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Mutubuki EN, Moye-Holz D, Peyroteo M, Lapão LV, Hilderink HBM. Foresight in public health: a tutorial on application and insights on challenges from the PHIRI foresight exercise. Eur J Public Health 2024; 34:i87-i93. [PMID: 38946445 PMCID: PMC11215316 DOI: 10.1093/eurpub/ckae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND The application of foresight to the field of public health is limited. There is growing need to anticipate uncertain future trends and to plan for them. Foresight provides tools to experts and policymakers to discuss and plan for possible futures. Hence, the aim of this study is to illustrate how the foresight six-step approach can be applied in public health, and to provide recommendations on dealing with challenges, drawn from the Population Health Information Research Infrastructure (PHIRI) foresight exercise. METHODS In this tutorial, we describe the six-step approach as part of foresight methodology and give examples of possible challenges. Step 1 comprises the formulation of study objectives. Step 2 focuses on developing a conceptual model and applying the Demographic Economic Sociocultural Technological Ecological and Political-Institutional (DESTEP) framework to identify and prioritize driving forces for the topic of interest. In Step 3, a time horizon and spatial level are defined. Step 4 discusses scenario logics. Steps 5 and 6 discuss different types of scenarios and associated tools for analyses. Possible challenges encountered whilst applying the foresight methodology at each of the steps, were drawn from experiences during PHIRI foresight exercise. RESULTS Challenges associated with applying the foresight six-step approach included: formulating concise objectives, developing a conceptual model, understanding driving forces and uncertainty and difficulties in building scenarios. CONCLUSIONS Understanding concepts used in the six-step approach and how they relate to each other remained difficult. Support from foresight experts, conducting more foresight exercises, tutorials and guidelines can enhance understanding and support building capacity.
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Affiliation(s)
- Elizabeth N Mutubuki
- Centre for Public Health, Health Services and Society, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Daniela Moye-Holz
- Centre for Public Health, Health Services and Society, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Mariana Peyroteo
- UNIDEMI, Department of Mechanical and Industrial Engineering, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Caparica, Portugal
- Laboratório Associado de Sistemas Inteligentes, LASI, Guimarães, Portugal
| | - Luís Velez Lapão
- UNIDEMI, Department of Mechanical and Industrial Engineering, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Caparica, Portugal
- Laboratório Associado de Sistemas Inteligentes, LASI, Guimarães, Portugal
- WHO Collaborating Center on Health Workforce Policy and Planning, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Henk B M Hilderink
- Centre for Public Health, Health Services and Society, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Wang J, Pouwels X, Ramaekers B, Frederix G, van Lieshout C, Hoogenveen R, Li X, de Wit GA, Joore M, Koffijberg H, van Giessen A, Knies S, Feenstra T. A Blueprint for Multi-use Disease Modeling in Health Economics: Results from Two Expert-Panel Consultations. PHARMACOECONOMICS 2024; 42:797-810. [PMID: 38613660 PMCID: PMC11180025 DOI: 10.1007/s40273-024-01376-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND The current use of health economic decision models in HTA is mostly confined to single use cases, which may be inefficient and result in little consistency over different treatment comparisons, and consequently inconsistent health policy decisions, for the same disorder. Multi-use disease models (MUDMs) (other terms: generic models, whole disease models, disease models) may offer a solution. However, much is uncertain about their definition and application. The current research aimed to develop a blueprint for the application of MUDMs. METHODS We elicited expert opinion using a two-round modified Delphi process. The panel consisted of experts and stakeholders in health economic modelling from various professional backgrounds. The first questionnaire concerned definition, terminology, potential applications, issues and recommendations for MUDMs and was based on an exploratory scoping review. In the second round, the panel members were asked to reconsider their input, based on feedback regarding first-round results, and to score issues and recommendations for priority. Finally, adding input from external advisors and policy makers in a structured way, an overview of issues and challenges was developed during two team consensus meetings. RESULTS In total, 54 respondents contributed to the panel results. The term 'multi-use disease models' was proposed and agreed upon, and a definition was provided. The panel prioritized 10 potential applications (with comparing alternative policies and supporting resource allocation decisions as the top 2), while 20 issues (with model transparency and stakeholders' roles as the top 2) were identified as challenges. Opinions on potential features concerning operationalization of multi-use models were given, with 11 of these subsequently receiving high priority scores (regular updates and revalidation after updates were the top 2). CONCLUSIONS MUDMs would improve on current decision support regarding cost-effectiveness information. Given feasibility challenges, this would be most relevant for diseases with multiple treatments, large burden of disease and requiring more complex models. The current overview offers policy makers a starting point to organize the development, use, and maintenance of MUDMs and to support choices concerning which diseases and policy decisions they will be helpful for.
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Affiliation(s)
- Junfeng Wang
- Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Xavier Pouwels
- Department of Health Technology and Services Research, Faculty of Behavioural, Management, and Social Sciences, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Bram Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Geert Frederix
- Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chris van Lieshout
- Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rudolf Hoogenveen
- Department of Statistics, Modelling and Data Science, Center of Research and Data services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Xinyu Li
- University of Groningen, Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, Groningen, The Netherlands
| | - G Ardine de Wit
- Department of Epidemiology and Health Economics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Centre for Public Health, Healthcare and Society, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department of Health Sciences, Faculty of Beta Sciences, Vrije Universiteit Amsterdam & Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Manuela Joore
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, CAPHRI Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Hendrik Koffijberg
- Department of Health Technology and Services Research, Faculty of Behavioural, Management, and Social Sciences, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Anoukh van Giessen
- Department of Statistics, Modelling and Data Science, Center of Research and Data services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Saskia Knies
- National Health Care Institute, Diemen, The Netherlands
| | - Talitha Feenstra
- University of Groningen, Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, Groningen, The Netherlands.
- Centre for Public Health, Healthcare and Society, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
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Nusselder WJ, Long D, Waterlander WE, Stronks K, Boshuizen HC. Estimating the contribution of overweight and obesity to ethnic inequalities in cardio-metabolic diseases in the Netherlands: a simulation study. Public Health 2024; 232:45-51. [PMID: 38733960 DOI: 10.1016/j.puhe.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/29/2024] [Accepted: 04/08/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVES Overweight and obesity (OWOB) starts in childhood, influences adult cardiovascular risk, and is not equally distributed across ethnic groups. It is unclear which effects can be expected from reductions in OWOB across the life course on inequalities in cardio-metabolic diseases in a multi-ethnic population. This study aims to estimate the effects of three scenarios of changes in OWOB (the Normal-Weight-for-All scenario, the No-Ethnic-Difference-over-the-Life-Course scenario, the and No-Ethnic-Differences-in-Childhood scenario). STUDY DESIGN A simulation study. METHODS We combine data from multiple data sources and use the Dynamic Modeling for Health Impact Assessment (DYNAMO-HIA) model to estimate the effects of three scenarios on the cumulative incidence of diabetes mellitus, ischaemic heart disease (IHD) and stroke between 18 and 70 years in the five largest ethnic groups in the Netherlands. RESULTS In the scenario where all individuals have normal weight, the cumulative incidence decreased in all ethnic minority groups for all diseases, with largest decreases among South-Asian Surinamese, where the reduction of diabetes incidence exceeded 50%. In the scenario where the prevalence of OWOB in each ethnic-minority group was reduced to the current level among the Dutch-origin population, ethnic inequalities in cardio-metabolic diseases were substantially reduced, particularly when lowered prevalence of OWOB persisted across the lifespan. Reductions were the largest for diabetes and for the Asian Surinamese population. CONCLUSIONS A substantial part of the well-known ethnic inequalities in incidence of diabetes, IHD, and stroke can be attributed to OWOB. Interventions aimed at reducing OWOB have clear potential to reduce the health inequalities in these outcomes, especially for diabetes, in particular when they have an impact across the lifespan.
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Affiliation(s)
- W J Nusselder
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - D Long
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - W E Waterlander
- Department of Public and Occupational Health, Academic Medical Centers Amsterdam/Universiteit of Amsterdam, Amsterdam, the Netherlands
| | - K Stronks
- Department of Public and Occupational Health, Academic Medical Centers Amsterdam/Universiteit of Amsterdam, Amsterdam, the Netherlands
| | - H C Boshuizen
- Department Statistics, Data Science and Mathematical Modelling, National Institute of Public Health and the Environment, Bilthoven, the Netherlands
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Náfrádi B, Kiiver H, Neupane S, Momen NC, Streicher KN, Pega F. Estimating the population exposed to a risk factor over a time window: A microsimulation modelling approach from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury. PLoS One 2022; 17:e0278507. [PMID: 36584100 PMCID: PMC9803131 DOI: 10.1371/journal.pone.0278507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 11/17/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Burden of disease estimation commonly requires estimates of the population exposed to a risk factor over a time window (yeart to yeart+n). We present a microsimulation modelling approach for producing such estimates and apply it to calculate the population exposed to long working hours for one country (Italy). METHODS We developed a three-model approach: Model 1, a multilevel model, estimates exposure to the risk factor at the first year of the time window (yeart). Model 2, a regression model, estimates transition probabilities between exposure categories during the time window (yeart to yeart+n). Model 3, a microsimulation model, estimates the exposed population over the time window, using the Monte Carlo method. The microsimulation is carried out in three steps: (a) a representative synthetic population is initiated in the first year of the time window using prevalence estimates from Model 1, (b) the exposed population is simulated over the time window using the transition probabilities from Model 2; and (c) the population is censored for deaths during the time window. RESULTS We estimated the population exposed to long working hours (i.e. 41-48, 49-54 and ≥55 hours/week) over a 10-year time window (2002-11) in Italy. We populated all three models with official data from Labour Force Surveys, United Nations population estimates and World Health Organization life tables. Estimates were produced of populations exposed over the time window, disaggregated by sex and 5-year age group. CONCLUSIONS Our modelling approach for estimating the population exposed to a risk factor over a time window is simple, versatile, and flexible. It however requires longitudinal exposure data and Model 3 (the microsimulation model) is stochastic. The approach can improve accuracy and transparency in exposure and burden of disease estimations. To improve the approach, a logical next step is changing Model 3 to a deterministic microsimulation method, such as modelling of microflows.
