Patients' sibling history was sensitive for hypertension and specific for diabetes

doi:10.1016/j.jclinepi.2003.10.008

Journal of Clinical Epidemiology

Volume 57, Issue 5, May 2004, Pages 497-501

https://doi.org/10.1016/j.jclinepi.2003.10.008 Get rights and content

Abstract

Objective

We examined the analytic validity of reported family history of hypertension and diabetes among siblings in the Seychelles.

Study design and setting

Four hundred four siblings from 73 families with at least two hypertensive persons were identified through a national hypertension register. Two gold standards were used prospectively. Sensitivity was the proportion of respondents who indicated the presence of disease in a sibling, given that the sibling reported to be affected (personal history gold standard) or was clinically affected (clinical status gold standard). Specificity was the proportion of respondents who reported an unaffected sibling, given that the sibling reported to be unaffected or was clinically unaffected. Respondents gave information on the disease status in their siblings in approximately two-thirds of instances.

Results

When sibling history could be obtained (n = 348 for hypertension, n = 404 for diabetes), the sensitivity and the specificity of the sibling history were, respectively, 90 and 55% for hypertension, and 61 and 98% for diabetes, using clinical status and, respectively, 89 and 78% for hypertension, and 53 and 98% for diabetes, using personal history.

Conclusion

The sibling history, when available, is a useful screening test to detect hypertension, but it is less useful to detect diabetes.

Introduction

Family history plays an important role in the prevention and clinical management of common chronic diseases [1]. Major modifiable cardiovascular risk factors, such as hypertension and diabetes, result from the complex interaction of several genetic and environmental factors and show familial aggregation [2]. By its ability to capture genetic information and gene–environment interactions, family history is a useful tool to predict the risk of future cardiovascular disease within family members [3]. An African study [4] found, for example, that individuals with a positive family history of hypertension had higher blood pressure, and those with a positive family history of diabetes had higher blood glucose. A case–control study conducted in South Africa observed a fourfold increased risk of diabetes in patients with a positive family history of diabetes [5].

Assessing the analytic validity of the family history is a key element in the evaluation of family history as a screening tool [6]. The analytic validity, that is, the sensitivity and specificity, indicates how accurately and reliably the family history can identify a particular disease in a family member of a respondent. Few studies have evaluated the analytic validity of the family history of diabetes [6], [7], [8] and hypertension [7], [8], [9]. Among them, only one has validated the relatives' disease status for hypertension [9].

In this report, we examined the analytic validity of reported family history of hypertension and diabetes mellitus among siblings in a middle income African country. All participants had their disease status validated through clinical measurement.

Section snippets

Population and methods

The study took place in the Republic of Seychelles, Indian Ocean, a middle-income country with a high prevalence of hypertension, diabetes, and other risk factors [10], [11], [12], [13]. Health care is delivered through a national health system, and medical care and treatment are free of charge to all inhabitants. More than 80% of adults seek primary health care at least once per year, and the basic knowledge on hypertension is fairly good among the adult population [14]. We used data from an

Results

Among the 404 participating siblings from 73 families, personal history data were available in 384 siblings for hypertension and in 404 for diabetes. The number of siblings per family varied from 2 to 11 with a median of 8. Information about the siblings' hypertension and diabetes were obtained for 1,588 respondent-sibling pairs. We excluded 122 pairs for hypertension and 13 pairs for diabetes because the personal disease status was unknown or the response missing, leaving respectively 1,466

Discussion

The analytic validity of the sibling history to identify hypertension and diabetes among siblings was assessed using two gold standards, the personal history provided by the sibling and the clinical status of the sibling. Although the sibling's clinical status reflects the sibling's actual cardiovascular risk, the sibling's personal history provides the best possible information that a respondent, when asked about a sibling's disease status, can be expected to know. Information on personal

Acknowledgements

The authors thank Dr Laurent Schild (Faculty of medicine of Lausanne) for helpful comments. The study benefited from a grant from the Swiss National Science Foundation (TANDEM No 31-51115.97).

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Put the Family Back in Family Health History: A Multiple-Informant Approach
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Accordingly, many advocate using FHH for preventing complex diseases such as heart disease and Type 2 diabetes mellitus (T2DM).5–7 In clinical practice, FHH is routinely collected but underutilized, owing in part to inaccuracy in self-reports.8–12 When validated with medical records, accuracy of individuals’ reports of parental history is 74% for heart disease, about 60% for T2DM, about 50% for hypertension, and less than 20% for high cholesterol.11
An accurate family health history is essential for individual risk assessment. This study uses a multiple-informant approach to examine whether family members have consistent perceptions of shared familial risk for four common chronic conditions (heart disease, Type 2 diabetes, high cholesterol, and hypertension) and whether accounting for inconsistency in family health history reports leads to more accurate risk assessment.
In 2012–2013, individual and family health histories were collected from 127 adult informants of 45 families in the Greater Cincinnati Area. Pedigrees were linked within each family to assess inter-informant (in)consistency regarding common biological family member’s health history. An adjusted risk assessment based on pooled pedigrees of multiple informants was evaluated to determine whether it could more accurately identify individuals affected by common chronic conditions, using self-reported disease diagnoses as a validation criterion. Analysis was completed in 2015–2016.
Inter-informant consistency in family health history reports was 54% for heart disease, 61% for Type 2 diabetes, 43% for high cholesterol, and 41% for hypertension. Compared with the unadjusted risk assessment, the adjusted risk assessment correctly identified an additional 7%–13% of the individuals who had been diagnosed, with a ≤2% increase in cases that were predicted to be at risk but had not been diagnosed.
Considerable inconsistency exists in individual knowledge of their family health history. Accounting for such inconsistency can, nevertheless, lead to a more accurate genetic risk assessment tool. A multiple-informant approach is potentially powerful when coupled with technology to support clinical decisions.
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In other words, family history reporting is more accurate when relatives have correct knowledge about their own personal health status. Bochud et al. [14] reported a smaller improvement in sensitivity for diabetes but no improvement for hypertension. In their study, the sensitivity for hypertension was already very high (89.0%), likely because all subjects were relatives of patients who participated in a hypertension study.
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Original ArticlesPatients' sibling history was sensitive for hypertension and specific for diabetes

Abstract

Objective

Study design and setting

Results

Conclusion

Introduction

Section snippets

Population and methods

Results

Discussion

Acknowledgements

Am J Prev Med

Am J Prev Med

J Clin Epidemiol

J Clin Epidemiol

Am J Prev Med

Familial aggregation of cardiovascular diseases in African-American pedigrees

Genet Epidemiol

Family history: an opportunity for early interventions and improved control of hypertension, obesity and diabetes

Bull World Health Organ

Importance of family history in type 2 black South African diabetic patients

Postgrad Med J

Accuracy of reported family history of diabetes mellitus. Results from San Luis Valley Diabetes Study

Diabetes Care

Original Articles
Patients' sibling history was sensitive for hypertension and specific for diabetes