Population-Level Heart Attack Risk Assessment Using Self-Reported Data: A Cross-Sectional Study with BRFSS 2023

The major cause of mortality in the country is still myocardial infarction, which is shaped by demographic, socioeconomic, and clinical elements. Despite research, there are still major gaps in understanding how these elements affect different populations. The present prediction models rely on laboratory values, which may be limited in resource-scarce settings. This study aimed to create and evaluate a heart attack risk prediction model by using a staging technique with demographic and clinical risk factors from the Behavioral Risk Factor Surveillance System 2023. Starting with a sample of 430,755 participants, this cross-sectional study randomly selected 100,000 participants with a fixed seed code cleaning the missing data and subsequently performing multiple imputations. The model adopted a staging approach, with four stages: (1) demographic factors including age, sex, race, income, and education; (2) diabetes (3) hypertension, and (4) cholesterol. The model performance was evaluated using AUC-ROC, calibration plots, and a sensitivity analysis. The overall heart attack prevalence based on these results was 5.3% (95% CI: 5.0-5.5%). The final model showed strong discrimination (AUC-ROC=0.80) and strong calibration. The strongest risk factors in this predictive model were ages  ≥ 70 (OR=6.58, 95% CI: 5:37-8.06), high cholesterol (OR=1.77), hypertension (OR=1.81), and diabetes (OR=1.50). There were protective associations identified, including female sex (OR=0.49) and having a college education (OR=0.42). Black (OR=0.62, 95% CI: 0.50-0.76), Hispanic (OR=0.76, 95% CI: 0.58-0.99), and Native American/Alaskan (OR=0.66, 95% CI: 0.54-0.81) people had lower odds of self-reported heart attack following adjustment compared to White participants. The model performance was consistent across sex groups, with an AUC-ROC, males=0.794 and females=0.787. The parsimonious model illustrated strong prediction can be achieved using self-reported data using a staging approach, which highlights incremental value of each risk factor contributing to a population-level heart attack risk assessment.