Transcript Coronary heart disease risk factors in Canada: a

Coronary heart disease risk
factors in Canada:
a Microsimulation
predictive model
Doug Manuel, MD, MSc,
William M. Flanagan, BM,
Meltem Tuna, PhD,
Anya Okhmatovskaia, PhD,
Philippe Finès, PhD;
Carol Bennett, MSc
Simulated Technology for
Applied Research (STAR)
• A Canadian Institute for Health Research New Emerging
Team including:
 Behnam
Sharif, MSc,
 Jacek A. Kopec, MD, PhD,
 Hubert Wong, PhD,
 Aslam Anis , PhD,
 Eric C. Sayre, PhD, M.
 Mushfiqur Rahman, MSc,
 David Buckeridge, MD, PhD,
 Jillian Oderkirk, MSc,
 Michal Abrahamowicz, PhD,
 Sam Harper, PhD,
 Michael C. Wolfson, PhD
Chronic Diseases
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Major cause of death and disability
worldwide.
Reason of more than 55 thousand deaths
in Canada so far this year.
57% of those under 65 live with at least
one chronic condition.
An additional chronic disease raises the
risk of hospitalization by 44% among
people under age 60.
Risk Factors
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Behavioural
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Smoking
Physical Inactivity
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Biophysical
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Obesity
Elevated Cholesterol
Blood Pressure
Micro-simulation at
Statistics Canada
ModGen
(Developed in C++)
Interacting
Agent models
Non-Interacting
Agent models
Child Vaccination
(CVMM)
LifePaths
HIVMM
PopSim
POHEM
POHEM: Population Health Model
Characteristics of POHEM
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case-by-case, longitudinal, continuous time,
stochastic, Monte Carlo microsimulation
directly encompasses competing risks and
comorbidity
longitudinal risk factor and disease sub-modules
projects population forward in continuous time
generates plausible health biographies over the
life course of synthetic individuals from empirical
observations
Process for projecting coronary heart
disease risks in Canada, 2001 to 2020
Initialize a predictive model
by creating a cohort of
Canadians, 2001, age 20
years and older.
Canadian Community
Health Survey (2001)
Update yearly
(2002 – 2009)
Each year from 2001 to
2009, update population
characteristic and CAD risks
Update for births,
deaths, immigration,
emigration and
change in CAD risks
Validate
(2002 – 2009)
Compare predictive
demographic characteristics
and CAD risks from 2001
and 2009
Compare births,
deaths, immigration ,
emigration and
prevalence of CAD.
Canadian population
(2001)
Generate predictive
estimates
(2010 – 2020)
Continue yearly updates to
project CAD risks from 2010
to 2020
Data sources
Initial
Population
•Canadian
Community
Health Survey
•Canadian Heart
Health Survey
Births and Deaths
Yearly Updates
Data
Sources
• Projected total fertility
rate and death rate from
Statistics Canada
Update
Method
• National population
projections
Validation
• Canadian population
estimated, Statistics Canada
adjusted census counts
Immigration and Emigration
Yearly Updates
Data
Sources
• Projected immigration and
emigration from Citizen and
Immigration Canada (CIC)
Update
Method
• Projected immigration based
on Canadian government
policy. Emigration based on
CIC projections.
Validation
• Vital Statistics (Statistics
Canada)
Socioeconomic
Yearly Updates
Data
Sources
• Projected education and
family income from
Statistics Canada
Update
Method
• From LifePaths, a
microsimulation model
used for social planning.
Validation
• Canadian population
estimates, Statistics Canada
adjusted census counts
CAD Risks
Yearly Updates
Data
Sources
• National Population
Health Survey 1994 2004
Update
Method
• Kaplan Meier survival
functions by sex, based on
observed change during 1994
to 2004.
Validation
• CCHS 2003 – 2009
(biannually) Canadian Health
Measures Survey (20052007)
Coronary heart disease risk
factors, prevalence in 2001
Sex
Male
Female
Million
%
11.5
0.49
12
0.51
Blood Pressure
Million
%
Optimal
15.7
0.66
Normal
4.1
0.18
High-normal
2.3
0.1
Hypertensive Stage I
1.3
0.05
0.3
0.01
Million
%
Mean
Median
46.8
45
Hypertensive Stage II-IV
Smoking
Million
%
Total Cholesterol
Current
6.3
0.28
Low
4.4
0.19
Former
8.7
0.39
Low-Medium
8.5
0.37
Never
7.4
0.33
Medium
7.3
0.32
Medium-High
2.3
0.1
High
0.6
0.02
Age
Observed vs. Predicted
POHEM-Diabetes
POHEM-Smoking
POHEM-BMI
0.3
CCHS-Diabetes
CCHS-Smoking
CCHS_BMI
0.25
0.2
0.15
0.1
0.05
0
2001
2003
2005
2007
2009
2011
2013
2015
2017
2019
2021
Multiple Risk Factors:
Diabetes – Obesity - Smoking
Predicted and observed
risk factors, 2009 Canada
Projected
Diabetes
Obesity
Smoking
Observed
References


M.C. Wolfson , POHEM—a framework for
understanding and modelling the health
of human populations. Wld. Hlth. Statist.
Quart. 47 (1994), pp. 157–176
Statistics Canada. Canadian Community
Health Surveys, Cycles 1.1-4.1, 20092010.