HEART & VASCULAR

Can a Polysocial Risk Score Help Identify Individuals at Increased Risk of Atherosclerotic Cardiovascular Disease?

Oct. 28, 2022 - Eden McCleskey

Houston Methodist researchers have developed and validated the first polysocial risk score for atherosclerotic cardiovascular disease (ASCVD), a tool that promises to highlight the role of social disparities and identify vulnerable individuals at increased risk for the condition.

In a recent study, the researchers showed that the tool, known as a PsRS, showed excellent calibration and discrimination for predicting ASCVD risk. The score included clinical, demographic and social determinants of health (SDOH) data.

"Our findings offer unique insights into the added value of social determinants of health as robust determinants of ASCVD, and their potential role in informing current and future approaches for tailored cardiovascular care, based on patients' unique SDOH burden," says Zulqarnain Javed, Ph.D., M.B.B.S., M.P.H., a cardiovascular epidemiologist at Houston Methodist Academic Institute and the study's lead author.

The study, published recently in the American Journal of Preventive Cardiology, found that ASCVD risk increased nearly four-fold between the lowest and highest PsRS scores, respectively denoting least and highest levels of social disadvantage.

The model, incorporating both social and clinical determinants of health, was a stronger predictor of ASCVD (c-statistic=0.862) than a model that included clinical factors only (c-statistic=0.852), further emphasizing the importance of social determinants in assessing ASCVD risk beyond traditional clinical risk factors. The PsRS accounted for individuals' age, sex and race/ethnicity and clinical risk profile, including diabetes, hypertension, hyperlipidemia and smoking status.

Socioeconomic factors such as educational attainment, economic stability, neighborhood and built environment, food security, transportation and access to health care have long been considered powerful predictors of population health. The extent to which these factors influence individuals' ASCVD risk — independent of one's clinical health status — has, until recently, been less clear.

Hoping to shed more light on the subject, a team of preventive cardiology researchers led by Dr. Javed and Dr. Khurram Nasir, chief of Cardiovascular Prevention and Wellness at Houston Methodist, generated the PsRS for ASCVD. The PsRS captures the comprehensive burden of an individual's social determinants of health without overloading the algorithm.

The derivation of the PsRS started with a regression analysis of 38 established social determinants of health.

"We realized early on that the number of social determinants was too unwieldy for most clinicians to track," says Dr. Javed. "Therefore, we sought to develop a robust prediction model with relatively fewer variables that could yield equally sensitive results."

Eventually, the research team landed on a practical model that narrowed the full suite of 38 social determinants of health down to just seven: inability to pay medical bills; unemployment; low income; psychological distress; food insecurity; delayed medical care due to lack of transport; and less than high school education.

The authors conducted ROC analysis to compare the performance of the model with clinical plus all 38 social determinants versus the model with clinical plus seven social determinants (the PsRS) and found the predictive power of both versions to be nearly identical.

"This shows that a highly sensitive model can be achieved by adding as few as seven social questions to the existing risk equation," explains Dr. Javed. "Most health care organizations will consider this a significantly easier lift than 38, which we believe makes polysocial risk score and SDOH screening checklists useful additions to any primary care physician or preventive cardiologist's toolkit."

 

This post is the second in a three-part series.

Read Part 1: Social Determinants of Health and Cardiovascular Disease: What's Driving the Shift in Research?

Read Part 3: Socially Vulnerable Counties Face Higher Premature Cardiovascular Mortality Rates