Supporting Vascular Risk Assessment: QDScore www.qdscore.org www.qdscore.org Julia Hippisley-Cox 15 th April 2010.

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Presentation transcript:

Supporting Vascular Risk Assessment: QDScore Julia Hippisley-Cox 15 th April 2010

04Feb2009 QRisk © 2008 All rights reserved Background Diabetes major causes of morbidity and mortality Many risk factors overlap with CVD Interventions may prevent upto 2/3 cases Early diagnosis improves outcomes Evidence that intervention is cost-effective Existing evidence of health inequalities Previous scores limited by size and samples

QRisk © 2008 All rights reserved Methodology QDScore Similar to QRISK2 E&W Cohort analysis based QResearch First diagnosis of type 2 diabetes 15 year study period 1993 to m patients aged ,000 new cases Type 2 diabetes Largest ever such study worldwide

QRisk © 2008 All rights reserved Risk Factors in Diabetes Score (suitable for patient self assessment) Age & Sex Deprivation & Self Assigned Ethnicity Body Mass Index Smoking Status Family history of diabetes Treated Hypertension Corticosteroids* Cardiovascular Disease

QRisk © 2008 All rights reserved Self Assigned Ethnicity Initial analysis NHS 16+1 categories Categories used for analysis White Indian Pakistani Bangladeshi Other Asian Black Caribbean Black African Chinese Other

04Feb2009 QRisk © 2008 All rights reserved Comparison with CRS Compared performance with Cambridge Risk Score (CRS) CRS has similar variables but doesn’t have Ethnicity Deprivation CVD Also CRS not based on cohort

04Feb2009 QRisk © 2008 All rights reserved Validation 0ne third sample of QR database (independent practices) Similar statistical tests to previous study Independent external validation by Oxford (in press)

04Feb2009 QRisk © 2008 All rights reserved Age-standardised Incidence of Diabetes by Ethnicity per 1000

04Feb2009 QRisk © 2008 All rights reserved Age standardised prevalence risk factors in men

04Feb2009 QRisk © 2008 All rights reserved Risk Ratios for Diabetes

How might we use this? No existing threshold for screening If we risk score the entire population and take top 10% We will capture half of all the new cases of diabetes in the next 10 years If we take top 20% then we will capture 70% of new cases. 22 nd May 2008 QRisk © 2008 All rights reserved

Summary QDSCore 1 st score to predict 10 yr risk diabetes incl ethnicity & deprivation But no need for lab tests Better performance than existing scores Can be applied to whole population Can be used at the point of care Can be used for self assessment 04Feb2009 QRisk © 2008 All rights reserved