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J Ambul Care Manage. 2017 Oct/Dec;40(4):297-304. doi: 10.1097/JAC.0000000000000177.

Evidence on the Validity of a Comprehensive Health Risk Index and Implications for Ambulatory Care and Population Health Management.

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Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts (Drs Massaro and D'Agostino); Section of General Internal Medicine (Dr Murabito) and Department of Neurology (Dr Au), Boston University School of Medicine, Boston Massachusetts; National Heart, Lung, and Blood Institute, Framingham Heart Study, Framingham, Massachusetts (Drs Massaro, Murabito, Au, and D'Agostino); Institute for Health Metrics and Evaluation, University of Washington, Seattle (Ms Carnahan and Drs Murray and Lim); The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Ms Morgan and Drs Fisher and Nelson); and Department of Mathematics and Statistics, Boston University, Boston, Massachusetts (Dr D'Agostino).


A novel, comprehensive health risk index for adults has been validated and is now ready for use to improve the health of individuals and populations. This health risk index provides an estimate of the avoidable risk of death for adults 30 years or older. It includes 12 evidence-based clinical and behavioral risk factors and was validated on discrimination and calibration using the NHANES (National Health and Nutrition Examination Survey) and Framingham Heart Study cohorts. The results from both cohorts were consistent and similar. Discrimination was good, and calibration was acceptable but tended to overpredict mortality risk for females in the higher-risk deciles.

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