Development and validation of mortality prediction models based on the social determinants of health

BackgroundThere is no standardised approach to screening adults for social risk factors. The goal of this study was to develop mortality risk prediction models based on the social determinants of health (SDoH) for clinical risk stratification.MethodsData were used from REasons for Geographic And Rac...

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Bibliographic Details
Published in:Journal of epidemiology and community health (1979) 2024-08, Vol.78 (8), p.508-514
Main Authors: Fahoum, Khalid, Ringel, Joanna Bryan, Hirsch, Jana A, Rundle, Andrew, Levitan, Emily B, Reshetnyak, Evgeniya, Sterling, Madeline R, Ezeoma, Chiomah, Goyal, Parag, Safford, Monika M
Format: Article
Language:English
Subjects:
Accuracy
Aged
Black or African American - statistics & numerical data
Decision making
Discrimination
Educational attainment
Female
Health insurance
Health risks
Humans
Longitudinal Studies
Low income groups
Male
Marital status
Middle Aged
MORTALITY
Mortality - trends
Mortality risk
Original research
Physiology
Population studies
Prediction models
PREVENTIVE MEDICINE
Proportional Hazards Models
PUBLIC HEALTH
Race
Racism
Risk Assessment
Risk Factors
Risk groups
Sampling
SCREENING
Sensitivity analysis
Social Determinants of Health
Social isolation
Statistical analysis
Statistics
Systemic racism
United States - epidemiology
Variables
White - statistics & numerical data
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Summary:BackgroundThere is no standardised approach to screening adults for social risk factors. The goal of this study was to develop mortality risk prediction models based on the social determinants of health (SDoH) for clinical risk stratification.MethodsData were used from REasons for Geographic And Racial Differences in Stroke (REGARDS) study, a national, population-based, longitudinal cohort of black and white Americans aged ≥45 recruited between 2003 and 2007. Analysis was limited to participants with available SDoH and mortality data (n=20 843). All-cause mortality, available through 31 December 2018, was modelled using Cox proportional hazards with baseline individual, area-level and business-level SDoH as predictors. The area-level Social Vulnerability Index (SVI) was included for comparison. All models were adjusted for age, sex and sampling region and underwent internal split-sample validation.ResultsThe baseline prediction model including only age, sex and REGARDS sampling region had a c-statistic of 0.699. An individual-level SDoH model (Model 1) had a higher c-statistic than the SVI (0.723 vs 0.708, p
ISSN:0143-005X
1470-2738
1470-2738
DOI:10.1136/jech-2023-221287