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Affiliation(s)
- Bálint Náfrádi
- Labour Administration, Labour Inspection and Occupational Safety and Health Branch, International Labour Organization, Geneva, Switzerland
| | | | - Subas Neupane
- Department of Climate Change, Environment and Health, World Health Organization, Geneva, Switzerland
| | - Natalie C. Momen
- Department of Climate Change, Environment and Health, World Health Organization, Geneva, Switzerland
| | - Kai N. Streicher
- Department of Climate Change, Environment and Health, World Health Organization, Geneva, Switzerland
| | - Frank Pega
- Department of Climate Change, Environment and Health, World Health Organization, Geneva, Switzerland
- * E-mail:
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Leandro J, Hotta CI, Pinto TA, Ahadzie DK. Expected annual probability of infection: A flood-risk approach to waterborne infectious diseases. WATER RESEARCH 2022; 219:118561. [PMID: 35576764 DOI: 10.1016/j.watres.2022.118561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/26/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
This study introduces a new approach for the investigation of infections after an accidental ingestion of contaminated floodwater. The concept of Expected Annual Probability of Infection (EAPI) is introduced and implemented in an infection risk-model approach, by combining a Quantitative Microbial Risk Assessment (QMRA) with the four steps in flood risk assessment. Two groups and exposure paths are considered: adults wading in floodwater and small children swimming/playing in floodwater. The study area is located in Ghana, West Africa. Even though Ghana is one of the most urbanized countries in Africa it has significant problems with water resources management and public health. While cholera is classified as endemic in Accra, the natural and human-made characteristics of the capital makes it prone to flooding. The results of the EAPI approach show that on one hand the concentration of pathogens in floodwater, and thus the risk of infection, decreases with the increase of the flood magnitude. On the other hand, larger floods can spread the pathogens further from the point source, threatening populations previously not identified as at risk by small-scale floods. The concept of EAPI is demonstrated for cholera but it can be extended to other waterborne diseases and also different pathways of exposure, requiring minimal adaptations. For future applications, better estimation of EAPI key components and improvement points are discussed and recommendations given for all the assessment steps.
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Affiliation(s)
- Jorge Leandro
- Chair of Hydromechanics and Hydraulic Engineering, Research Institute for Water and Environment, Faculty IV School of Science and Technology, University of Siegen, Paul-Bonatz-Str. 9-11, Siegen 57068, Germany.
| | - Carolina I Hotta
- Chair of Hydrology and River Basin Management, Department of Civil, Geo and Environmental Engineering, Technical University of Munich, Arcisstrasse 21, Munich 80333, Germany
| | - Thaiza Alvarenga Pinto
- Chair of Hydrology and River Basin Management, Department of Civil, Geo and Environmental Engineering, Technical University of Munich, Arcisstrasse 21, Munich 80333, Germany
| | - Divine Kwaku Ahadzie
- Center for Settlements Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Tuvdendorj A, Konings SRA, Purevdorj B, Buskens E, Feenstra TL. Reducing the Burden of Disease Through Tobacco Taxes in Mongolia: A Health Impact Analysis Using a Dynamic Public Health Model. Nicotine Tob Res 2022; 24:233-240. [PMID: 34498055 PMCID: PMC8807155 DOI: 10.1093/ntr/ntab182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 09/08/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND/OBJECTIVES Smoking is the leading risk factor for many chronic diseases. The quantitative analysis of potential health gains from reduced smoking is important for establishing priorities in Mongolia's health policy. This study quantifies the effect of tobacco-tax increases on future smoking prevalence and the associated smoking-related burden of disease in Mongolia. METHODS The dynamic model for health impact assessment (DYNAMO-HIA) tool was used. The most recent data were used as input for evaluating tobacco-taxation scenarios. Demographic data were taken from the Mongolian Statistical Information Services. Smoking data came from a representative population-based STEPS survey, and smoking-related disease data were obtained from the health-information database of Mongolia's National Health Center. Simulation was used to evaluate various levels of one-time price increases on tobacco products (25% and 75%) in Mongolia. Conservative interpretation suggests that the population will eventually adjust to the higher tobacco price and return to baseline smoking behaviors. RESULTS Over a three-year period, smoking prevalence would be reduced by 1.2% points, corresponding to almost 40 thousand smokers at the population level for a price increase of 75%, compared to the baseline scenario. Projected health benefits of this scenario suggest that more than 137 thousand quality adjusted of life years would be gained by avoiding smoking-related diseases within a population of three million over a 30-year period. DISCUSSION Prevention through effective tobacco-control policy could yield considerable gains in population health in Mongolia. Compared to current policy, tax increases must be higher to have a significant effect on population health. IMPLICATIONS Tobacco taxation is an effective policy for reducing the harm of tobacco smoking, while benefiting population health in countries where the tobacco epidemic is still in an early stage. Smoking prevalence and smoking behaviors in these countries differ from those in Western countries. Reducing the uptake of smoking among young people could be a particularly worthwhile benefit of tobacco-tax increases.
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Affiliation(s)
- Ariuntuya Tuvdendorj
- Department of Health Policy and Management, School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan R A Konings
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Erik Buskens
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Talitha L Feenstra
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Soerjomataram I, Bray F. Planning for tomorrow: global cancer incidence and the role of prevention 2020-2070. Nat Rev Clin Oncol 2021; 18:663-672. [PMID: 34079102 DOI: 10.1038/s41571-021-00514-z] [Citation(s) in RCA: 289] [Impact Index Per Article: 96.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 02/06/2023]
Abstract
Cancer is currently the first or second most common contributor to premature mortality in most countries of the world. The global number of patients with cancer is expected to rise over the next 50 years owing to the strong influence of demographic changes, such as population ageing and growth, on the diverging trends in cancer incidence in different regions. Assuming that the latest incidence trends continue for the major cancer types, we predict a doubling of the incidence of all cancers combined by 2070 relative to 2020. The greatest increases are predicted in lower-resource settings, in countries currently assigned a low Human Development Index (HDI), whereas the predicted increases in national burden diminish with increasing levels of national HDI. Herein, we assess studies modelling the future burden of cancer that underscore how comprehensive cancer prevention strategies can markedly reduce the prevalence of major risk factors and, in so doing, the number of future cancer cases. Focusing on an in-depth assessment of prevention strategies that target tobacco smoking, overweight and obesity, and human papillomavirus infection, we discuss how stepwise, population-level approaches with amenable goals can avert millions of future cancer diagnoses worldwide. In the absence of a step-change in cancer prevention delivery, tobacco smoking will remain the leading preventable cause of cancer, and overweight and obesity might well present a comparable opportunity for prevention, given its increasing prevalence globally in the past few decades. Countries must therefore instigate national cancer control programmes aimed at preventing cancer, and with some urgency, if such programmes are to yield the desired public health and economic benefits in this century.
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Affiliation(s)
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
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HIA and EIA Are Different, but Maybe Not in the Way We Thought They Were: A Bibliometric Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179101. [PMID: 34501690 PMCID: PMC8430742 DOI: 10.3390/ijerph18179101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/14/2021] [Accepted: 08/23/2021] [Indexed: 11/16/2022]
Abstract
Background: The fields of Health Impact Assessment (HIA) and Environmental Impact Assessment (EIA) have grown with increasing numbers of disciplines and sectors contributing to their advancements, but with it, perceived conflict over methodological and disciplinary approaches to integrate health in impact assessments. This study maps the current field of HIA and health in EIA to examine the scientific landscape of the field. Methods: We carried out a bibliometric analysis of HIA papers and EIA papers that included a health focus in peer-reviewed journals in the Web of Science Core Collection (n = 229). We carried out co-authorship and co-citation network analyses of authors and documents in VOSviewer. Results: We identified two main co-authorship and co-citation groupings. Our document co-citation analysis also identified four clusters with two major groups, the Defining HIA cluster and the Describing the fields cluster versus the Active transport quantitative HIA cluster, and the Quantitative modelling tools cluster. Conclusion: Our findings strongly suggest that there exist two groups of thought in the scholarly fields of HIA and health in EIA. Barriers to developing more methodologically integrated approaches to considering health within EIA are related more to disciplinary differences than field (HIA versus EIA)-based differences and we advocate for the development of transdisciplinary approaches to both HIA and EIA.
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Fuertes E, Marcon A, Potts L, Pesce G, Lhachimi SK, Jani V, Calciano L, Adamson A, Quint JK, Jarvis D, Janson C, Accordini S, Minelli C. Health impact assessment to predict the impact of tobacco price increases on COPD burden in Italy, England and Sweden. Sci Rep 2021; 11:2311. [PMID: 33504847 PMCID: PMC7840977 DOI: 10.1038/s41598-021-81876-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/12/2021] [Indexed: 11/28/2022] Open
Abstract
Raising tobacco prices effectively reduces smoking, the main risk factor for chronic obstructive pulmonary disease (COPD). Using the Health Impact Assessment tool "DYNAMO-HIA", this study quantified the reduction in COPD burden that would occur in Italy, England and Sweden over 40 years if tobacco prices were increased by 5%, 10% and 20% over current local prices, with larger increases considered in secondary analyses. A dynamic Markov-based multi-state simulation modelling approach estimated the effect of changes in smoking prevalence states and probabilities of transitioning between smoking states on future smoking prevalence, COPD burden and life expectancy in each country. Data inputs included demographics, smoking prevalences and behaviour and COPD burden from national data resources, large observational cohorts and datasets within DYNAMO-HIA. In the 20% price increase scenario, the cumulative number of COPD incident cases saved over 40 years was 479,059 and 479,302 in Italy and England (populous countries with higher smoking prevalences) and 83,694 in Sweden (smaller country with lower smoking prevalence). Gains in overall life expectancy ranged from 0.25 to 0.45 years for a 20 year-old. Increasing tobacco prices would reduce COPD burden and increase life expectancy through smoking behavior changes, with modest but important public health benefits observed in all three countries.
