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By neglecting deprivation, cardiovascular risk scoring will exacerbate social gradients in disease

Objective: To examine whether the efficiency and equity of cardiovascular risk scores that identify patients at high risk for preventive interventions are compromised by omitting social deprivation, which contributes to risk. Design: Cohort study. Setting: The SHHEC (Scottish heart health extended c... Full description

Journal Title: Heart (British Cardiac Society) 2006-03, Vol.92 (3), p.307-310
Main Author: Tunstall-Pedoe, H
Other Authors: Woodward, M
Format: Electronic Article Electronic Article
Language: English
Subjects:
Age
Quelle: Alma/SFX Local Collection
Publisher: London: BMJ Publishing Group Ltd and British Cardiovascular Society
ID: ISSN: 1355-6037
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recordid: cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_1860840
title: By neglecting deprivation, cardiovascular risk scoring will exacerbate social gradients in disease
format: Article
creator:
  • Tunstall-Pedoe, H
  • Woodward, M
subjects:
  • Abridged Index Medicus
  • Adult
  • Age
  • Aged
  • Atherosclerosis (general aspects, experimental research)
  • Biological and medical sciences
  • Blood and lymphatic vessels
  • Blood pressure
  • Cardiac patients
  • Cardiology. Vascular system
  • Cardiovascular disease
  • Cardiovascular diseases
  • Cardiovascular Diseases - prevention & control
  • Cardiovascular Medicine
  • Care and treatment
  • Cohort Studies
  • Demographic aspects
  • Evaluation
  • Female
  • Framingham score
  • Health risk assessment
  • Heart attacks
  • Humans
  • Information services
  • Male
  • Medical sciences
  • Mens health
  • Middle Aged
  • MONICA
  • MONICA project
  • monitoring trends and determinants in cardiovascular disease
  • Mortality
  • Population
  • prevention
  • Risk Assessment
  • Risk Factors
  • Scotland
  • Scottish heart health extended cohort
  • Scottish index of multiple deprivation
  • SHHEC
  • SIMD
  • Social classes
  • social status
  • Socioeconomic Factors
  • Studies
  • Trends
  • Womens health
ispartof: Heart (British Cardiac Society), 2006-03, Vol.92 (3), p.307-310
description: Objective: To examine whether the efficiency and equity of cardiovascular risk scores that identify patients at high risk for preventive interventions are compromised by omitting social deprivation, which contributes to risk. Design: Cohort study. Setting: The SHHEC (Scottish heart health extended cohort) study of random sample risk factor surveys across 25 districts of Scotland in 1984–87 and North Glasgow in 1989, 1992, and 1995 Participants: 6419 men and 6618 women aged 30–74, free of cardiovascular disease at baseline, followed up with permission for mortality and morbidity to March 1997. Participants were allocated to population fifths of the Scottish index of multiple deprivation (SIMD) and their observed coronary risk was compared with that expected from the Framingham score for all coronary heart disease. Results: The Framingham score overestimated risk overall and in each SIMD fifth. It seriously underestimated the variation in risk with deprivation. The relative risk of observed 10 year coronary risk (sexes combined) analysed across population fifths had a steep gradient, from least to most deprived, of 1.00, 1.81, 1.98, 2.22, and 2.57. Expected risk, calculated from baseline risk factor values and the Framingham score, had one quarter of that gradient, with relative risks of 1.00, 1.17, 1.19, 1.28, and 1.36. Conclusion: Cardiovascular risk estimated by the Framingham and related scores is misleading in guiding treatment decisions among people at different levels of social deprivation. Such scores foster relative undertreatment of the socially deprived, exacerbating the social gradients in disease, which national policies seek to minimise. Debate and action are needed to correct this anomaly.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 1355-6037
fulltext: fulltext
issn:
  • 1355-6037
  • 1468-201X
url: Link


