What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Atherosclerotic cardiovascular disease (ASCVD). Intervention: Polysocial risk score (PsRS) incorporating social determinants of health vs. Demographic and clinical risk factors alone. Primary outcome: Discriminatory power for prevalent ASCVD (AU-ROC).

August 30, 2021Open Access

Development and validation of a polysocial risk score for atherosclerotic cardiovascular disease

Resultado clave

Adding a polysocial risk score to demographic and clinical risk factors improved discriminatory power for prevalent ASCVD (AU-ROC 0.862 vs 0.852).

Diseño del estudio

Tipo

Cross-Sectional

PICO estructurado

Does a polysocial risk score (PsRS) improve the identification of prevalent ASCVD in US adults compared to traditional risk factors alone?

Población

164,696 adults ≥ 18 years of age from the 2013-2017 National Health Interview Survey (NHIS) in the United States.

Intervención

Polysocial risk score (PsRS) comprising 7 social determinants of health (unemployment, inability to pay medical bills, low income, psychological distress, delayed care due to lack of transport, food insecurity, and less than high school education)

Comparador

Traditional demographic and clinical risk factors alone

Resultado

Prevalent atherosclerotic cardiovascular disease (ASCVD), defined as history of coronary artery disease or strokehard clinical

A novel polysocial risk score incorporating 7 social determinants of health significantly improves the identification of prevalent ASCVD beyond traditional demographic and clinical risk factors.

Resultado numérico

Tasa de eventos absoluta: 0.862% vs 0.852%

Limitaciones

Lack of longitudinal study design
Need for validation in diverse populations

Resumen

OBJECTIVE: To date, the extent to which social determinants of health (SDOH) may help identify individuals with atherosclerotic cardiovascular disease (ASCVD) - beyond traditional risk factors - has not been quantified using a cumulative social disadvantage approach. The objective of this study was to develop, and validate, a polysocial risk score (PsRS) for prevalent ASCVD in a nationally representative sample of adults in the United States (US). METHODS: We used data from the 2013-2017 National Health Interview Survey. A total of 38 SDOH were identified from the database. Stepwise and criterion-based selection approaches were applied to derive PsRS, after adjusting for traditional risk factors. Logistic regression models were fitted to assign risk scores to individual SDOH, based on relative effect size magnitudes. PsRS was calculated by summing risk scores for individual SDOH, for each participant; and validated using a separate validation cohort. RESULTS: quintile). Area under receiver operating curve (AU-ROC) for PsRS with SDOH alone was 0.836. Addition of SDOH to the model with only demographic and clinical risk factors (AU-ROC=0.852) improved overall discriminatory power, with AU-ROC for final PsRS (demographics + clinical + SDOH) = 0.862. CONCLUSIONS: Cumulatively, SDOH may help identify individuals with ASCVD, beyond traditional cardiovascular risk factors. In this study, we provide a unique validated PsRS for ASCVD in a national sample of US adults. Future study should target development of similar scores in diverse populations, and incorporate longitudinal study designs.

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