河南省心脑血管疾病发病预测模型的建立与评估

王炳源 高莉 秦露伟 潘盼 冯化飞 邢天放 底秀娟 李少芳 李卉 杨文杰 康锴

王炳源, 高莉, 秦露伟, 潘盼, 冯化飞, 邢天放, 底秀娟, 李少芳, 李卉, 杨文杰, 康锴. 河南省心脑血管疾病发病预测模型的建立与评估[J]. 疾病监测, 2023, 38(10): 1239-1246. doi: 10.3784/jbjc.202303130099
引用本文: 王炳源, 高莉, 秦露伟, 潘盼, 冯化飞, 邢天放, 底秀娟, 李少芳, 李卉, 杨文杰, 康锴. 河南省心脑血管疾病发病预测模型的建立与评估[J]. 疾病监测, 2023, 38(10): 1239-1246. doi: 10.3784/jbjc.202303130099
Wang Bingyuan, Gao Li, Qin Luwei, Pan Pan, Feng Huafei, Xing Tianfang, Di Xiujuan, Li Shaofang, Li Hui, Yang Wenjie, Kang Kai. Establishment and evaluation of cardio-cerebrovascular disease prediction model in Henan[J]. Disease Surveillance, 2023, 38(10): 1239-1246. doi: 10.3784/jbjc.202303130099
Citation: Wang Bingyuan, Gao Li, Qin Luwei, Pan Pan, Feng Huafei, Xing Tianfang, Di Xiujuan, Li Shaofang, Li Hui, Yang Wenjie, Kang Kai. Establishment and evaluation of cardio-cerebrovascular disease prediction model in Henan[J]. Disease Surveillance, 2023, 38(10): 1239-1246. doi: 10.3784/jbjc.202303130099

河南省心脑血管疾病发病预测模型的建立与评估

doi: 10.3784/jbjc.202303130099
基金项目: 河南省科技攻关计划项目(No. 212102310111);河南省医学科技攻关计划项目(No. LHGJ20200127,No. LHGJ20210162,No. LHGJ20220172)
详细信息
    作者简介:

    王炳源,女,医学博士,医师,主要从事慢性病及伤害预防控制工作,Email:wangby95@163.com

    通讯作者:

    康锴,Tel:13838183521,Email:kangk79@163.com

  • 中图分类号: R211;R181.3+8

Establishment and evaluation of cardio-cerebrovascular disease prediction model in Henan

Funds: This study was supported by the fund of Program for Science and Technology Development in Henan Province (No. 212102310111) and Medical Science and Technological Project of Henan Province (No. LHGJ20200127, No. LHGJ20210162, No. LHGJ20220172)
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  • 摘要:   目的  构建河南省心脑血管疾病发病预测模型,为河南省心脑血管疾病的防控提供科学依据。  方法  采用队列研究设计,选取2013—2014年参加中国慢性病及危险因素监测的18岁以上河南省常住居民,将基线无心脑血管疾病、无失访、无关键变量缺失的5 757人作为随访队列。 采用加权的Cox回归分析构建模型,以C统计量和校准曲线评估模型的区分度和校准度,并采用Bootstrap法进行内部验证。  结果  平均随访时间7.01±1.02年,心脑血管疾病累积发病率为9.23%。 纳入预测模型的变量有年龄[风险率(HR)= 1.05,95%置信区间(CI):1.04~1.06,P<0.001]、收缩压(HR =1.01,95%CI: 1.01~1.02,P=0.001)、吸烟(HR= 1.44,95%CI:1.19~1.74,P=0.002)、高血压服药(HR= 1.81,95%CI:1.32~2.50,P=0.002)和糖尿病(HR= 1.49,95%CI:1.11~2.00,P=0.014)。 模型的C统计量为0.76(0.74~0.78),校准曲线显示预测值与观察值有较好的一致性。 采用Bootstrap法验证结果显示,C统计量均值的偏差为0.000 16。  结论  该模型具有较好的可信度和准确性,可为河南省心脑血管疾病高危人群的筛查提供科学依据。
  • 图  1  心脑血管发病预测模型在建模队列中的校准曲线

    Figure  1.  Calibration curve for prediction model of cardio-cerebrovascular disease in training cohort

    图  2  心脑血管发病预测模型的列线图

    Figure  2.  Nomogram of cardio-cerebrovascular disease prediction model

    表  1  2020年河南省居民心脑血管病未发病组和心脑血管病发病组人群的基线特征比较

    Table  1.   Baseline characteristics of population with or without cardio-cerebrovascular disease in Henan in 2020