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descriptionObjective: To examine whether the efficiency and equity of cardiovascular risk scores that identify patients at high risk for preventive interventions are compromised by omitting social deprivation, which contributes to risk. Design: Cohort study. Setting: The SHHEC (Scottish heart health extended cohort) study of random sample risk factor surveys across 25 districts of Scotland in 1984–87 and North Glasgow in 1989, 1992, and 1995 Participants: 6419 men and 6618 women aged 30–74, free of cardiovascular disease at baseline, followed up with permission for mortality and morbidity to March 1997. Participants were allocated to population fifths of the Scottish index of multiple deprivation (SIMD) and their observed coronary risk was compared with that expected from the Framingham score for all coronary heart disease. Results: The Framingham score overestimated risk overall and in each SIMD fifth. It seriously underestimated the variation in risk with deprivation. The relative risk of observed 10 year coronary risk (sexes combined) analysed across population fifths had a steep gradient, from least to most deprived, of 1.00, 1.81, 1.98, 2.22, and 2.57. Expected risk, calculated from baseline risk factor values and the Framingham score, had one quarter of that gradient, with relative risks of 1.00, 1.17, 1.19, 1.28, and 1.36. Conclusion: Cardiovascular risk estimated by the Framingham and related scores is misleading in guiding treatment decisions among people at different levels of social deprivation. Such scores foster relative undertreatment of the socially deprived, exacerbating the social gradients in disease, which national policies seek to minimise. Debate and action are needed to correct this anomaly.
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subjectAbridged Index Medicus ; Adult ; Age ; Aged ; Atherosclerosis (general aspects, experimental research) ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood pressure ; Cardiac patients ; Cardiology. Vascular system ; Cardiovascular disease ; Cardiovascular diseases ; Cardiovascular Diseases - prevention & control ; Cardiovascular Medicine ; Care and treatment ; Cohort Studies ; Demographic aspects ; Evaluation ; Female ; Framingham score ; Health risk assessment ; Heart attacks ; Humans ; Information services ; Male ; Medical sciences ; Mens health ; Middle Aged ; MONICA ; MONICA project ; monitoring trends and determinants in cardiovascular disease ; Mortality ; Population ; prevention ; Risk Assessment ; Risk Factors ; Scotland ; Scottish heart health extended cohort ; Scottish index of multiple deprivation ; SHHEC ; SIMD ; Social classes ; social status ; Socioeconomic Factors ; Studies ; Trends ; Womens health
ispartofHeart (British Cardiac Society), 2006-03, Vol.92 (3), p.307-310
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descriptionObjective: To examine whether the efficiency and equity of cardiovascular risk scores that identify patients at high risk for preventive interventions are compromised by omitting social deprivation, which contributes to risk. Design: Cohort study. Setting: The SHHEC (Scottish heart health extended cohort) study of random sample risk factor surveys across 25 districts of Scotland in 1984–87 and North Glasgow in 1989, 1992, and 1995 Participants: 6419 men and 6618 women aged 30–74, free of cardiovascular disease at baseline, followed up with permission for mortality and morbidity to March 1997. Participants were allocated to population fifths of the Scottish index of multiple deprivation (SIMD) and their observed coronary risk was compared with that expected from the Framingham score for all coronary heart disease. Results: The Framingham score overestimated risk overall and in each SIMD fifth. It seriously underestimated the variation in risk with deprivation. The relative risk of observed 10 year coronary risk (sexes combined) analysed across population fifths had a steep gradient, from least to most deprived, of 1.00, 1.81, 1.98, 2.22, and 2.57. Expected risk, calculated from baseline risk factor values and the Framingham score, had one quarter of that gradient, with relative risks of 1.00, 1.17, 1.19, 1.28, and 1.36. Conclusion: Cardiovascular risk estimated by the Framingham and related scores is misleading in guiding treatment decisions among people at different levels of social deprivation. Such scores foster relative undertreatment of the socially deprived, exacerbating the social gradients in disease, which national policies seek to minimise. Debate and action are needed to correct this anomaly.
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7Blood pressure
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11Cardiovascular diseases
12Cardiovascular Diseases - prevention & control
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20Health risk assessment
21Heart attacks
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notesCorrespondence to:
 Professor Hugh Tunstall-Pedoe
 Cardiovascular Epidemiology Unit, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK; h.tunstallpedoe@dundee.ac.uk
abstractObjective: To examine whether the efficiency and equity of cardiovascular risk scores that identify patients at high risk for preventive interventions are compromised by omitting social deprivation, which contributes to risk. Design: Cohort study. Setting: The SHHEC (Scottish heart health extended cohort) study of random sample risk factor surveys across 25 districts of Scotland in 1984–87 and North Glasgow in 1989, 1992, and 1995 Participants: 6419 men and 6618 women aged 30–74, free of cardiovascular disease at baseline, followed up with permission for mortality and morbidity to March 1997. Participants were allocated to population fifths of the Scottish index of multiple deprivation (SIMD) and their observed coronary risk was compared with that expected from the Framingham score for all coronary heart disease. Results: The Framingham score overestimated risk overall and in each SIMD fifth. It seriously underestimated the variation in risk with deprivation. The relative risk of observed 10 year coronary risk (sexes combined) analysed across population fifths had a steep gradient, from least to most deprived, of 1.00, 1.81, 1.98, 2.22, and 2.57. Expected risk, calculated from baseline risk factor values and the Framingham score, had one quarter of that gradient, with relative risks of 1.00, 1.17, 1.19, 1.28, and 1.36. Conclusion: Cardiovascular risk estimated by the Framingham and related scores is misleading in guiding treatment decisions among people at different levels of social deprivation. Such scores foster relative undertreatment of the socially deprived, exacerbating the social gradients in disease, which national policies seek to minimise. Debate and action are needed to correct this anomaly.
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pmid16166099
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