Objective: Prediction models for cardiovascular disease (CVD) mortality come from high-income countries, comprising laboratory measurements, not suitable for resource-limited countries. This study... Show moreObjective: Prediction models for cardiovascular disease (CVD) mortality come from high-income countries, comprising laboratory measurements, not suitable for resource-limited countries. This study aims to develop and validate a non-laboratory model to predict CVD mortality in a middle-income setting. Study design and setting: We used data of population aged 40-80 years from three cohort studies: Tehran Lipid and Glucose Study (n = 5160), Isfahan Cohort Study (n = 4350), and Golestan Cohort Study (n = 45,500). Using Cox proportional hazard models, we developed prediction models for men and women, separately. Cross-validation and bootstrapping procedures were applied. The models' discrimination and calibration were assessed by concordance statistic (C-index) and calibration plot, respectively. We calculated the models' sensitivity, specificity and net benefit fraction in a threshold probability of 5%. Results: The 10-year CVD mortality risks were 5.1% (95%CI: 4.8-5.5) in men and 3.1% (95%CI: 2.9%-3.3%) in women. The optimism-corrected performance of the model was c = 0.774 in men and c = 0.798 in women. The models showed good calibration in both sexes, with a predicted-to-observed ratio of 1.07 in men and 1.09 in women. The sensitivity was 0.76 in men and 0.66 in women. The net benefit fraction was higher in men compared to women (0.46 vs. 0.35). Conclusion: A low-cost model can discriminate well between low-and high-risk individuals, and can be used for screening in low-middle income countries. (C)& nbsp;2021 Elsevier Inc. All rights reserved. Show less
Abdollahpour, I.; Mooijaart, S.; Aguilar-Palacio, I.; Salimi, Y.; Nedjat, S.; Mansournia, M.A.; Courten, M. de 2019
Background: There is little evidence comparing the role of subjective versus objective indicators of socioeconomic status (SES) on individuals' self-rated health (SRH) in Iran.Objectives: We aimed... Show moreBackground: There is little evidence comparing the role of subjective versus objective indicators of socioeconomic status (SES) on individuals' self-rated health (SRH) in Iran.Objectives: We aimed to investigate underlying predictors of SRH including subjective and objective SES in Tehran, a multi-ethnic city.Method: This is an analysis of cross-sectional survey data on subjective and objective SES from a population-based case-control study conducted in Tehran, Iran (2015). We used random digit dialing for study sample recruitment. Linear regression models were used for estimating crude and adjusted coefficients (95% confidence intervals). Age, gender, SES as well as cigarette smoking were included as confounders.Results: 15-50 years old residents of Tehran were recruited in the study (n = 1057). High reported objective and subjective SES was consistently associated with a better SRH. Subjective current SES (p < .001), subjective adolescence SES (p = .018), change in subjective SES (current vs. adolescent) (p = .034) and participants' education years (p < .001). Improvements over time in current SES in comparison to SES rated during adolescence increased the participants' SRH after adjustment for potential confounders (coefficient = 0.170, 95% CI: (0.015, 0.325)). Female participants (coefficient = -0.305, 95% CI: (-0.418, -0.192)) and smokers (high category vs. never smokers) (coefficient = -0.456, 95% CI: (-0.714, -0.197)) reported significantly worse SRH. Increasing age - 0.008 (95% CI: -0.014, -0.002) was associated with decreased SRH.Conclusion: High subjective and objective SES consistently was the most important predictor of high SRH. Show less