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Affiliation(s)
- Elaine Fuertes
- National Heart and Lung Institute, Emmanuel Kaye Building, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK.
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Laura Potts
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Giancarlo Pesce
- Sorbonne Université, INSERM UMR-S 1136, Epidemiology of Allergic and Respiratory Diseases (EPAR), Pierre Louis Institute of Epidemiology and Public Health (IPLESP), Saint-Antoine Medical School, Paris, France
| | - Stefan K Lhachimi
- Health Sciences Bremen, Institute for Public Health and Nursing, University of Bremen, Bremen, Germany
| | - Virjal Jani
- National Heart and Lung Institute, Emmanuel Kaye Building, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK
| | - Lucia Calciano
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Alex Adamson
- National Heart and Lung Institute, Emmanuel Kaye Building, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK
| | - Jennifer K Quint
- National Heart and Lung Institute, Emmanuel Kaye Building, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK
| | - Debbie Jarvis
- National Heart and Lung Institute, Emmanuel Kaye Building, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK
- MRC Centre for Environment and Health, Imperial College London, London, UK
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Cosetta Minelli
- National Heart and Lung Institute, Emmanuel Kaye Building, Imperial College London, 1B Manresa Road, London, SW3 6LR, UK
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Bender AM, Sørensen J, Diderichsen F, Brønnum-Hansen H. A health inequality impact assessment from reduction in overweight and obesity. BMC Public Health 2020; 20:1823. [PMID: 33256647 PMCID: PMC7706236 DOI: 10.1186/s12889-020-09831-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 11/04/2020] [Indexed: 11/12/2022] Open
Abstract
Background In recent years, social differences in overweight and obesity (OWOB) have become more pronounced. Health impact assessments provide population-level scenario evaluations of changes in disease prevalence and risk factors. The objective of this study was to simulate the health effects of reducing the prevalence of overweight and obesity in populations with short and medium education. Methods The DYNAMO-HIA tool was used to conduct a health inequality impact assessment of the future reduced disease prevalence (ischemic heart disease (IHD), diabetes, stroke, and multi-morbidity) and changes in life expectancy for the 2040-population of Copenhagen, Denmark (n = 742,130). We simulated an equalized weight scenario where the prevalence of OWOB in the population with short and medium education was reduced to the levels of the population with long education. Results A higher proportion of the population with short and medium education were OWOB relative to the population with long education. They also had a higher prevalence of cardiometabolic diseases. In the equalized weight scenario, the prevalence of diabetes in the population with short education was reduced by 8–10% for men and 12–13% for women. Life expectancy increased by one year among women with short education. Only small changes in prevalence and life expectancy related to stroke and IHD were observed. Conclusion Reducing the prevalence of OWOB in populations with short and medium education will reduce the future prevalence of cardiometabolic diseases, increase life expectancy, and reduce the social inequality in health. These simulations serve as reference points for public health debates. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09831-x.
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Affiliation(s)
- Anne Mette Bender
- Department of Public Health, University of Copenhagen, Faculty of Health Sciences, Section of Social Medicine, CSS, Øster Farimagsgade 5, Postbox 2099, DK-1014, Copenhagen K, Denmark.
| | - Jan Sørensen
- Danish Centre for Health Economics (DaCHE), University of Southern Denmark, Odense, Denmark.,Healthcare Outcome Research Centre (HORC), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Finn Diderichsen
- Department of Public Health, University of Copenhagen, Faculty of Health Sciences, Section of Social Medicine, CSS, Øster Farimagsgade 5, Postbox 2099, DK-1014, Copenhagen K, Denmark
| | - Henrik Brønnum-Hansen
- Department of Public Health, University of Copenhagen, Faculty of Health Sciences, Section of Social Medicine, CSS, Øster Farimagsgade 5, Postbox 2099, DK-1014, Copenhagen K, Denmark
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Blakely T, Moss R, Collins J, Mizdrak A, Singh A, Carvalho N, Wilson N, Geard N, Flaxman A. Proportional multistate lifetable modelling of preventive interventions: concepts, code and worked examples. Int J Epidemiol 2020; 49:1624-1636. [PMID: 33038892 DOI: 10.1093/ije/dyaa132] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/14/2020] [Indexed: 11/12/2022] Open
Abstract
Burden of Disease studies-such as the Global Burden of Disease (GBD) Study-quantify health loss in disability-adjusted life-years. However, these studies stop short of quantifying the future impact of interventions that shift risk factor distributions, allowing for trends and time lags. This methodology paper explains how proportional multistate lifetable (PMSLT) modelling quantifies intervention impacts, using comparisons between three tobacco control case studies [eradication of tobacco, tobacco-free generation i.e. the age at which tobacco can be legally purchased is lifted by 1 year of age for each calendar year) and tobacco tax]. We also illustrate the importance of epidemiological specification of business-as-usual in the comparator arm that the intervention acts on, by demonstrating variations in simulated health gains when incorrectly: (i) assuming no decreasing trend in tobacco prevalence; and (ii) not including time lags from quitting tobacco to changing disease incidence. In conjunction with increasing availability of baseline and forecast demographic and epidemiological data, PMSLT modelling is well suited to future multiple country comparisons to better inform national, regional and global prioritization of preventive interventions. To facilitate use of PMSLT, we introduce a Python-based modelling framework and associated tools that facilitate the construction, calibration and analysis of PMSLT models.
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Affiliation(s)
- Tony Blakely
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Rob Moss
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - James Collins
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Anja Mizdrak
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Ankur Singh
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Natalie Carvalho
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Nick Wilson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nicholas Geard
- Computing and Information Systems, University of Melbourne, Melbourne, VIC, Australia
| | - Abraham Flaxman
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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12
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Schönbach JK, Bolte G, Czwikla G, Manz K, Mensing M, Muellmann S, Voelcker-Rehage C, Lhachimi SK. Equity impacts of interventions to increase physical activity among older adults: a quantitative health impact assessment. Int J Behav Nutr Phys Act 2020; 17:103. [PMID: 32795299 PMCID: PMC7427912 DOI: 10.1186/s12966-020-00999-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 07/21/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Behavioural interventions may increase social inequalities in health. This study aimed to project the equity impact of physical activity interventions that have differential effectiveness across education groups on the long-term health inequalities by education and gender among older adults in Germany. METHODS We created six intervention scenarios targeting the elderly population: Scenarios #1-#4 applied realistic intervention effects that varied by education (low, medium high). Under scenario #5, all older adults adapted the physical activity pattern of those with a high education. Under scenario #6, all increased their physical activity level to the recommended 300 min weekly. The number of incident ischemic heart disease, stroke and diabetes cases as well as deaths from all causes under each of these six intervention scenarios was simulated for males and females over a 10-year projection period using the DYNAMO-HIA tool. Results were compared against a reference-scenario with unchanged physical activity. RESULTS Under scenarios #1-#4, approximately 3589-5829 incident disease cases and 6248-10,320 deaths could be avoided among males over a 10-year projection period, as well as 4381-7163 disease cases and 6914-12,605 deaths among females. The highest reduction for males would be achieved under scenario #4, under which the intervention is most effective for those with a high education level. Scenario #4 realizes 2.7 and 2.4% of the prevented disease cases and deaths observed under scenario #6, while increasing inequalities between education groups. In females, the highest reduction would be achieved under scenario #3, under which the intervention is most effective amongst those with low levels of education. This scenario realizes 2.7 and 2.9% of the prevented disease cases and deaths under scenario #6, while decreasing inequalities between education groups. Under scenario #5, approximately 31,687 incident disease cases and 59,068 deaths could be prevented among males over a 10-year projection period, as well as 59,173 incident disease cases and 121,689 deaths among females. This translates to 14.4 and 22.2% of the prevented diseases cases among males and females under scenario #6, and 13.7 and 27.7% of the prevented deaths under scenario #6. CONCLUSIONS This study shows how the overall population health impact varies depending on how the intervention-induced physical activity change differs across education groups. For decision-makers, both the assessment of health impacts overall as well as within a population is relevant as interventions with the greatest population health gain might be accompanied by an unintended increase in health inequalities.
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Affiliation(s)
- Johanna-Katharina Schönbach
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Bremen, Germany.
- University of Bremen, Health Sciences Bremen, Bremen, Germany.
| | - Gabriele Bolte
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Bremen, Germany
- University of Bremen, Health Sciences Bremen, Bremen, Germany
| | - Gesa Czwikla
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Bremen, Germany
- University of Bremen, Health Sciences Bremen, Bremen, Germany
| | | | | | - Saskia Muellmann
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Claudia Voelcker-Rehage
- Chemnitz University of Technology, Institute of Human Movement Science and Health, Chemnitz, Germany
- University of Münster, Institute of Sport and Exercise Sciences, Münster, Germany
| | - Stefan K Lhachimi
- University of Bremen, Health Sciences Bremen, Bremen, Germany
- University of Bremen, Institute of Public Health and Nursing Research, Department of Health Services Research, Bremen, Germany
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13
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Bender AM, Sørensen J, Holm A, Simonsen K, Diderichsen F, Brønnum-Hansen H. Simulations of future cardiometabolic disease and life expectancy under counterfactual obesity reduction scenarios. Prev Med Rep 2020; 19:101150. [PMID: 32685361 PMCID: PMC7358723 DOI: 10.1016/j.pmedr.2020.101150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 03/07/2020] [Accepted: 06/14/2020] [Indexed: 12/05/2022] Open
Abstract
HIAs provide simulations of future disease levels related to an array of obesity scenarios. In a relatively lean population, obesity still contribute to a substantial reduction in life expectancy. Large reductions in diabetes and multi-morbidity is estimated as an effect of reducing obesity. Incremental increase in future stroke and IHD cases is expected.