      变量总体
    n=5 757,加权n=48 741 947)
    心脑血管病未发病组
    n=5 052,加权n=44 245 101)
    心脑血管病发病组
    n=705,加权n=4 496 846)
    t/χ2P
    性别 2.670 0.102
     男性 24 072 555 (49.39) 21 641 648 (48.91) 2 430 907 (54.06)
     女性 24 669 393 (50.61) 22 603 454 (51.09) 2 065 939 (45.94)
    年龄(岁) 43.41±15.93 41.81±15.19 59.19±14.37 15.700 <0.001
    文化程度 20.430 <0.001
     初中及以下 36 703 548 (75.30) 32 810 673 (74.16) 3 892 875 (86.57)
     高中及以上 12 038 400 (24.70) 11 434 429 (25.84) 603 971 (13.43)
    婚姻状态 1.980 0.159
     已婚/同居 42 369 870 (86.93) 38 583 740 (87.21) 3 786 130 (84.19)
     未婚/离婚/丧偶/分居 6 372 077 (13.07) 5 661 361 (12.79) 710 716 (15.81)
    城乡 6.170 0.013
     城市 19 989 831 (41.01) 17 831 465 (40.30) 2 158 367 (48.00)
     农村 28 752 116 (58.99) 26 413 637 (59.70) 2 338 479 (52.00)
    吸烟 6.090 0.014
     否 32 324 309 (66.32) 29 646 419 (67.01) 2 677 890 (59.55)
     是 16 417 639 (33.68) 14 598 683 (32.99) 1 818 956 (40.45)
    饮酒 6.690 0.010
     否 30 882 929 (63.36) 27 698 463 (62.60) 3 184 466 (70.82)
     是 17 859 019 (36.64) 16 546 638 (37.40) 1 312 380 (29.18)
    蔬菜水果摄入不足 0.420 0.515
     否 27 829 168(57.09) 25 179 215 (56.91) 2 649 953 (58.93)
     是 20 912 779 (42.91) 19 065 887 (43.09) 1 846 893 (41.07)
    红肉摄入过多 0.640 0.422
     否 42 114 995 (86.40) 38 147 376 (86.22) 3 967 620 (88.23)
     是 6 626 952 (13.60) 6 097 726 (13.78) 529 226 (11.77)
    体力活动 6.430 0.011
     高水平 20 926 808 (42.93) 19 351 643 (43.74) 1 575 165 (35.03)
     中等水平 14 853 080 (30.47) 13 293 736 (30.05) 1 559 344 (34.68)
     低水平 12 962 059 (26.60) 11 599 723 (26.21) 1 362 337 (30.29)
    高血压服药 145.790 <0.001
     否 43 939 720 (90.15) 40 872 632 (92.38) 3 067 089 (68.21)
     是 4 802 227 (9.85) 3 372 470 (7.62) 1 429 757 (31.79)
    糖尿病患病 41.790 <0.001
     否 43 061 191 (88.35) 39 649 065 (89.61) 3 412 125 (75.88)
     是 5 680 757 (11.65) 4 596 036 (10.39) 1 084 721 (24.12)
    BMI 24.52±3.72 24.48±3.69 24.86±3.92 1.560 0.120
    WC 84.47±10.49 84.31±10.50 86.10±10.35 2.710 0.007
    SBP 130.74±21.16 129.18±20.12 146.18±24.61 10.450 <0.001
    DBP 76.69±11.85 76.19±11.58 81.64±13.24 6.520 <0.001
    心率 75.85±10.88 75.82±10.88 76.02±10.88 0.310 0.759
    TC 4.46±0.96 4.44±0.96 4.64±0.97 3.150 0.002
    TG 1.43±1.25 1.41±1.27 1.60±1.10 2.890 0.004
    HDL-C 1.28±0.34 1.28±0.34 1.24±0.35 −1.670 0.095
    LDL-C 2.73±0.82 2.71±0.82 2.90±0.85 3.580 <0.001
    注:表中数据均进行加权调整;表头括号中n是实际例数,加权n是加权例数。连续性变量采用加权均值±标准差描述,分类变量采用加权例数(构成比)描述;BMI. 体质指数;WC. 腰围;SBP. 收缩压;DBP. 舒张压;TC. 总胆固醇;TG. 甘油三酯;HDL-C. 高密度脂蛋白胆固醇;LDL-C. 低密度脂蛋白胆固醇
    下载: 导出CSV

    表  2  心脑血管疾病发病危险因素的单因素Cox回归分析

    Table  2.   Univariate Cox regression analysis on risk factors for cardio-cerebrovascular disease

