BMJ open · 2018
Predicting 7-year mortality for use with evidence-based guidelines for Prostate-Specific Antigen (PSA) testing: findings from a large prospective study of 123 697 Australian men.
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Joshy Grace, Banks Emily, Lowe Anthony, Wolfe Rory, Tickle Leonie, Armstrong Bruce, Clements Mark
Аннотация
OBJECTIVES: To develop and validate a prediction model for short-term mortality in Australian men aged ≥45years, using age and self-reported health variables, for use when implementing the Australian Clinical Practice Guidelines for Prostate-Specific Antigen (PSA) Testing and Early Management of Test-Detected Prostate Cancer. Implementation of one of the Guideline recommendations requires an estimate of 7-year mortality.
DESIGN: Prospective cohort study using questionnaire data linked to mortality data.
SETTING: Men aged ≥45years randomly sampled from the general population of New South Wales, Australia, participating in the 45 and Up Study.
PARTICIPANTS: 123 697 men who completed the baseline postal questionnaire (distributed from 1 January 2006 to 31 December 2008) and gave informed consent for follow-up through linkage of their data to population health databases.
PRIMARY OUTCOME MEASURES: The primary outcome was all-cause mortality.
RESULTS: 12 160 died during follow-up (median=5.9 years). Following age-adjustment, self-reported health was the strongest predictor of all-cause mortality (C-index: 0.827; 95% CI 0.824 to 0.831). Three prediction models for all-cause mortality were validated, with predictors: Model-1: age group and self-rated health; Model-2: variables common to the 45 and Up Study and the Australian Health Survey and subselected using stepwise regression and Model-3: all variables selected using stepwise regression. Final predictions calibrated well with observed all-cause mortality rates. The 90th percentile for the 7-year mortality risks ranged from 1.92% to 83.94% for ages 45-85 years.
CONCLUSIONS: We developed prediction scores for short-term mortality using age and self-reported health measures and validated the scores against national mortality rates. Along with age, simple measures such as self-rated health, which can be easily obtained without physical examination, were strong predictors of all-cause mortality in the 45 and Up Study. Seven-year mortality risk estimates from Model-3 suggest that the impact of the mortality risk prediction tool on men's decision making would be small in the recommended age (50-69 years) for PSA testing, but it may discourage testing at older ages.
DESIGN: Prospective cohort study using questionnaire data linked to mortality data.
SETTING: Men aged ≥45years randomly sampled from the general population of New South Wales, Australia, participating in the 45 and Up Study.
PARTICIPANTS: 123 697 men who completed the baseline postal questionnaire (distributed from 1 January 2006 to 31 December 2008) and gave informed consent for follow-up through linkage of their data to population health databases.
PRIMARY OUTCOME MEASURES: The primary outcome was all-cause mortality.
RESULTS: 12 160 died during follow-up (median=5.9 years). Following age-adjustment, self-reported health was the strongest predictor of all-cause mortality (C-index: 0.827; 95% CI 0.824 to 0.831). Three prediction models for all-cause mortality were validated, with predictors: Model-1: age group and self-rated health; Model-2: variables common to the 45 and Up Study and the Australian Health Survey and subselected using stepwise regression and Model-3: all variables selected using stepwise regression. Final predictions calibrated well with observed all-cause mortality rates. The 90th percentile for the 7-year mortality risks ranged from 1.92% to 83.94% for ages 45-85 years.
CONCLUSIONS: We developed prediction scores for short-term mortality using age and self-reported health measures and validated the scores against national mortality rates. Along with age, simple measures such as self-rated health, which can be easily obtained without physical examination, were strong predictors of all-cause mortality in the 45 and Up Study. Seven-year mortality risk estimates from Model-3 suggest that the impact of the mortality risk prediction tool on men's decision making would be small in the recommended age (50-69 years) for PSA testing, but it may discourage testing at older ages.
Предметные рубрики MeSH
AgedAged, 80 and overCause of DeathCohort StudiesDisability EvaluationEarly Detection of CancerEarly DiagnosisEarly Medical InterventionEvidence-Based MedicineGuideline AdherenceHumansKallikreinsMaleMiddle AgedNew South WalesPredictive Value of TestsProspective StudiesProstate-Specific AntigenProstatic NeoplasmsRiskSurvival Analysis