title: Utility of existing diabetes risk prediction tools for young black and white adults: Evidence from the Bogalusa Heart Study.
abstract: To evaluate several adult diabetes risk calculation tools for predicting the development of incident diabetes and pre-diabetes in a bi-racial, young adult population.
  
  
  
  Surveys beginning in young adulthood (baseline age ≥18) and continuing across multiple decades for 2122 participants of the Bogalusa Heart Study were used to test the associations of five well-known adult diabetes risk scores with incident diabetes and pre-diabetes using separate Cox models for each risk score. Racial differences were tested within each model. Predictive utility and discrimination were determined for each risk score using the Net Reclassification Index (NRI) and Harrell's c-statistic.
  
  
  
  All risk scores were strongly associated (p<.0001) with incident diabetes and pre-diabetes. The Wilson model indicated greater risk of diabetes for blacks versus whites with equivalent risk scores (HR=1.59; 95% CI 1.11-2.28; p=.01). C-statistics for the diabetes risk models ranged from 0.79 to 0.83. Non-event NRIs indicated high specificity (non-event NRIs: 76%-88%), but poor sensitivity (event NRIs: -23% to -3%).
  
  
  
  Five diabetes risk scores established in middle-aged, racially homogenous adult populations are generally applicable to younger adults with good specificity but poor sensitivity. The addition of race to these models did not result in greater predictive capabilities. A more sensitive risk score to predict diabetes in younger adults is needed.
authors: Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112. Electronic address: bpollock@tulane.edu.
authors: Benjamin D
authors: BD
authors: Pollock
authors: Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112.
authors: Tian
authors: T
authors: Hu
authors: Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112.
authors: Wei
authors: W
authors: Chen
authors: Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112.
authors: Emily W
authors: EW
authors: Harville
authors: Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112.
authors: Shengxu
authors: S
authors: Li
authors: Department of Biostatistics & Bioinformatics, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112.
authors: Larry S
authors: LS
authors: Webber
authors: Department of Endocrinology, Tulane University School of Medicine, New Orleans, LA 70112.
authors: Vivian
authors: V
authors: Fonseca
authors: Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA 70112.
authors: Lydia A
authors: LA
authors: Bazzano
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis* / Q000208:ethnology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D011236:Prediabetic State / Q000175:diagnosis* / Q000208:ethnology / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Diabetes; Pre-diabetes; Race; Risk prediction; Young adults