The aim of this study was to provide decision makers with an assessment of potential future health effects of interventions against overweight and obesity (OWOB). By means of the DYNAMO-HIA tool we conducted a health impact assessment simulating future prevented disease (ischemic heart disease (IHD), diabetes, stroke, and multi morbidity) incidence, prevalence and life expectancy (LE) related to a scenario where OWOB is reduced by 25% and a scenario where obesity is eliminated. The study covered projected number of persons living in Copenhagen, Denmark during year 2014–2040 (n 2040 = 742,129). Reducing the proportion of men/women with OWOB with 25% will increase population LE by 2.4/1.2 months and at the same time decrease LE with diabetes by 3.1/2.2 months. As a result of eliminating obesity, total LE will increase by 6.0/3.6 months and LE with diabetes will decrease with 9.8/10.3 months for men/women. We found no important effects on LE with IHD and stroke. This illustrates that the positive effects of lowering OWOB levels on IHD and stroke incidence is offset due to increasing total LE. Although the population of Copenhagen is relatively lean, reducing obesity levels will result in significant benefits for population cardiometabolic health status and LE. Future public health prevention programs may use the results as reference data for potential impact of reductions in OWOB.
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Affiliation(s)
- Anne Mette Bender
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jan Sørensen
- Centre for Health Economics Research (COHERE), University of Southern Denmark, Odense, Denmark.,Health Outcome Research Centre (HORC), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Astrid Holm
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Finn Diderichsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Fundação Oswaldo Cruz - IAM, Recife, Brazil
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14
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To what extent could cardiovascular diseases be reduced if Germany applied fiscal policies to increase fruit and vegetable consumption? A quantitative health impact assessment. Public Health Nutr 2020; 24:2570-2576. [PMID: 32662362 PMCID: PMC8145472 DOI: 10.1017/s1368980020000634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: This study aimed to dynamically model and quantify expected health effects of four scenarios: (i) a reference scenario with an unchanged fruit and vegetable intake, (ii) the removal of value-added tax (VAT) on fruits and vegetables, (iii) the implementation of a 20 % subsidy on fruits and vegetables and (iv) a guideline scenario with a population-wide fruit and vegetable intake of five portions per day. Design: Baseline fruit and vegetable intake data was derived from the GEDA 2012 study. We used price elasticities for Germany to calculate the change in fruit and vegetable consumption under the zero VAT and the 20 % subsidy scenario. All scenarios were modelled over a 10-year projection period using DYNAMO-HIA. Setting: Germany. Participants: A projected real-life population. Results: Cumulated over the 10-year projection period, an estimated 4450 incident ischaemic heart disease (IHD) cases, 7010 stroke cases and 13 960 deaths would be prevented under the zero VAT scenario. Under the 20 % subsidy scenario, 17 990 incident IHD cases, 27 390 stroke cases and 54 880 deaths would be averted. Although this corresponds to only a fraction of the incidents that would occur under the reference scenario, the averted cases translate to 2 % (for the zero VAT scenario) and 9 % (for the 20 % subsidy scenario) of IHD, stroke and death cases that would be prevented if the whole population consumed the recommended five portions of fruits and vegetables per day. Conclusions: Fiscal policies on fruits and vegetables provide a non-negligible step towards the removal of the health burden induced by low fruit and vegetable intake.
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Leão T, Perelman J, Clancy L, Mlinarić M, Kinnunen JM, Nuyts PAW, Mélard N, Rimpelä A, Lorant V, Kunst AE. Economic Evaluation of Five Tobacco Control Policies Across Seven European Countries. Nicotine Tob Res 2020; 22:1202-1209. [PMID: 31350556 PMCID: PMC7291799 DOI: 10.1093/ntr/ntz124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 08/08/2019] [Indexed: 11/25/2022]
Abstract
Introduction Economic evaluations of tobacco control policies targeting adolescents are scarce. Few take into account real-world, large-scale implementation costs; few compare cost-effectiveness of different policies across different countries. We assessed the cost-effectiveness of five tobacco control policies (nonschool bans, including bans on sales to minors, bans on smoking in public places, bans on advertising at points-of-sale, school smoke-free bans, and school education programs), implemented in 2016 in Finland, Ireland, the Netherlands, Belgium, Germany, Italy, and Portugal. Methods Cost-effectiveness estimates were calculated per country and per policy, from the State perspective. Costs were collected by combining quantitative questionnaires with semi-structured interviews on how policies were implemented in each setting, in real practice. Short-term effectiveness was based on the literature, and long-term effectiveness was modeled using the DYNAMO-HIA tool. Discount rates of 3.5% were used for costs and effectiveness. Sensitivity analyses considered 1%–50% short-term effectiveness estimates, highest cost estimates, and undiscounted effectiveness. Findings Nonschool bans cost up to €253.23 per healthy life year, school smoking bans up to €91.87 per healthy life year, and school education programs up to €481.35 per healthy life year. Cost-effectiveness depended on the costs of implementation, short-term effectiveness, initial smoking rates, dimension of the target population, and weight of smoking in overall mortality and morbidity. Conclusions All five policies were highly cost-effective in all countries according to the World Health Organization thresholds for public health interventions. Cost-effectiveness was preserved even when using the highest costs and most conservative effectiveness estimates. Implications Economic evaluations using real-world data on tobacco control policies implemented at a large scale are scarce, especially considering nonschool bans targeting adolescents. We assessed the cost-effectiveness of five tobacco control policies implemented in 2016 in Finland, Ireland, the Netherlands, Belgium, Germany, Italy, and Portugal. This study shows that all five policies were highly cost-effective considering the World Health Organization threshold, even when considering the highest costs and most conservative effectiveness estimates.
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Affiliation(s)
- Teresa Leão
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal.,Centro de Investigação em Saúde Pública, Lisboa, Portugal.,Local Health Unit of Matosinhos, Matosinhos, Portugal
| | - Julian Perelman
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal.,Centro de Investigação em Saúde Pública, Lisboa, Portugal
| | - Luke Clancy
- TobaccoFree Research Institute Ireland, Dublin, Ireland
| | - Martin Mlinarić
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Jaana M Kinnunen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | | | - Nora Mélard
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Arja Rimpelä
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland.,Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland
| | - Vincent Lorant
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Anton E Kunst
- Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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16
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Broeks MJ, Biesbroek S, Over EAB, van Gils PF, Toxopeus I, Beukers MH, Temme EHM. A social cost-benefit analysis of meat taxation and a fruit and vegetables subsidy for a healthy and sustainable food consumption in the Netherlands. BMC Public Health 2020; 20:643. [PMID: 32389120 PMCID: PMC7212616 DOI: 10.1186/s12889-020-08590-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 03/25/2020] [Indexed: 12/31/2022] Open
Abstract
Background Implementation of food taxes or subsidies may promote healthier and a more sustainable diet in a society. This study estimates the effects of a tax (15% or 30%) on meat and a subsidy (10%) on fruit and vegetables (F&V) consumption in the Netherlands using a social cost-benefit analysis with a 30-year time horizon. Methods Calculations with the representative Dutch National Food Consumption Survey (2012–2014) served as the reference. Price elasticities were applied to calculate changes in consumption and consumer surplus. Future food consumption and health effects were estimated using the DYNAMO-HIA model and environmental impacts were estimated using Life Cycle Analysis. The time horizon of all calculations is 30 year. All effects were monetarized and discounted to 2018 euros. Results Over 30-years, a 15% or 30% meat tax or 10% F&V subsidy could result in reduced healthcare costs, increased quality of life, and higher productivity levels. Benefits to the environment of a meat tax are an estimated €3400 million or €6300 million in the 15% or 30% scenario respectively, whereas the increased F&V consumption could result in €100 million costs for the environment. While consumers benefit from a subsidy, a consumer surplus of €10,000 million, the tax scenarios demonstrate large experienced costs of respectively €21,000 and €41,000 million. Overall, a 15% or 30% price increase in meat could lead to a net benefit for society between €3100–7400 million or €4100–12,300 million over 30 years respectively. A 10% F&V subsidy could lead to a net benefit to society of €1800–3300 million. Sensitivity analyses did not change the main findings. Conclusions The studied meat taxes and F&V subsidy showed net total welfare benefits for the Dutch society over a 30-year time horizon.
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Affiliation(s)
- Marlin J Broeks
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, Bilthoven, 3721, MA, The Netherlands
| | - Sander Biesbroek
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, Bilthoven, 3721, MA, The Netherlands
| | - Eelco A B Over
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, Bilthoven, 3721, MA, The Netherlands
| | - Paul F van Gils
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, Bilthoven, 3721, MA, The Netherlands
| | - Ido Toxopeus
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, Bilthoven, 3721, MA, The Netherlands
| | - Marja H Beukers
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, Bilthoven, 3721, MA, The Netherlands
| | - Elisabeth H M Temme
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, Bilthoven, 3721, MA, The Netherlands.