      变量βHR值(95%CItP
    性别
     男性 1.00     
     女性 −0.16 0.85 (0.72~1.01) −2.11 0.061
    年龄 0.06 1.06 (1.06~1.07) 18.38 <0.001
    文化程度
     初中及以下 1.00     
     高中及以上 −0.73 0.48 (0.37~0.62) −6.35 <0.001
    婚姻状态
     已婚/同居 1.00     
     未婚/离婚/丧偶/分居 0.24 1.27 (1.03~1.56) 2.53 0.030
    城乡
     城市 1.00     
     农村 −0.42 0.66 (0.38~1.15) −1.66 0.128
    吸烟
     否 1.00     
     是 0.30 1.35 (1.13~1.61) 3.81 0.003
    饮酒
     否 1.00     
     是 −0.36 0.70 (0.58~0.85) −4.13 0.002
    蔬菜水果摄入不足
     否 1.00     
     是 −0.11 0.90 (0.67~1.21) −0.82 0.430
    红肉摄入过多
     否 1.00     
     是 −0.16 0.85 (0.40~1.85) −0.46 0.657
    体力活动
     高水平 1.00     
     中等水平 0.44 1.55 (1.13~2.13) 3.05 0.012
     低水平 0.36 1.44 (1.17~1.77) 3.86 0.003
    高血压服药
     否 1.00     
     是 1.60 4.97 (3.75~6.58) 12.67 <0.001
    糖尿病
     否 1.00     
     是 0.95 2.60 (1.95~3.46) 7.37 <0.001
    BMI (kg/m2 0.03 1.03 (1.01~1.05) 3.32 0.008
    WC (cm) 0.02 1.02 (1.00~1.03) 2.51 0.031
    SBP (mmHg) 0.03 1.03 (1.02~1.04) 7.03 <0.001
    DBP (mmHg) 0.03 1.04 (1.02~1.05) 5.05 <0.001
    心率 (次/分) 0.00 1.00 (0.99~1.02) 0.47 0.650
    TC (mmol/L) 0.16 1.17 (0.99~1.39) 2.05 0.068
    TG (mmol/L) 0.10 1.10 (1.02~1.19) 2.84 0.018
    HDL-C (mmol/L) −0.42 0.66 (0.37~1.17) −1.61 0.138
    LDL-C (mmol/L) 0.22 1.25 (1.04~1.50) 2.68 0.023
    注:BMI. 体质指数;WC. 腰围;SBP. 收缩压;DBP. 舒张压;TC. 总胆固醇;TG. 甘油三酯;HDL-C. 高密度脂蛋白胆固醇;LDL-C. 低密度脂蛋白胆固醇;HR, 风险比;CI, 置信区间
    下载: 导出CSV

    表  3  心脑血管疾病预测模型纳入变量分析

    Table  3.   Analysis on variables included in prediction model of cardio-cerebrovascular disease

    新纳入危险因素危险因素系数PC统计量 (95%CIPaNRI (95%CI
    模型10.76 (0.74~0.78)
    模型1+性别0.9410.76 (0.74~0.78)0.525−0.03 (−0.09~0.13)
    模型1+文化程度0.1580.76 (0.74~0.78)0.9600.20 (−0.13~0.28)
    模型1+婚姻状态0.2830.76 (0.74~0.78)0.020−0.24 (−0.31~0.33)
    模型1+城乡0.1130.76 (0.74~0.77)0.0800.10 (0.01~0.18)
    模型1+饮酒0.8440.76 (0.74~0.78)0.8360.08 (−0.06~0.15)
    模型1+体力活动0.0030.76 (0.74~0.78)0.8210.11 (0.02~0.17)
    模型1+BMI0.5880.76 (0.74~0.78)0.7690.05 (−0.04~0.14)
    模型1+WC0.3860.76 (0.74~0.78)0.1840.05 (−0.05~0.13)
    模型1+DBP0.5560.76 (0.74~0.78)0.9860.19 (0.03~0.32)
    模型1+TC0.7640.76 (0.74~0.78)0.6190.13 (−0.16~0.28)
    模型1+TG0.1540.76 (0.74~0.78)0.0580.19 (−0.21~0.31)
    模型1+HDL-C0.2120.76 (0.74~0.78)0.3150.09 (−0.06~0.18)
    模型1+LDL-C0.1350.76 (0.74~0.78)0.8650.19 (−0.10~0.27)
    注:a. 与模型1的C统计量进行比较的P值;BMI. 体质指数;WC. 腰围;TC. 总胆固醇;TG. 甘油三酯;HDL-C. 高密度脂蛋白胆固醇;LDL-C. 低密度脂蛋白胆固醇;NRI. 净重分类指数;CI. 置信区间;−表示无数据
    下载: 导出CSV

    表  4  心脑血管疾病发病风险预测模型参数

    Table  4.   Parameters of risk prediction model of cardio-cerebrovascular disease

      变量β$S\bar x$HR (95%CIt值P
    年龄0.050.001.05 (1.04~1.06)12.67<0.001
    收缩压0.010.001.01 (1.01~1.02)4.510.001
    吸烟(1=是,0=否)0.370.091.44 (1.19~1.74)4.270.002
    高血压服药(1=是,0=否)0.600.141.81 (1.32~2.50)4.140.002
    糖尿病(1=是,0=否)0.400.131.49 (1.11~2.00)2.980.014
    注:HR. 风险比;CI. 置信区间
    下载: 导出CSV
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出版历程
  • 收稿日期:  2023-03-13
  • 网络出版日期:  2023-08-09
  • 刊出日期:  2023-11-07

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