Agreement and Fairness of Cardiovascular Risk Assessment Models Among Older People Living With HIV in China: A...

Area of Science:

• Public Health
• Epidemiology
• Cardiology

Background:

• Cardiovascular disease (CVD) is a significant concern for people living with HIV (PLWH).
• Existing CVD prediction models may not accurately assess risk in diverse populations, including older Chinese PLWH.
• Understanding model agreement is crucial for reliable CVD risk stratification.

Purpose of the Study:

• To evaluate the agreement of commonly used 10-year CVD prediction models in older Chinese PLWH.
• To examine the fairness of these models across socioeconomically disadvantaged subgroups.
• To inform the development of future HIV-specific CVD risk prediction tools.

Main Methods:

• Cross-sectional study of 473 older Chinese PLWH.
• Calculated 10-year CVD risk using multiple models: D:A:D (2010 & 2016), Framingham Risk Score (FRS), Systematic COronary Risk Evaluation (SCORE), Pooled Cohort Equations (PCE), and Predicting Risk of Cardiovascular Disease EVENTs (PREVENT).
• Assessed model agreement using weighted Kappa statistics and conducted subgroup fairness analyses by sex, age, and employment status.

Main Results:

• Agreement between the D:A:D (2010) model and others ranged from 34% (SCORE low) to 77% (PCE).
• Observed poor agreement between D:A:D and FRS, SCORE, PCE, and PREVENT.
• The D:A:D (2010) model showed a greater difference in CVD risk between age groups (<60 vs. ≥60) compared to other models.

Conclusions:

• Current CVD prediction models exhibit poor agreement in older Chinese PLWH.
• Model fairness varies across demographic subgroups.
• Future HIV-specific CVD risk models should integrate HIV-related factors and social determinants of health, validated for Chinese populations.