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17
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Accordini S, Calciano L, Marcon A, Pesce G, Antó JM, Beckmeyer-Borowko AB, Carsin AE, Corsico AG, Imboden M, Janson C, Keidel D, Locatelli F, Svanes C, Burney PGJ, Jarvis D, Probst-Hensch NM, Minelli C. Incidence trends of airflow obstruction among European adults without asthma: a 20-year cohort study. Sci Rep 2020; 10:3452. [PMID: 32103063 PMCID: PMC7044325 DOI: 10.1038/s41598-020-60478-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/13/2020] [Indexed: 11/08/2022] Open
Abstract
Investigating COPD trends may help healthcare providers to forecast future disease burden. We estimated sex- and smoking-specific incidence trends of pre-bronchodilator airflow obstruction (AO) among adults without asthma from 11 European countries within a 20-year follow-up (ECRHS and SAPALDIA cohorts). We also quantified the extent of misclassification in the definition based on pre-bronchodilator spirometry (using post-bronchodilator measurements from a subsample of subjects) and we used this information to estimate the incidence of post-bronchodilator AO (AOpost-BD), which is the primary characteristic of COPD. AO incidence was 4.4 (95% CI: 3.5-5.3) male and 3.8 (3.1-4.6) female cases/1,000/year. Among ever smokers (median pack-years: 20, males; 12, females), AO incidence significantly increased with ageing in men only [incidence rate ratio (IRR), 1-year increase: 1.05 (1.03-1.07)]. A strong exposure-response relationship with smoking was found both in males [IRR, 1-pack-year increase: 1.03 (1.02-1.04)] and females [1.03 (1.02-1.05)]. The positive predictive value of AO for AOpost-BD was 59.1% (52.0-66.2%) in men and 42.6% (35.1-50.1%) in women. AOpost-BD incidence was 2.6 (1.7-3.4) male and 1.6 (1.0-2.2) female cases/1,000/year. AO incidence was considerable in Europe and the sex-specific ageing-related increase among ever smokers was strongly related to cumulative tobacco exposure. AOpost-BD incidence is expected to be half of AO incidence.
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Affiliation(s)
- Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
| | - Lucia Calciano
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Alessandro Marcon
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Giancarlo Pesce
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
- Sorbonne Universités, INSERM UMR-S 1136, IPLESP, Team EPAR, F75012, Paris, France
| | - Josep M Antó
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Anna B Beckmeyer-Borowko
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Anne-Elie Carsin
- ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Angelo G Corsico
- Division of Respiratory Diseases, IRCCS 'San Matteo' Hospital Foundation-University of Pavia, Pavia, Italy
| | - Medea Imboden
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Dirk Keidel
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Francesca Locatelli
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Cecilie Svanes
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Peter G J Burney
- Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, UK
- MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
| | - Deborah Jarvis
- Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, UK
- MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
| | - Nicole M Probst-Hensch
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Cosetta Minelli
- Population Health and Occupational Disease, National Heart and Lung Institute, Imperial College London, London, UK
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18
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Otavova M, Van Oyen H, Yokota RTC, Charafeddine R, Joossens L, Molenberghs G, Nusselder WJ, Boshuizen HC, Devleesschauwer B. Potential impact of reduced tobacco use on life and health expectancies in Belgium. Int J Public Health 2019; 65:129-138. [PMID: 31781804 PMCID: PMC7049546 DOI: 10.1007/s00038-019-01315-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/30/2019] [Accepted: 11/19/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES We investigated the potential impact of reduced tobacco use scenarios on total life expectancy and health expectancies, i.e., healthy life years and unhealthy life years. METHODS Data from the Belgian Health Interview Survey 2013 were used to estimate smoking and disability prevalence. Disability was based on the Global Activity Limitation Indicator. We used DYNAMO-HIA to quantify the impacts of risk factor changes and to compare the "business-as-usual" with alternative scenarios. RESULTS The "business-as-usual" scenario estimated that in 2028 the 15-year-old men/women would live additional 50/52 years without disability and 14/17 years with disability. The "smoking-free population" scenario added 3.4/2.8 healthy life years and reduced unhealthy life years by 0.79/1.9. Scenarios combining the prevention of smoking initiation with smoking cessation programs are the most effective, yielding the largest increase in healthy life years (1.9/1.7) and the largest decrease in unhealthy life years (- 0.80/- 1.47). CONCLUSIONS Health impact assessment tools provide different scenarios for evidence-informed public health actions. New anti-smoking strategies or stricter enforcement of existing policies potentially gain more healthy life years and reduce unhealthy life years in Belgium.
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Affiliation(s)
- Martina Otavova
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, 5000, Odense, Denmark.,Interdisciplinary Center on Population Dynamics, Department of Public Health, University of Southern Denmark, 5000, Odense, Denmark
| | - Herman Van Oyen
- Department of Epidemiology and public health, Sciensano, Rue J Wytsman 14, 1050, Brussels, Belgium.,Department of Public Health and Primary Care, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Renata T C Yokota
- Department of Epidemiology and public health, Sciensano, Rue J Wytsman 14, 1050, Brussels, Belgium
| | - Rana Charafeddine
- Department of Epidemiology and public health, Sciensano, Rue J Wytsman 14, 1050, Brussels, Belgium
| | - Luk Joossens
- Association of European Cancer Leagues, Brussels, Belgium
| | | | - Wilma J Nusselder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hendriek C Boshuizen
- Department of Statistics, Informatics and Mathematical Modeling, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Brecht Devleesschauwer
- Department of Epidemiology and public health, Sciensano, Rue J Wytsman 14, 1050, Brussels, Belgium. .,Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
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19
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Bardach AE, Alcaraz AO, Ciapponi A, Garay OU, Riviere AP, Palacios A, Cremonte M, Augustovski F. Alcohol consumption's attributable disease burden and cost-effectiveness of targeted public health interventions: a systematic review of mathematical models. BMC Public Health 2019; 19:1378. [PMID: 31655600 PMCID: PMC6815367 DOI: 10.1186/s12889-019-7771-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 10/11/2019] [Indexed: 12/11/2022] Open
Abstract
Background Around 6% of total deaths are related to alcohol consumption worldwide. Mathematical models are important tools to estimate disease burden and to assess the cost-effectiveness of interventions to address this burden. Methods We carried out a systematic review on models, searching main health literature databases up to July 2017. Pairs of reviewers independently selected, extracted data and assessed the quality of the included studies. Discrepancies were resolved by consensus. We selected those models exploring: a) disease burden (main metrics being attributable deaths, disability-adjusted life years, quality-adjusted life years) or b) economic evaluations of health interventions or policies, based on models including the aforementioned outcomes. We grouped models into broad families according to their common central methodological approach. Results Out of 4295 reports identified, 63 met our inclusion criteria and were categorized in three main model families that were described in detail: 1) State transition -i.e Markov- models, 2) Life Table-based models and 3) Attributable fraction-based models. Most studies pertained to the latter one (n = 29, 48.3%). A few miscellaneous models could not be framed into these families. Conclusions Our findings can be useful for future researchers and decision makers planning to undertake alcohol-related disease burden or cost-effectiveness studies. We found several different families of models. Countries interested in adopting relevant public health measures may choose or adapt the one deemed most convenient, based on the availability of existing data at the local level, burden of work, and public health and economic outcomes of interest.
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Affiliation(s)
- Ariel Esteban Bardach
- Centre for Research in Epidemiology and Public Health, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina.
| | - Andrea Olga Alcaraz
- Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Agustín Ciapponi
- Centre for Research in Epidemiology and Public Health, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Osvaldo Ulises Garay
- Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Andrés Pichón Riviere
- Centre for Research in Epidemiology and Public Health, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Alfredo Palacios
- Center for Study of State and Society (CEDES), Sánchez de Bustamante 27 (C1173AAA) CABA, Buenos Aires, Argentina
| | - Mariana Cremonte
- Group of Psychoactive Substances and injuries due to external cause, Institute of Basic, Applied Psychology and Technology (IPSIBAT) CONICET National University of Mar del Plata, Dean Funes 3250, B7602AYJ, Mar del Plata, Buenos Aires, Argentina
| | - Federico Augustovski
- Centre for Research in Epidemiology and Public Health, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Dr Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
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Verschuuren M, Hilderink HBM, Vonk RAA. The Dutch Public Health Foresight Study 2018: an example of a comprehensive foresight exercise. Eur J Public Health 2019; 30:30-35. [DOI: 10.1093/eurpub/ckz200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
The use of foresight studies is common in some policy fields, but not in public health. Interest in such studies is growing. This paper gives a general overview of the Dutch Public Health Foresight Study (PHFS) 2018, providing insight into what performing a broad scenario exercise in the field of public health entails and its societal impacts.
Methods
The aim of the PHFS-2018 was: (a) to show how public health and healthcare in the Netherlands will develop over the next 25 years if we pursue our current course and detect ‘new’ developments; (b) to give options for dealing with the major future societal challenges. Part a was addressed by means of a quantitative business-as-usual scenario exercise complemented with qualitative thematic studies, and part b by elaborating courses of action for three key challenges, based on stakeholder consultation. Typical aspects of the PHFS methods are a multidisciplinary, participatory and conceptual approach and using a broad definition of health.
Results
The PHFS-2018 is the basis for the upcoming National Health Policy Memorandum and the Trend Scenario is the baseline for the National Prevention Agreement. Unexpectedly, the findings about increasing mental pressure in young people received most attention. There still is room for expanding use of the study to its full potential.
Conclusions
Long-term thinking could be stimulated by using back casting techniques and stronger involvement of policy-makers in the elaboration of options for action. Lessons learned from developing intersectoral policy at the local level could be applied at the national level.
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Affiliation(s)
- Marieke Verschuuren
- Department of Health Knowledge Integration, Center for Health and Society, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Henk B M Hilderink
- Department of Health Knowledge Integration, Center for Health and Society, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Robert A A Vonk
- Department of Health Knowledge Integration, Center for Health and Society, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Schönbach JK, Nusselder W, Lhachimi SK. Substituting polyunsaturated fat for saturated fat: A health impact assessment of a fat tax in seven European countries. PLoS One 2019; 14:e0218464. [PMID: 31291265 PMCID: PMC6619676 DOI: 10.1371/journal.pone.0218464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/03/2019] [Indexed: 01/22/2023] Open
Abstract
There is evidence that replacing saturated fat (SFA) with polyunsaturated fat (PUFA) lowers ischemic heart disease (IHD). In order to improve the population’s diet, the World Health Organization has called for the taxation of foods that are high in SFA. We aimed to assess the potential health gains of a European fat tax by applying the SFA intake reduction that has been observed under the Danish fat tax to six other European countries. For each country, we created a fat tax scenario with a decreased SFA intake and a corresponding increase in PUFA. We compared this fat tax scenario to a reference scenario with no change in SFA intake, and to a guideline scenario with a population-wide SFA intake in line with dietary recommendations. We used DYNAMO-HIA to dynamically project the policy-attributable IHD cases of these three scenarios 10 years into the future. A fat tax would reduce prevalent IHD cases by a minimum of 500 and 300 among males and females in Denmark, respectively, up to a maximum of 5,600 and 4,000 among males and females in the UK. Thereby, the prevented IHD cases under a fat tax scenario would correspond to between 11.0% (in females in the Netherlands) and 29.5% (in females in Italy) of the prevented IHD cases under a guideline scenario, which represents the maximum preventable disease burden. Henceforth, our quantification of beneficial health impacts makes the case for the policy debate on fat taxes.
