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Calculating population attributable fraction for cardiovascular risk factors using different methods in a population
Sayyedeh Sara Azimi1, Davood Khalili2, Farzad Hadaegh3
1Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences and Center for Non-communicable disease Control, Deputy of Health, Ministry of health and medical Education, Tehran, Iran.
Journal of Research in Health Sciences
|March 31, 2015
Summary
Directly estimating Population Attributable Fraction (PAF) for cardiovascular disease (CVD) risk factors is more practical than indirect methods. This study found direct PAF estimation more expedient for public health strategies.
Area of Science:
- Epidemiology
- Public Health
- Biostatistics
Background:
- Cardiovascular disease (CVD) is a leading global cause of death.
- Accurate estimation of Population Attributable Fraction (PAF) for CVD risk factors is crucial for effective prevention.
- Calculating PAF presents challenges, necessitating evaluation of different methodologies.
Purpose of the Study:
- To estimate Population Attributable Fractions (PAFs) for cardiovascular disease (CVD) risk factors.
- To compare direct (regression-based) and indirect (equation-based) methods for PAF calculation.
- To determine the most expedient method for informing preventive strategies.
Main Methods:
- Utilized data from the Tehran Lipid and Glucose Study (TLGS) cohort (3200 males, 4245 females, aged ≥30 yr).
- Calculated Hazard Ratios (HR) and Odds Ratios (OR) for CVD events over ten years.
- Applied Levin's and Miettinen's equations for indirect PAF estimation and logistic regression for direct PAF estimation.
Main Results:
- Indirect PAF estimations summed to over 100% (approx. 200% and 150% via Levin's and Miettinen's formulas).
- Direct estimation attributed 80% of CVD burden in men and 86% in women to conventional risk factors.
- The ranking and pattern of risk factor PAFs varied significantly between direct and indirect methods.
Conclusions:
- The choice of PAF calculation method impacts the estimated burden and prioritization of risk factors.
- Direct PAF estimation is more expedient than indirect methods when individual-level data from population-based cohorts is available.
- Findings support the direct method for guiding public health interventions against CVD risk factors.
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