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Comparison of risk-assessment tools for cardio-cerebrovascular diseases (CVD) in male shipyard workers: a
Jea Chul Ha1, Jun Seok Son1, Young Ouk Kim1
1Department of Occupational and Environmental Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
Insights
The National Health Screening Program (NHS) HRA 2018 tool shows promise for assessing cardio-cerebrovascular diseases (CVDs) risk in workplaces. Adjusting classification criteria is key to improving the Korea Occupational Safety and Health Agency (KOSHA) guideline
Area of Science:
- Occupational Health
- Cardiovascular Epidemiology
- Risk Assessment
Background:
- Periodic revision of assessment tools is crucial for reliable and valid risk assessment in occupational health.
- The Korea Occupational Safety and Health Agency (KOSHA) 2018 revision lacks comparative evidence against other cardio-cerebrovascular diseases (CVDs) risk-assessment tools for workplace health management.
- A comparative analysis is needed to identify the most effective CVDs risk-assessment tool for workplace health management, using the Framingham risk score (FRS) as a gold standard.
Purpose of the Study:
- To compare the effectiveness of various CVDs risk-assessment tools in a workplace setting.
- To evaluate the KOSHA 2018 revision against other tools, including the FRS, KOSHA 2013, KOSHA 2017, and National Health Screening Program health risk appraisal (NHS HRA) 2017 and 2018.
- To identify the most suitable risk-assessment tool for workplace health management.
Main Methods:
- A cohort of 4,460 shipyard workers undergoing health examinations in 2016 was analyzed.
- Cardio-cerebrovascular diseases (CVDs) risk levels were calculated using the Framingham risk score (FRS) as a gold standard, alongside KOSHA 2013, KOSHA 2017, KOSHA 2018 (two methods), NHS HRA 2017, and NHS HRA 2018.
- Statistical analysis included sensitivity, specificity, correlation (Spearman's rank correlation coefficient), and agreement (linearly weighted kappa coefficient) compared to the FRS.
Main Results:
- The KOSHA 2018 (health risk appraisal [HRA]) demonstrated the highest sensitivity.
- Correlation coefficients with the FRS ranged from 0.288 (NHS HRA 2017) to 0.622 (NHS HRA 2018).
- Agreement (kappa values) with the FRS was highest for NHS HRA 2018 (0.559), followed by KOSHA 2018 (0.352).
Conclusions:
- The NHS HRA 2018 is a valuable tool for CVDs risk assessment when appropriate classification criteria are employed.
- The study proposes adopting classification criteria based on the 2018 Korean Society of Hypertension guidelines to improve the KOSHA 2018 guideline's risk-group identification capability.
- Enhancing the KOSHA guideline's classification criteria is recommended for more effective workplace health management regarding CVDs risk.
Background:
Periodic revision of assessment tools is essential to ensure risk assessment reliability and validity. Despite the recent revision of the Korea Occupational Safety and Health Agency (KOSHA) 2018, there is no evidence showing that the revision is superior to other cardio-cerebrovascular diseases (CVDs) risk-assessment tools for workplace health management. We conducted a comparative analysis using the Framingham risk score (FRS) as a gold standard to identify the most relevant CVDs risk-assessment tool for workplace health management.
Methods:
We included 4,460 shipyard workers who had undergone a workers' health examination during January-December 2016. Risk levels for CVDs were calculated based on the FRS, KOSHA 2013, KOSHA 2017, KOSHA 2018 (2 methods), National Health Screening Program health risk appraisal (NHS HRA) 2017, and NHS HRA 2018. Study participants were categorized into low-risk, moderate-risk, or high-risk groups. Sensitivity, specificity, correlation, and agreement of each risk-assessment tool were calculated compared with the FRS as a gold standard. For statistical analyses, Spearman's rank correlation coefficient and the linearly weighted kappa coefficient were calculated.
Results:
Sensitivity of the risk assessments was highest in the KOSHA 2018 (health risk appraisal [HRA]). The FRS showed correlation coefficients of 0.354 with the KOSHA 2013, 0.396 with the KOSHA 2017, 0.386 with the KOSHA 2018, 0.505 with the KOSHA 2018 (HRA), 0.288 with the NHS HRA 2017, and 0.622 with the NHS HRA 2018. Kappa values, calculated to examine the agreement in relation to the KOSHA 2013, KOSHA 2017, KOSHA 2018, KOSHA 2018 (HRA), NHS HRA 2017, and NHS HRA 2018 with the FRS, were 0.268, 0.322, 0.352, 0.136, 0.221, and 0.559, respectively.
Conclusions:
The NHS HRA 2018 risk calculation method is a useful risk-assessment tool for CVDs, but only when appropriate classification criteria are applied. In order to enhance the risk-group identification capability of the KOSHA guideline, we propose to apply the classification criteria set in this study based on the risk group definition of the 2018 Korean Society of Hypertension guidelines for the management of hypertension instead of the current classification criteria of the KOSHA 2018.
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