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Affiliation(s)
- Johanna-Katharina Schönbach
- Institute for Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Research Group for Evidence-Based Public Health, Leibniz Institute for Prevention Research and Epidemiology–BIPS, Bremen, Germany
- * E-mail:
| | - Wilma Nusselder
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Stefan K. Lhachimi
- Institute for Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Research Group for Evidence-Based Public Health, Leibniz Institute for Prevention Research and Epidemiology–BIPS, Bremen, Germany
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Paalanen L, Härkänen T, Tolonen H. Protocol of a research project 'Projections of the burden of disease and disability in Finland - health policy prospects' using cross-sectional health surveys and register-based follow-up. BMJ Open 2019; 9:e029338. [PMID: 31227540 PMCID: PMC6596950 DOI: 10.1136/bmjopen-2019-029338] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION With the rapid ageing of the population in Europe, reliable estimates of the future development of the disease and disability burden as well as healthy life years in the older sections of the population are crucial. Meanwhile, the future prospects of the health and functional ability of the working-aged population are critical. The aims of the Projections of the burden of disease and disability in Finland - health policy prospects research project are to provide information about the long-term consequences of health-related behaviours of the population and to project the potential improvement of the burden of disease and disability based on realistic scenarios about the development of risk behaviours in the total population and its subgroups. METHODS AND ANALYSIS The analyses will be based on data from representative cross-sectional and longitudinal health examination surveys (HESs) conducted between 1972 to 2017 in Finland, and register data from several national administrative registers. Included HESs (FINRISK Surveys from 1972 to 2012, Mini-Finland Survey from 1978 to 1980, the Health 2000/2011 Surveys and the FinHealth 2017 Study) provide abundant information about biological and behavioural risk factors and the health and morbidity of the population. The modifiable risk factors used as predictors include hypertension, hyperlipidaemia, obesity, diabetes, physical inactivity, smoking, alcohol use and unfavourable diet. The main outcomes are ischaemic heart disease, cerebrovascular diseases, lung cancer, chronic obstructive pulmonary disease, Alzheimer's disease and diabetes. Within the project, novel projection techniques of data-driven Bayesian hierarchical models to provide robust and comparable estimates will be developed. ETHICS AND DISSEMINATION The prevailing legislation and regulations have been followed for all surveys. Surveys since 1997 have been approved by the respective Ethics Committees covering the scope of this project. A written informed consent was obtained from participants since 1997. The outputs of the project will include 8 to 10 scientific papers in peer-reviewed journals.
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Affiliation(s)
- Laura Paalanen
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Tommi Härkänen
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Hanna Tolonen
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Helsinki, Finland
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Devaux M, Lerouge A, Ventelou B, Goryakin Y, Feigl A, Vuik S, Cecchini M. Assessing the potential outcomes of achieving the World Health Organization global non-communicable diseases targets for risk factors by 2025: is there also an economic dividend? Public Health 2019; 169:173-179. [PMID: 30876722 DOI: 10.1016/j.puhe.2019.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 10/20/2018] [Accepted: 02/04/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study assesses the change in premature mortality and in morbidity under the scenario of meeting the World Health Organization (WHO) global targets for non-communicable disease (NCD) risk factors (RFs) by 2025 in France. It also estimates medical expenditure savings because of the reduction of NCD burden. STUDY DESIGN A microsimulation model is used to predict the future health and economic outcomes in France. METHODS A 'RF targets' scenario, assuming the achievement of the six targets on RFs by 2025, is compared to a counterfactual scenario with respect to disability-adjusted life years and healthcare costs differences. RESULTS The achievement of the RFs targets by 2025 would save about 25,300 (and 75,500) life years in good health in the population aged 25-64 (respectively 65+) years on average every year and would help to reduce healthcare costs by about €660 million on average per year, which represents 0.35% of the current annual healthcare spending in France. Such a reduction in RFs (net of the natural decreasing trend in mortality) would contribute to achieving about half of the 2030 NCD premature mortality target in France. CONCLUSIONS The achievement of the RF targets would lead France to save life years and life years in good health in both working-age and retired people and would modestly reduce healthcare expenditures. To achieve RFs targets and to curb the growing burden of NCDs, France has to strengthen existing and implement new policy interventions.
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Affiliation(s)
- M Devaux
- Health Division, Organization for Economic Co-operation and Development, Paris, France
| | - A Lerouge
- Health Division, Organization for Economic Co-operation and Development, Paris, France
| | - B Ventelou
- Aix-Marseille School of Economics, Aix-Marseille University, Marseille, France
| | - Y Goryakin
- Health Division, Organization for Economic Co-operation and Development, Paris, France
| | - A Feigl
- Health Division, Organization for Economic Co-operation and Development, Paris, France
| | - S Vuik
- Health Division, Organization for Economic Co-operation and Development, Paris, France
| | - M Cecchini
- Health Division, Organization for Economic Co-operation and Development, Paris, France.
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Füssenich K, Nusselder WJ, Lhachimi SK, Boshuizen HC, Feenstra TF. Potential gains in health expectancy by improving lifestyle: an application for European regions. Popul Health Metr 2019; 17:1. [PMID: 30654828 PMCID: PMC6337827 DOI: 10.1186/s12963-018-0181-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 12/11/2018] [Indexed: 02/07/2023] Open
Abstract
Background Prevention aiming at smoking, alcohol consumption, and BMI could potentially bring large gains in life expectancy (LE) and health expectancy measures such as Healthy Life Years (HLY) and Life Expectancy in Good Perceived Health (LEGPH) in the European Union. However, the potential gains might differ by region. Methods A Sullivan life table model was applied for 27 European countries to calculate the impact of alternative scenarios of lifestyle behavior on life and health expectancy. Results were then pooled over countries to present the potential gains in HLY and LEGPH for four European regions. Results Simulations show that up to 4 years of extra health expectancy can be gained by getting all countries to the healthiest levels of lifestyle observed in EU countries. This is more than the 2 years to be gained in life expectancy. Generally, Eastern Europe has the lowest LE, HLY, and LEGPH. Even though the largest gains in LEPGH and HLY can also be made in Eastern Europe, the gap in LE, HLY, and LEGPH can only in a small part be closed by changing smoking, alcohol consumption, and BMI. Conclusion Based on the current data, up to 4 years of good health could be gained by adopting lifestyle as seen in the best-performing countries. Only a part of the lagging health expectancy of Eastern Europe can potentially be solved by improvements in lifestyle involving smoking and BMI. Before it is definitely concluded that lifestyle policy for alcohol use is of relatively little importance compared to smoking or BMI, as our findings suggest, better data should be gathered in all European countries concerning alcohol use and the odds ratios of overconsumption of alcohol. Electronic supplementary material The online version of this article (10.1186/s12963-018-0181-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Koen Füssenich
- National Institute for Public Health and the Environment, Postbus 1, 3720 BA, Bilthoven, The Netherlands. .,Department of Epidemiology, University Medical Center, Groningen University, Groningen, The Netherlands.
| | - Wilma J Nusselder
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Stefan K Lhachimi
- Research Group for Evidence Based Public Health, Institute for Public Health and Nursing, University Bremen & Leibniz Institute for Epidemiology and Prevention Research, Bremen, Germany
| | - Hendriek C Boshuizen
- National Institute for Public Health and the Environment, Postbus 1, 3720 BA, Bilthoven, The Netherlands.,Department of Agrotechnology and Food Sciences, Wageningen University & Research, Wageningen, The Netherlands
| | - Talitha F Feenstra
- National Institute for Public Health and the Environment, Postbus 1, 3720 BA, Bilthoven, The Netherlands.,Department of Epidemiology, University Medical Center, Groningen University, Groningen, The Netherlands
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Schönbach JK, Thiele S, Lhachimi SK. What are the potential preventive population-health effects of a tax on processed meat? A quantitative health impact assessment for Germany. Prev Med 2019; 118:325-331. [PMID: 30468795 DOI: 10.1016/j.ypmed.2018.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 11/07/2018] [Accepted: 11/17/2018] [Indexed: 01/28/2023]
Abstract
The International Agency for Research on Cancer considers processed meat to be carcinogenic. Further, processed meat is associated with diabetes, ischemic heart disease (IHD) and all-cause mortality. We aimed to assess health gains of four processed meat taxation scenarios in comparison to the reference and a minimum-risk-exposure-scenario. To estimate the shift in processed meat intake following respective taxes, we calculated price elasticities for processed meat. DYNAMO-HIA was used to dynamically project policy-attributable differences in the prevalence of diseases and deaths. In projection year 10, an extra 9300 males and 4500 females would be alive under the lowest tax scenario (4% tax), compared to the reference scenario. Prevalent IHD, diabetes and colorectal cancer cases in males would be 8400, 9500 and 500 lower, respectively, and there would be 4600, 7800 and 300 less cases in females. Of the respective death and disease reduction that would be achieved under the minimum-risk-exposure-scenario, the lowest tax reaches 2.84% (colorectal cancer in males) to 6.02% (diabetes in females). Under the highest tax scenario (33.3% tax), an extra 76,700 males and 37,100 females would be alive, compared to the reference scenario. Prevalent IHD, diabetes and colorectal cancer cases would be 70,800, 77,900 and 4900 lower in males and 29,900, 48,900 and 2300 lower in females, which represents 27.84% (colorectal cancer in males) to 37.76% (diabetes in females) of the maximal preventable death and disease burden. Further research needs to examine to what extent these health benefits are outweighed by a simultaneous tax-induced decrease in fish intake.
