title: Cardiovascular Disease Population Risk Tool (CVDPoRT): predictive algorithm for assessing CVD risk in the community setting. A study protocol.
abstract: BACKGROUND
  Recent publications have called for substantial improvements in the design, conduct, analysis and reporting of prediction models. Publication of study protocols, with prespecification of key aspects of the analysis plan, can help to improve transparency, increase quality and protect against increased type I error. Valid population-based risk algorithms are essential for population health planning and policy decision-making. The purpose of this study is to develop, evaluate and apply cardiovascular disease (CVD) risk algorithms for the population setting.
  
  
  METHODS
  The Ontario sample of the Canadian Community Health Survey (2001, 2003, 2005; 77,251 respondents) will be used to assess risk factors focusing on health behaviours (physical activity, diet, smoking and alcohol use). Incident CVD outcomes will be assessed through linkage to administrative healthcare databases (619,886 person-years of follow-up until 31 December 2011). Sociodemographic factors (age, sex, immigrant status, education) and mediating factors such as presence of diabetes and hypertension will be included as predictors. Algorithms will be developed using competing risks survival analysis. The analysis plan adheres to published recommendations for the development of valid prediction models to limit the risk of overfitting and improve the quality of predictions. Key considerations are fully prespecifying the predictor variables; appropriate handling of missing data; use of flexible functions for continuous predictors; and avoiding data-driven variable selection procedures. The 2007 and 2009 surveys (approximately 50,000 respondents) will be used for validation. Calibration will be assessed overall and in predefined subgroups of importance to clinicians and policymakers.
  
  
  BACKGROUND
  This study has been approved by the Ottawa Health Science Network Research Ethics Board. The findings will be disseminated through professional and scientific conferences, and in peer-reviewed journals. The algorithm will be accessible electronically for population and individual uses.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02267447.
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Monica
authors.initials: M
authors.lastname: Taljaard
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada.
authors.forename: Meltem
authors.initials: M
authors.lastname: Tuna
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada.
authors.forename: Carol
authors.initials: C
authors.lastname: Bennett
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Perez
authors.affiliation: Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada.|Public Health Ontario, Toronto, Ontario, Canada.|Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Rosella
authors.affiliation: Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada.|Sunnybrook Schulich Heart Centre, University of Toronto, Toronto, Ontario, Canada.|Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jack V
authors.initials: JV
authors.lastname: Tu
authors.affiliation: Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada.
authors.forename: Claudia
authors.initials: C
authors.lastname: Sanmartin
authors.affiliation: Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada.
authors.forename: Deirdre
authors.initials: D
authors.lastname: Hennessy
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada.|Bruyère Research Institute, Ottawa, Ontario, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Tanuseputro
authors.affiliation: Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Lebenbaum
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada.|Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada.|Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.|Bruyère Research Institute, Ottawa, Ontario, Canada.
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Manuel
mesh_terms: D000367:Age Factors; D000428:Alcohol Drinking / Q000453:epidemiology; D000465:Algorithms; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology; D015331:Cohort Studies; D003661:Decision Support Techniques; D003920:Diabetes Mellitus / Q000453:epidemiology; D004032:Diet / Q000706:statistics & numerical data; D004522:Educational Status; D004641:Emigration and Immigration / Q000706:statistics & numerical data; D015444:Exercise; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D009864:Ontario / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods; D012907:Smoking / Q000453:epidemiology
keywords: EPIDEMIOLOGY; PUBLIC HEALTH; STATISTICS & RESEARCH METHODS