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Abstract
Background and Objectives Female-specific factors and psychosocial factors may be important in the prediction of stroke but are not included in prediction models that are currently used. We investigated whether addition of these factors would improve the performance of prediction models for the risk of stroke in women younger than 50 years.
Methods We used data from the Stichting Informatievoorziening voor Zorg en Onderzoek, population-based, primary care database of women aged 20–49 years without a history of cardiovascular disease. Analyses were stratified by 10-year age intervals at cohort entry. Cox proportional hazards models to predict stroke risk were developed, including traditional cardiovascular factors, and compared with models that additionally included female-specific and psychosocial factors. We compared the risk models using the c-statistic and slope of the calibration curve at a follow-up of 10 years. We developed an age-specific stroke risk prediction tool that may help communicating the risk of stroke in clinical practice.
Results We included 409,026 women with a total of 3,990,185 person-years of follow-up. Stroke occurred in 2,751 women (incidence rate 6.9 [95% CI 6.6–7.2] per 10,000 person-years). Models with only traditional cardiovascular factors performed poorly to moderately in all age groups: 20–29 years: c-statistic: 0.617 (95% CI 0.592–0.639); 30–39 years: c-statistic: 0.615 (95% CI 0.596–0.634); and 40–49 years: c-statistic: 0.585 (95% CI 0.573–0.597). After adding the female-specific and psychosocial risk factors to the reference models, the model discrimination increased moderately, especially in the age groups 30–39 (Δc-statistic: 0.019) and 40–49 years (Δc-statistic: 0.029) compared with the reference models, respectively.
Discussion The addition of female-specific factors and psychosocial risk factors improves the discriminatory performance of prediction models for stroke in women younger than 50 years.
Glossary
- aHR=
- adjusted HR;
- ATC=
- Anatomical Therapeutic Chemical;
- EHR=
- electronic health record;
- HR=
- hazard ratio;
- ICD-9=
- International Classification of Diseases, Ninth Revision;
- ICD-10=
- International Classification of Diseases, Tenth Revision;
- ICPC=
- International Classification of Primary Care;
- SCORE2=
- Systematic COronary Risk Evaluation 2;
- STIZON=
- Stichting Informatievoorziening voor Zorg en Onderzoek
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Editor-in-Chief José Merino, MD, MPhil, FAAN.
CME Course: NPub.org/cmelist
- Received August 26, 2022.
- Accepted in final form April 25, 2023.
- © 2023 American Academy of Neurology
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