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Affiliation(s)
- Johanna-Katharina Schönbach
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Bibliothekstraße 1, 28359 Bremen, Germany; Research Group for Evidence-Based Public Health, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359 Bremen, Germany.
| | - Silke Thiele
- ife Institute of Food Economics, Science Park Kiel, Fraunhoferstraße 13, 24118 Kiel, Germany
| | - Stefan K Lhachimi
- Institute for Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Bibliothekstraße 1, 28359 Bremen, Germany; Research Group for Evidence-Based Public Health, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359 Bremen, Germany
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Brønnum-Hansen H, Bender AM, Andersen ZJ, Sørensen J, Bønløkke JH, Boshuizen H, Becker T, Diderichsen F, Loft S. Assessment of impact of traffic-related air pollution on morbidity and mortality in Copenhagen Municipality and the health gain of reduced exposure. ENVIRONMENT INTERNATIONAL 2018; 121:973-980. [PMID: 30408890 DOI: 10.1016/j.envint.2018.09.050] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 05/10/2023]
Abstract
BACKGROUND Health impact assessment (HIA) of exposure to air pollution is commonly based on city level (fine) particle concentration and may underestimate health consequences of changing local traffic. Exposure to traffic-related air pollution can be assessed at a high resolution by modelling levels of nitrogen dioxide (NO2), which together with ultrafine particles mainly originate from diesel-powered vehicles in urban areas. The purpose of this study was to estimate the health benefits of reduced exposure to vehicle emissions assessed as NO2 at the residence among the citizens of Copenhagen Municipality, Denmark. METHODS We utilized residential NO2 concentrations modelled by use of chemistry transport models to calculate contributions from emission sources to air pollution. The DYNAMO-HIA model was applied to the population of Copenhagen Municipality by using NO2 concentration estimates combined with demographic data and data from nationwide registers on incidence and prevalence of selected diseases, cause specific mortality, and total mortality of the population of Copenhagen. We used exposure-response functions linking NO2 concentration estimates at the residential address with the risk of diabetes, cardiovascular diseases, and respiratory diseases derived from a large Danish cohort study with the majority of subjects residing in Copenhagen between 1971 and 2010. Different scenarios were modelled to estimate the dynamic impact of NO2 exposure on related diseases and the potential health benefits of lowering the NO2 level in the Copenhagen Municipality. RESULTS The annual mean NO2 concentration was 19.6 μg/m3 and for 70% of the population the range of exposure was between 15 and 21 μg/m3. If NO2 exposure was reduced to the annual mean rural level of 6 μg/m3, life expectancy in 2040 would increase by one year. The greatest gain in disease-free life expectancy would be lifetime without ischemic heart disease (1.4 years), chronic obstructive pulmonary disease (1.5 years for men and 1.6 years for women), and asthma (1.3 years for men and 1.5 years for women). Lowering NO2 exposure by 20% would increase disease-free life expectancy for the different diseases by 0.3-0.5 years. Using gender specific relative risks affected the results. CONCLUSIONS Reducing the NO2 exposure by controlling traffic-related air pollution reduces the occurrence of some of the most prevalent chronic diseases and increases life expectancy. Such health benefits can be quantified by DYNAMO-HIA in a high resolution exposure modelling. This paper demonstrates how traffic planners can assess health benefits from reduced levels of traffic-related air pollution.
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Affiliation(s)
- Henrik Brønnum-Hansen
- Faculty of Health Sciences, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Anne Mette Bender
- Faculty of Health Sciences, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Zorana Jovanovic Andersen
- Faculty of Health Sciences, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Centre for Epidemiological Research, Nykøbing F Hospital, Nykøbing F, Denmark
| | - Jan Sørensen
- Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jakob Hjort Bønløkke
- Department of Occupational and Environmental Diseases, Danish Ramazzini Centre, Aalborg University Hospital, Aalborg, Denmark
| | - Hendriek Boshuizen
- Department Statistics, Informatics and Mathematical Modelling, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Biometrics, Wageningen University, Wageningen, the Netherlands
| | - Thomas Becker
- Department of Environmental Science, Aarhus University, Aarhus, Denmark
| | - Finn Diderichsen
- Faculty of Health Sciences, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Loft
- Faculty of Health Sciences, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Kooiker R, Boshuizen HC. Internal consistency of a synthetic population construction method for chronic disease micro-simulation models. PLoS One 2018; 13:e0205225. [PMID: 30439941 PMCID: PMC6237328 DOI: 10.1371/journal.pone.0205225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 09/22/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Micro-simulation models of risk-factors and chronic diseases are built increasingly often, and each model starts with an initial population. Constructing such populations when no survey data covering all variables are available is no trivial task, often requiring complex methods based on several (untested) assumptions. In this paper, we propose a method for evaluating the merits of construction methods, and apply this to one specific method: the construction method used in the DYNAMO-HIA model. METHODS The initial population constructed using the DYNAMO-HIA method is compared to another population constructed by starting a simulation with only newborns and simulating the course taken by one risk-factor and several diseases. In this simulation, the age- and sex-specific prevalence of the risk-factor is kept constant over time. RESULTS Our simulations show that, in general, the DYNAMO-HIA method clearly outperforms a method that assumes independence of the risk-factor and the prevalence of diseases and independence between all diseases. In many situations the DYNAMO-HIA method performs reasonably well, but in some the proportion with the risk-factor for those with a disease is under- or overestimated by as much as 10 percentage points. For determining comorbidity between diseases linked by a common causal disease or a common risk-factor it also performs reasonably well. However, the current method performs poorly for determining the comorbidity between one disease caused by the other. CONCLUSION The DYNAMO-HIA methods perform reasonably well; they outperform a baseline assumption of independence between the risk-factor and diseases in the initial population. The method for determining the comorbidity between diseases that are causally linked needs improvement. Given the existing discrepancies for situations with high relative risks, however, developing more elaborate methods based on running simulation models to generate an initial population would be worthwhile.
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Affiliation(s)
- René Kooiker
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Hendriek C. Boshuizen
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Wageningen University, Wageningen, the Netherlands
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Angus C, Thomas C, Anderson P, Meier PS, Brennan A. Estimating the cost-effectiveness of brief interventions for heavy drinking in primary health care across Europe. Eur J Public Health 2017; 27:345-351. [PMID: 27558943 DOI: 10.1093/eurpub/ckw122] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Screening and Brief Interventions for alcohol are an effective public health measure to tackle alcohol-related harm, however relatively few countries across the European Union (EU) have implemented them widely. This may be due to a lack of understanding of the specific financial implications of such policies within each country. Methods A novel 'meta-modelling' approach was developed based on previous SBI cost-effectiveness models for four EU countries. Data were collected on the key factors which drive cost-effectiveness for all 28 EU countries (mean per capita alcohol consumption, proportion of the population to be screened over a 10-year SBI programme; per capita alcohol-attributable mortality; per capita alcohol-attributable morbidity; mean cost of an alcohol-related hospitalisation and mean SBI-delivery staff cost). Regression analysis was used to fit two meta-models estimating net programme costs and Quality-Adjusted Life Years (QALYs) gained, to calculate cost-effectiveness estimates specific to each EU country. Results Costs are dependent upon the proportion of the population covered by the screening programme, the country-specific per capita mortality and morbidity rate and the country-specific costs of GP care and hospitalisation. QALYs depend on the proportion of the population screened and per capita alcohol consumption. Despite large inter-country variability in factor values, SBI programmes are likely to be cost-effective in 24 out of 28 EU countries and cost-saving in 50% of countries. Conclusion Implementing national programmes of SBI in primary health care would be a cost-effective means of reducing alcohol-attributable morbidity and deaths in almost all countries of the EU.
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Affiliation(s)
- Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Chloe Thomas
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Peter Anderson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Petra S Meier
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alan Brennan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Brondeel R, Kestens Y, Chaix B. An evaluation of transport mode shift policies on transport-related physical activity through simulations based on random forests. Int J Behav Nutr Phys Act 2017; 14:143. [PMID: 29061144 PMCID: PMC5651637 DOI: 10.1186/s12966-017-0600-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 10/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical inactivity is widely recognized as one of the leading causes of mortality, and transport accounts for a large part of people's daily physical activity. This study develops a simulation approach to evaluate the impact of the Ile-de-France Urban Mobility Plan (2010-2020) on physical activity, under the hypothesis that the intended transport mode shifts are realized. METHODS Based on the Global Transport Survey (2010, n = 21,332) and on the RECORD GPS Study (2012-2013, n = 229) from the French capital region of Paris (Ile-de-France), a simulation method was designed and tested. The simulation method used accelerometer data and random forest models to predict the impact of the transport mode shifts anticipated in the Mobility Plan on transport-related moderate-to-vigorous physical activity (T-MVPA). The transport mode shifts include less private motorized trips in favor of more public transport, walking, and biking trips. RESULTS The simulation model indicated a mean predicted increase of 2 min per day of T-MVPA, in case the intended transport mode shifts in the Ile-de-France Urban Mobility Plan were realized. The positive effect of the transport mode shifts on T-MVPA would, however, be larger for people with a higher level of education. This heterogeneity in the positive effect would further increase the existing inequality in transport-related physical activity by educational level. CONCLUSIONS The method presented in this paper showed a significant increase in transport-related physical activity in case the intended mode shifts in the Ile-de-France Urban Mobility Plan were realized. This simulation method could be applied on other important health outcomes, such as exposure to noise or air pollution, making it a useful tool to anticipate the health impact of transport interventions or policies.
