTo improve screening for atherosclerotic cardiovascular disease (ASCVD), we aimed to develop and temporally evaluate sex-specific models to predict 4-year ASCVD risk in South Limburg based on age and neighbourhood characteristics concerning home address.MethodsWe included 40- to 70-year-olds living in South Limburg on 1 January 2015 for model development, and 40- to 70-year-olds living in South Limburg on 1 January 2016 for model evaluation. We randomly sampled people selected in 1 year and in both years to create development and evaluation data sets. Follow-up of ASCVD and competing events (overall mortality excluding ASCVD) lasted until 31 December 2020. Candidate predictors were the individual's age, the neighbourhood's socio-economic status, and the neighbourhood's particulate matter concentration. Using the evaluation data sets, we compared two model types, subdistribution and cause-specific hazard models, and eight model structures. Discrimination was assessed by the area under the receiver operating characteristic curve (AUROC). Calibration was assessed by calculating overall expected-observed ratios (E/O). For the final models, calibration plots were made additionally.ResultsThe development data sets consisted of 67,549 males (4-year cumulative ASCVD incidence: 3.08%) and 67,947 females (4-year cumulative ASCVD incidence: 1.50%). The evaluation data sets consisted of 66,068 males (4-year cumulative ASCVD incidence: 3.22%) and 66,231 females (4-year cumulative ASCVD incidence: 1.49%). For males, the AUROC of the final model equalled 0.6548. The E/O equalled 0.9466. For females, the AUROC equalled 0.6744. The E/O equalled 0.9838.ConclusionsThe resulting model shows promise for further research. These models may be used for ASCVD screening in the future.