北京市成年人冠心病七年发病风险评估与预测模型

A model of 7-year risk assessment and prediction for coronary heart disease in adults in Beijing

目的:对北京市成年人群冠心病七年发病风险进行评估,并构建预测模型。方法 :收集固定功能单位体检数据及生活行为问卷资料,采用非条件Logistic回归构建七年冠心病发病风险评估模型。通过受试者工作特征曲线及Wolber’s一致性指数统计量(C-指数)评估模型的判别效果,十折交叉法进行内部验证,绘制列线图,预测不同等级发病风险。结果 :研究基线共纳入43 499人,截至第七年,累计2 526人发生冠心病。将性别、年龄、婚姻状况、教育程度、冠心病家族史、吸烟频率、睡眠时长、糖尿病、高血压、血脂异常十个危险因素入选模型。模型C指数为0.87(95%CI:0.85~0.88)。结论 :构建的北京市成年人群冠心病七年风险列线图,具有较好的判别能力。

Objective: The study aimed at evaluating the 7-year risk of coronary heart disease(CHD) in adults in Beijing, and construct a prediction model. Methods: Participants in this study were recruited from the Beijing health management cohort study(BHMCS),all of them are from permanent institutions or communities.A total of 43 499 participants with completed data were finally included, there were 23 993 males and 19 506 females. Data including general physical examination and life behavior questionnaire, a model was developed by Logistic regression to calculate the risk of coronary heart disease in the next seven years.ROC curves and Wolber’s concordance index(C-index) statistics were used to assess model performance. Then construct a nomogram to predict the incidence risk of different levels. Results: There were 43 499 subjects in the cohort,including 23 993 males and 19 506 females. Up to the seventh year, coronary heart disease occurred in 2 526 subjects, the incidence rate of male was 5.99%and the incidence rate of female was 5.58%.Ten predictors were associated with CHD: gender, age, married, education, family history of CHD, smoking, sleeping time,hypertension, diabetes mellitus and dislipidemia. The results from Logistic regression were then used to construct a nomogram to predict the probability of CHD. In the ten-fold cross validation model, the C-index of the model is 0.87(95% CI: 0.85-0.88), which showed good discrimination. Conclusions: We construct a nomogram to predict the 7-year risk probability of CHD for adults in Beijing. Early prevention should become a key element of coronary heart disease.