Supporting Vascular Risk Assessment: QDScore Julia Hippisley-Cox 15 th April 2010

Supporting Vascular Risk Assessment: QDScore

www.qdscore.org

Julia Hippisley-Cox15th April 2010

04Feb2009 QRisk © 2008 All rights reserved

Background Diabetes major causes of morbidity and

mortality Many risk factors overlap with CVD Interventions may prevent upto 2/3 cases Early diagnosis improves outcomes Evidence that intervention is cost-effective Existing evidence of health inequalities Previous scores limited by size and

samples

QRisk © 2008 All rights reserved

Methodology QDScore Similar to QRISK2 E&W Cohort analysis based QResearch First diagnosis of type 2 diabetes 15 year study period 1993 to 2008 2.5m patients aged 25-79 78,000 new cases Type 2 diabetes Largest ever such study worldwide


Risk Factors in Diabetes Score(suitable for patient self assessment)

Age & Sex Deprivation & Self Assigned Ethnicity Body Mass Index Smoking Status Family history of diabetes Treated Hypertension Corticosteroids* Cardiovascular Disease


Self Assigned Ethnicity Initial analysis NHS 16+1 categories Categories used for analysis

White Indian Pakistani Bangladeshi Other Asian Black Caribbean Black African Chinese Other


Comparison with CRS

Compared performance with Cambridge Risk Score (CRS)

CRS has similar variables but doesn’t have Ethnicity Deprivation CVD

Also CRS not based on cohort


Validation

0ne third sample of QR database (independent practices)

Similar statistical tests to previous study

Independent external validation by Oxford (in press)


Age-standardised Incidence of Diabetes by Ethnicity per 1000

02468

101214161820

Females Males

WhiteIndianPakistaniBangladeshiOther AsianBlack CaribbeanBlack AfricanChineseOther


Age standardised prevalence risk factors in men

05

101520253035404550

smokers FH diabetes Hypertension

White/ not recordedIndianPakistaniBangladeshiOther AsianBlack CaribbeanBlack AfricanChineseOther


Risk Ratios for Diabetes

00.5

11.5

22.5

33.5

44.5

5

female (DM) Males (DM)

Haza

rd r

ati

o

WhiteIndianPakistaniBangladeshiOther AsianCaribbeanBlack AfricanChineseOther

How might we use this?

No existing threshold for screening If we risk score the entire

population and take top 10% We will capture half of all the new

cases of diabetes in the next 10 years

If we take top 20% then we will capture 70% of new cases.

22nd May 2008 QRisk © 2008 All rights reserved

Summary QDSCore

1st score to predict 10 yr risk diabetes incl ethnicity & deprivation

But no need for lab tests Better performance than existing

scores Can be applied to whole population Can be used at the point of care Can be used for self assessment04Feb2009


Documents

Supporting Vascular Risk Assessment: QDScore Julia Hippisley-Cox 15 th April 2010