Methods for assessing cardiovascular disease risk in a UK black population
- 1Division of Health and Social Care Research, Department of Primary Care and Public Health Sciences, King's College London, London, UK
- 2Faculty of Health and Social Care, London South Bank University, London, UK
- Correspondence to Dr Peter Schofield, Division of Health and Social Care Research, Department of Primary Care and Public Health Sciences, King's College London, 9th Floor, Capital House, 42 Weston Street, London SE1 3QD, UK;
Contributors PS designed the statistical analysis plan, cleaned and analysed the data, and drafted and revised the paper. He is guarantor. RC revised the draft paper and advised on the final draft. NC initiated the project, conceived the initial study design and advised on initial and final drafts of the paper.
- Accepted 26 June 2012
- Published Online First 26 July 2012
Objective To assess differences between cardiovascular disease (CVD) risk estimation methods when applied to a black UK population.
Design Cross-sectional study.
Setting 51 GP practices in Lambeth, south-east London.
Patients 26 370 black and 52 288 white registered patients aged 40–74 years.
Main outcome measures 10-year CVD risk score estimates derived using Framingham, QRISK2, ASSIGN and ETHRISK algorithms. κ measures of agreement between risk scores and age-adjusted black/white mean risk ratios (RR) derived for each score.
Results There was a moderate agreement between the various risk scores for the black population (pooled κ 0.59 (95% CI 0.57 to 0.61) for men and 0.42 (95% CI 0.39 to 0.46) for women). For the white population, agreement was significantly improved (pooled κ 0.74 (95% CI 0.73 to 0.76) for men and 0.51 (95% CI 0.49 to 0.54) for women). Except for QRISK2, each method consistently overpredicted the CVD risk for the black population in comparison with national (Health Survey for England) prevalence figures. QRISK2 estimates were the least divergent from national data, giving a black/white mean RR of 0.73 (95% CI 0.71 to 0.74) for men and 0.85 (95% CI 0.83 to 0.87) for women.
Conclusions The choice of risk estimation method does make a difference to estimates of CVD risk for black patients. The QRISK2 method, which incorporates ethnicity as a risk factor, appears to have the best fit with national data for this population.
Funding The study was supported by a grant from the Guy's and St Thomas' Charity.
Competing interests None.
Ethics approval Ethical approval was given by the South East Research Ethics Committee (07/MREOI/26).
Provenance and peer review Not commissioned; externally peer reviewed.