title: Ten-year risk of all-cause mortality: assessment of a risk prediction algorithm in a French general population.
abstract: While assessment of global cardiovascular risk is uniformly recommended for risk factor management, prediction of all-cause death has seldom been considered in available charts. We established an updated algorithm to predict absolute 10-year risk of all-cause mortality in apparently healthy subjects living in France, a country with high life expectancy. Analyses were based on the Third French MONICA Survey on cardiovascular risk factors (1995-1996) carried out in 3,208 participants from the general population aged 35-64. Vital status was obtained 10 years after inclusion and assessment of determinants of mortality was based on multivariable Cox modelling. One-hundred-fifty-six deaths were recorded. Independent determinants of mortality were living area (Northern France), older age, male gender, no high-school completion, smoking, systolic blood pressure ≥ 160 mmHg, LDL-cholesterol ≥ 5.2 mmol/l, and diabetes. Score sheets were developed to easily estimate 10-year risk of death. For example, a non diabetic, heavy smoker, 46-year old man, living in South-Western France, who did not complete high-school, with LDL-cholesterol ≥ 5.2 mmol/l and systolic blood pressure < 160 mmHg, has a 17% probability of death in the ten coming years. The C-statistic of the prediction model was 0.76 [95% CI: 0.72-0.80] with a degree of overoptimism estimated at 0.0058 in a bootstrap sample. Calibration was satisfying: P value for Hosmer-Lemeshow χ(2) test was 0.483. This prediction algorithm is a simple tool for guiding practitioners towards a more or less aggressive management of risk factors in apparently healthy subjects.
authors.affiliation: Department of Epidemiology, Health Economics and Public Health, Centre Hospitalier Universitaire de Toulouse, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Bérard
authors.forename: Vanina
authors.initials: V
authors.lastname: Bongard
authors.forename: Dominique
authors.initials: D
authors.lastname: Arveiler
authors.forename: Philippe
authors.initials: P
authors.lastname: Amouyel
authors.forename: Aline
authors.initials: A
authors.lastname: Wagner
authors.forename: Jean
authors.initials: J
authors.lastname: Dallongeville
authors.forename: Bernadette
authors.initials: B
authors.lastname: Haas
authors.forename: Dominique
authors.initials: D
authors.lastname: Cottel
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Ruidavets
authors.forename: Jean
authors.initials: J
authors.lastname: Ferrières
mesh_terms: D000328:Adult; D000465:Algorithms; D002423:Cause of Death / Q000639:trends*; D015331:Cohort Studies; D005260:Female; D005544:Forecasting; D005602:France / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D016019:Survival Analysis