title: Predicting Stroke Risk Based on Health Behaviours: Development of the Stroke Population Risk Tool (SPoRT).
abstract: BACKGROUND
  Health behaviours, important factors in cardiovascular disease, are increasingly a focus of prevention. We appraised whether stroke risk can be accurately assessed using self-reported information focused on health behaviours.
  
  
  METHODS
  Behavioural, sociodemographic and other risk factors were assessed in a population-based survey of 82,259 Ontarians who were followed for a median of 8.6 years (688,000 person-years follow-up) starting in 2001. Predictive algorithms for 5-year incident stroke resulting in hospitalization were created and then validated in a similar 2007 survey of 28,605 respondents (median 4.2 years follow-up).
  
  
  RESULTS
  We observed 3236 incident stroke events (1551 resulting in hospitalization; 1685 in the community setting without hospital admission). The final algorithms were discriminating (C-stat: 0.85, men; 0.87, women) and well-calibrated (in 65 of 67 subgroups for men; 61 of 65 for women). An index was developed to summarize cumulative relative risk of incident stroke from health behaviours and stress. For men, each point on the index corresponded to a 12% relative risk increase (180% risk difference, lowest (0) to highest (9) scores). For women, each point corresponded to a 14% relative risk increase (340% difference, lowest (0) to highest (11) scores). Algorithms for secondary stroke outcomes (stroke resulting in death; classified as ischemic; excluding transient ischemic attack; and in the community setting) had similar health behaviour risk hazards.
  
  
  CONCLUSIONS
  Incident stroke can be accurately predicted using self-reported information focused on health behaviours. Risk assessment can be performed with population health surveys to support population health planning or outside of clinical settings to support patient-focused prevention.
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada.|Statistics Canada, Ottawa, Ontario, Canada.|Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.|Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.|Bruyère Research Institute, Ottawa, Ontario, Canada.
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Manuel
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: Richard
authors.initials: R
authors.lastname: Perez
authors.affiliation: Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada.|Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Tanuseputro
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|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.
authors.forename: Carol
authors.initials: C
authors.lastname: Bennett
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: Statistics Canada, Ottawa, Ontario, Canada.
authors.forename: Claudia
authors.initials: C
authors.lastname: Sanmartin
authors.affiliation: Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Ottawa and Toronto, Ontario, Canada.|Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.|Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Carl
authors.initials: C
authors.lastname: van Walraven
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
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005260:Female; D015438:Health Behavior; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods; D057566:Self Report; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology*; D055815:Young Adult