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  • Predicting 7-year mortality for use with evidence-based guidelines for Prostate-Specific Antigen (PSA) testing: findings from a large prospective study of 123 697 Australian men

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Epidemiology
Research
Predicting 7-year mortality for use with evidence-based guidelines for Prostate-Specific Antigen (PSA) testing: findings from a large prospective study of 123 697 Australian men
  1. Grace Joshy1,
  2. Emily Banks1,2,
  3. Anthony Lowe3,
  4. Rory Wolfe4,
  5. Leonie Tickle5,
  6. Bruce Armstrong6,
  7. Mark Clements7
  1. 1 National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
  2. 2 Sax Institute, Haymarket, New South Wales, Australia
  3. 3 Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
  4. 4 School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  5. 5 Department of Applied Finance and Actuarial Studies, Macquarie University, Sydney, New South Wales, Australia
  6. 6 School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
  7. 7 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Grace Joshy; grace.joshy{at}anu.edu.au

Abstract

Objectives To develop and validate a prediction model for short-term mortality in Australian men aged ≥45years, using age and self-reported health variables, for use when implementing the Australian Clinical Practice Guidelines for Prostate-Specific Antigen (PSA) Testing and Early Management of Test-Detected Prostate Cancer. Implementation of one of the Guideline recommendations requires an estimate of 7-year mortality.

Design Prospective cohort study using questionnaire data linked to mortality data.

Setting Men aged ≥45years randomly sampled from the general population of New South Wales, Australia, participating in the 45 and Up Study.

Participants 123 697 men who completed the baseline postal questionnaire (distributed from 1 January 2006 to 31 December 2008) and gave informed consent for follow-up through linkage of their data to population health databases.

Primary outcome measures The primary outcome was all-cause mortality.

Results 12 160 died during follow-up (median=5.9 years). Following age-adjustment, self-reported health was the strongest predictor of all-cause mortality (C-index: 0.827; 95% CI 0.824 to 0.831). Three prediction models for all-cause mortality were validated, with predictors: Model-1: age group and self-rated health; Model-2: variables common to the 45 and Up Study and the Australian Health Survey and subselected using stepwise regression and Model-3: all variables selected using stepwise regression. Final predictions calibrated well with observed all-cause mortality rates. The 90th percentile for the 7-year mortality risks ranged from 1.92% to 83.94% for ages 45–85 years.

Conclusions We developed prediction scores for short-term mortality using age and self-reported health measures and validated the scores against national mortality rates. Along with age, simple measures such as self-rated health, which can be easily obtained without physical examination, were strong predictors of all-cause mortality in the 45 and Up Study. Seven-year mortality risk estimates from Model-3 suggest that the impact of the mortality risk prediction tool on men’s decision making would be small in the recommended age (50–69 years) for PSA testing, but it may discourage testing at older ages.

  • mortality prediction
  • self-rated health
  • life expectancy
  • Australian men
  • validation
  • 45 and up study
  • calibration
  • cox model

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-022613

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    Footnotes

    • Contributors BA, AL and EB conceived the project. GJ and MC wrote the analysis plan. GJ and MC conducted the analysis and drafted the initial version of the manuscript, with methodological input from RW and LT. All authors contributed to a review of the analysis plan, interpretation of results and revisions of the manuscript.

    • Funding This research was cofunded by Actuaries Institute and Prostate Cancer Foundation of Australia. A VICBiostat visiting fellowship awarded to author GJ supported the statistical analysis.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval NSW Population and Health Services Research Ethics Committee, the University of NSW Human Research Ethics Committee and the Australian National University Human Research Ethics Committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Information about data access and governance policies is available at: https://www.saxinstitute.org.au/our-work/45-up-study/for-researchers/.