Risk Factors

A risk factor is a condition that is associated with an increased likelihood of a disease. For example, obesity is a risk factor for diabetes; obesity makes it more likely that a person will develop diabetes in his or her lifetime compared with someone who is not obese. Some risk factors are causal; the risk factor causes the disease. For example, smoking is a risk factor for and a proven cause of lung cancer; a smoker is many times more likely than a nonsmoker to develop lung cancer in his or her lifetime. Other risk factors are associations; people living at northern latitudes are more likely to have multiple sclerosis (i.e., there is no known causal relationship; it is simply an association). Risk factors for having a heart attack include gender, age, hypertension, smoking, and high cholesterol levels; other risk factors include sedentary lifestyle, obesity, and diabetes. Some risk factors are modifiable (i.e., can be changed), such as smoking, level of physical activity, and cholesterol levels, and others are nonmodifiable, such as age, gender, family history, and race. Some risk factors are behavioral risk factors, such as alcohol use, physical activity, and diet, and some type of change in behavior is required to modify these risk factors. Modifiable behavioral risk factors are significant contributors to most of the leading causes of death in the United States (Table 6-2). Preventive services strive to identify and change modifiable risk factors to prevent or delay disease.

When considering prevention programs, it is often cost-effective to target populations who have a higher risk of disease rather than to offer the service to the general population, in whom the risk factor or disease may be uncommon overall. For example, some sexually transmitted infections

Table 6-2 The 15 Leading Causes of Death—United States, 2006

are rare in the general population but are more prevalent among certain groups of people. In some areas of the United States, gonorrhea has a prevalence of zero, whereas other areas have concentrated populations with gonorrhea. If community clinicians were asked to design a program to prevent gonorrhea, they might selectively screen those with risk factors or those living in communities with a documented high prevalence of gonorrhea. A key concept to consider is that even with a high sensitivity and specificity, screening for a risk factor or disease that is rare will result in a low positive predictive value. In other words, the yield of screening will be low, and false positives may outnumber true positives. It is therefore important to consider the burden of a risk factor or disease in a given population before deciding whether screening for that condition is worthwhile.

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