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Individual- and Area-Level SES in Diabetes Risk Prediction: The Multi-Ethnic Study of Atherosclerosis
Journal article   Open access   Peer reviewed

Individual- and Area-Level SES in Diabetes Risk Prediction: The Multi-Ethnic Study of Atherosclerosis

Paul J Christine, Rebekah Young, Sara D Adar, Alain G Bertoni, Michele Heisler, Mercedes R Carnethon, Rodney A Hayward and Ana V Diez Roux
American journal of preventive medicine, v 53(2)
Aug 2017
DOI: https://doi.org/10.1016/j.amepre.2017.04.019
PMID: 28625713
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://europepmc.org/articles/pmc5584566View
Accepted (AM)Open Access (License Unspecified),  Open

Abstract

Aged Atherosclerosis - epidemiology Diabetes Mellitus, Type 2 - epidemiology Diabetes Mellitus, Type 2 - prevention & control Ethnic Groups - statistics & numerical data Female Humans Male Middle Aged Proportional Hazards Models Prospective Studies Risk Assessment - methods Risk Assessment - statistics & numerical data Risk Factors Social Class
The purpose of this study was to evaluate if adding SES to risk prediction models based upon traditional risk factors improves the prediction of diabetes. Risk prediction models without and with individual- and area-level SES predictors were compared using the prospective Multi-Ethnic Study of Atherosclerosis. Cox proportional hazards models were utilized to estimate hazard ratios for SES predictors and to generate 10-year predicted risks for 5,021 individuals without diabetes at baseline followed from 2000 to 2012. C-statistics were used to compare model discrimination, and the proportion of individuals reclassified into higher or lower risk categories with the addition of SES predictors was calculated. The accuracy of risk prediction by SES was assessed by comparing observed and predicted risks across tertiles of the SES variables. Statistical analyses were performed in 2015-2016. Over a median of 9.2 years of follow-up, 615 individuals developed diabetes. Individual- and area-level SES variables did not significantly improve model discrimination or reclassify substantial numbers of individuals across risk categories. Models without SES predictors generally underestimated risk for low-SES individuals or individuals residing in low-SES areas (underestimates ranging from 0.31% to 1.07%) and overestimated risk for high-SES individuals or individuals residing in high-SES areas (overestimates ranging from 0.70% to 1.30%), and the addition of SES variables largely mitigated these differences. Standard diabetes risk models may underestimate risk for low-SES individuals and overestimate risk for those of high SES. Adding SES predictors helps correct this systematic misestimation, but may not improve model discrimination.

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9 Record Views
11 citations in Web of Science
11 citations in Scopus

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#10 Reduced Inequalities
#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Public, Environmental & Occupational Health
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