Key result
Sex-specific risk prediction models for aneurysmal subarachnoid hemorrhage did not improve predictive performance compared to the general SMA2SH2ERS model, yielding c-statistics of 0.63 in women and 0.57 in men.
Why the study?
Because women have higher ASAH incidence than men and ASAH predictors have different effect sizes between sexes, the authors sought to develop sex-specific risk prediction models.
Do sex-specific risk prediction models improve the prediction of incident aneurysmal subarachnoid hemorrhage compared to a general model in the general population?
Cohort (n=456,856)
Yes
Do sex-specific risk prediction models improve the prediction of incident aneurysmal subarachnoid hemorrhage compared to a general model in the general population?
Effect estimate: ΔC -0.00 (95% CI -0.04-0.04)
Absolute Event Rate: 0.63% vs 0.63%
Sex-specific risk prediction models for aneurysmal subarachnoid hemorrhage did not outperform a general prediction model, though they identified different independent risk factors for women and men.
Sex-specific models should not yet replace general prediction for aneurysmal subarachnoid hemorrhage; leaves open value of sex-stratified factors in targeted cohorts.
Background: We recently developed and validated the SMA 2 SH 2 ERS risk prediction model for aneurysmal subarachnoid hemorrhage (ASAH) in the general population (c-statistic 0.62; 95% confidence interval [CI] 0.60–0.64). Given that women have higher ASAH incidence than men, and that predictors for ASAH have different effect sizes between sexes, we developed sex-specific risk prediction models. Methods: Data from the prospective UK Biobank Study were used for model development. Participants with ASAH (per hospital-based ICD codes) before baseline or with missing predictor data were excluded. We developed multivariable Cox proportional hazards models for women and men separately to study the association between earlier recognized SMA 2 SH 2 ERS predictors and incident ASAH. Predictive performances were assessed with c-statistics and calibration plots and corrected for overfitting using bootstrapping. Results: A total of 246,771 women and 210,085 men were included with median follow-up of 12 years. ASAH incidence rate per 100 000 person years was 16.1 in women, and 10.7 in men. The women-specific model had a c-statistic of 0.63 (95% CI 0.60–0.65) and the mean predicted absolute 10-year ASAH risk was 0.15%. Independent predictors for women were higher age, family history of stroke, former and current smoking, alcohol consumption, and intermediate education. The men-specific model c-statistic was 0.57 (95% CI 0.53–0.60) and the mean 10-year risk 0.10%. Independent predictors for men were higher age, hypertension, and smoking status. Conclusion: The sex-specific models did not perform better than the general SMA 2 SH 2 ERS model in women or in men. Further validation studies are needed before clinical use can be recommended.
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Rissanen et al. (2025) conducted a cohort in Aneurysmal subarachnoid hemorrhage (n=456,856). Sex-specific risk prediction models vs. General SMA2SH2ERS risk prediction model was evaluated on Predictive performance (c-statistic) of the women-specific model for incident ASAH compared to the general model (ΔC -0.00, 95% CI -0.04-0.04). Sex-specific risk prediction models for aneurysmal subarachnoid hemorrhage did not improve predictive performance compared to the general SMA2SH2ERS model, yielding c-statistics of 0.63 in women and 0.57 in men.
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