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Affiliation(s)
- Ruben Brondeel
- Inserm, UMR-S 1136, Pierre Louis Institute of Epidemiology and Public Health, Nemesis team, Médecine Saint-Antoine, 27 rue Chaligny, UMR-S 1136, 75012, Paris, France. .,Sorbonne Universités, UPMC Univ Paris 06, UMR-S 1136, Pierre Louis Institute of Epidemiology and Public Health, Nemesis team, Paris, France. .,EHESP School of Public Health, Rennes, France.
| | - Yan Kestens
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Basile Chaix
- Inserm, UMR-S 1136, Pierre Louis Institute of Epidemiology and Public Health, Nemesis team, Médecine Saint-Antoine, 27 rue Chaligny, UMR-S 1136, 75012, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR-S 1136, Pierre Louis Institute of Epidemiology and Public Health, Nemesis team, Paris, France
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Kang E. Assessing Health Impacts of Pictorial Health Warning Labels on Cigarette Packs in Korea Using DYNAMO-HIA. J Prev Med Public Health 2017; 50:251-261. [PMID: 28768403 PMCID: PMC5541276 DOI: 10.3961/jpmph.17.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 06/13/2017] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES This study aimed to predict the 10-year impacts of the introduction of pictorial warning labels (PWLs) on cigarette packaging in 2016 in Korea for adults using DYNAMO-HIA. METHODS In total, four scenarios were constructed to better understand the potential health impacts of PWLs: two for PWLs and the other two for a hypothetical cigarette tax increase. In both policies, an optimistic and a conservative scenario were constructed. The reference scenario assumed the 2015 smoking rate would remain the same. Demographic data and epidemiological data were obtained from various sources. Differences in the predicted smoking prevalence and prevalence, incidence, and mortality from diseases were compared between the reference scenario and the four policy scenarios. RESULTS It was predicted that the optimistic PWLs scenario (PWO) would lower the smoking rate by 4.79% in males and 0.66% in females compared to the reference scenario in 2017. However, the impact on the reduction of the smoking rate was expected to diminish over time. PWO will prevent 85 238 cases of diabetes, 67 948 of chronic obstructive pulmonary disease, 31 526 of ischemic heart disease, 21 036 of lung cancer, and 3972 prevalent cases of oral cancer in total over the 10-year span due to the reductions in smoking prevalence. The impacts of PWO are expected to be between the impact of the optimistic and the conservative cigarette tax increase scenarios. The results were sensitive to the transition probability of smoking status. CONCLUSIONS The introduction of PWLs in 2016 in Korea is expected reduce smoking prevalence and disease cases for the next 10 years, but regular replacements of PWLs are needed for persistent impacts.
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Affiliation(s)
- Eunjeong Kang
- Department of Health Administration and Management, Soonchunhyang University, Asan, Korea
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Boshuizen HC, Nusselder WJ, Plasmans MHD, Hilderink HH, Snijders BEP, Poos R, van Gool CH. Taking multi-morbidity into account when attributing DALYs to risk factors: comparing dynamic modeling with the GBD2010 calculation method. BMC Public Health 2017; 17:197. [PMID: 28196501 PMCID: PMC5310082 DOI: 10.1186/s12889-017-4024-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 01/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disability Adjusted Life Years (DALYs) quantify the loss of healthy years of life due to dying prematurely and due to living with diseases and injuries. Current methods of attributing DALYs to underlying risk factors fall short on two main points. First, risk factor attribution methods often unjustly apply incidence-based population attributable fractions (PAFs) to prevalence-based data. Second, it mixes two conceptually distinct approaches targeting different goals, namely an attribution method aiming to attribute uniquely to a single cause, and an elimination method aiming to describe a counterfactual situation without exposure. In this paper we describe dynamic modeling as an alternative, completely counterfactual approach and compare this to the approach used in the Global Burden of Disease 2010 study (GBD2010). METHODS Using data on smoking in the Netherlands in 2011, we demonstrate how an alternative method of risk factor attribution using a pure counterfactual approach results in different estimates for DALYs. This alternative method is carried out using the dynamic multistate disease table model DYNAMO-HIA. We investigate the differences between our alternative method and the method used by the GBD2010 by doing additional analyses using data from a synthetic population in steady state. RESULTS We observed important differences between the outcomes of the two methods: in an artificial situation where dynamics play a limited role, DALYs are a third lower as compared to those calculated with the GBD2010 method (398,000 versus 607,000 DALYs). The most important factor is newly occurring morbidity in life years gained that is ignored in the GBD2010 approach. Age-dependent relative risks and exposures lead to additional differences between methods as they distort the results of prevalence-based DALY calculations, but the direction and magnitude of the distortions depend on the particular situation. CONCLUSIONS We argue that the GBD2010 approach is a hybrid of an attributional and counterfactual approach, making the end result hard to understand, while dynamic modelling uses a purely counterfactual approach and thus yields better interpretable results.
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Affiliation(s)
- Hendriek C Boshuizen
- National Institute for Public Health and the Environment, P.O. Box 13720 BA, Bilthoven, The Netherlands. .,Wageningen University, Wageningen, The Netherlands.
| | - Wilma J Nusselder
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Marjanne H D Plasmans
- National Institute for Public Health and the Environment, P.O. Box 13720 BA, Bilthoven, The Netherlands
| | - Henk H Hilderink
- National Institute for Public Health and the Environment, P.O. Box 13720 BA, Bilthoven, The Netherlands
| | - Bianca E P Snijders
- National Institute for Public Health and the Environment, P.O. Box 13720 BA, Bilthoven, The Netherlands
| | - René Poos
- National Institute for Public Health and the Environment, P.O. Box 13720 BA, Bilthoven, The Netherlands
| | - Coen H van Gool
- National Institute for Public Health and the Environment, P.O. Box 13720 BA, Bilthoven, The Netherlands
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McLean S, Hoogendoorn M, Hoogenveen RT, Feenstra TL, Wild S, Simpson CR, Mölken MRV, Sheikh A. Projecting the COPD population and costs in England and Scotland: 2011 to 2030. Sci Rep 2016; 6:31893. [PMID: 27583987 PMCID: PMC5008118 DOI: 10.1038/srep31893] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/22/2016] [Indexed: 12/21/2022] Open
Abstract
We aimed to estimate the prevalence, healthcare costs and number of deaths among people with chronic obstructive pulmonary disease (COPD) in England and Scotland 2011–2030. We adapted the Dutch COPD Model by using English and Scottish demographic, COPD incidence, COPD prevalence, smoking prevalence and mortality data to make projections. In England, the prevalence of COPD was estimated to be 1.79% (95% uncertainty interval 1.77–1.81) in 2011, increasing to 2.19% (1.85–2.33) by 2030. In Scotland, prevalence was 2.03% (1.96–2.10) in 2011 increasing to 2.20% (1.98–2.40) in 2030. These increases were driven by more women developing COPD. Annual direct healthcare costs of COPD in England were estimated to increase from £1.50 billon (1.18–2.50) in 2011 to £2.32 (1.85–3.08) billion in 2030. In Scotland, costs increased from £159 million (128–268) in 2011 to £207 (165–274) million in 2030. The deaths in England were estimated to increase from 99,200 (92,500–128,500) in 2011, to 129,400 (126,400–133,400) by 2030. In Scotland, in 2011 there were 9,700 (9,000–12,300) deaths and 13,900 (13,400–14,500) deaths in 2030. The number of people with COPD will increase substantially over the coming years in England and Scotland, particularly in females. Services need to adapt to this increasing demand.
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Affiliation(s)
- Susannah McLean
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Doorway 1, Medical Quad, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK
| | - Martine Hoogendoorn
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
| | - Rudolf T Hoogenveen
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Talitha L Feenstra
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Sarah Wild
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Doorway 1, Medical Quad, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK
| | - Colin R Simpson
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Doorway 1, Medical Quad, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK
| | | | - Aziz Sheikh
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Doorway 1, Medical Quad, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK
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Erkoyun E, Sözmen K, Bennett K, Unal B, Boshuizen HC. Predicting the health impact of lowering salt consumption in Turkey using the DYNAMO health impact assessment tool. Public Health 2016; 140:228-234. [PMID: 27545691 DOI: 10.1016/j.puhe.2016.04.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 03/16/2016] [Accepted: 04/26/2016] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To estimate the impact of three daily salt consumption scenarios on the prevalence and incidence of ischaemic heart disease (IHD) and cerebrovascular disease in 2025 in the Turkish population aged ≥30 years using the DYNAMO Health Impact Assessment tool. STUDY DESIGN Statistical disease modelling study. METHODS DYNAMO health impact assessment was populated using data from Turkey to estimate the prevalence and incidence of IHD and cerebrovascular disease in 2025. TurkSTAT data were used for demographic data, and national surveys were used for salt consumption and disease-specific burden. Three salt consumption scenarios were modelled: (1) reference scenario: mean salt consumption stays the same from 2012-2013 until 2025; (2) gradual decline: daily salt intake reduces steadily by 0.47 g per year by lowering salt intake from bread by 50% and from table salt by 40% by 2025; and (3) World Health Organization (WHO) advice: daily salt intake of 5 g per day from 2013 until 2025. RESULTS The gradual decline scenario would lead to a decrease in the prevalence of IHD and cerebrovascular disease by 0.3% and 0.2%, respectively, and a decrease in the incidence by 0.6 and 0.4 per 1000, respectively. Following WHO's advice would lead to a decrease in the prevalence of IHD and cerebrovascular disease by 0.8% and 0.5%, respectively, and a decrease in the incidence by 1.0 and 0.7 per 1000, respectively. CONCLUSION This model indicates that Turkey can lower its future cardiovascular disease burden by following the gradual decline scenario. Following WHO's advice would achieve an even greater benefit.
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Affiliation(s)
- E Erkoyun
- Department of Public Health, Dokuz Eylul University, Izmir, Turkey.
| | - K Sözmen
- Department of Public Health, Izmir Katip Celebi University, Izmir, Turkey
| | - K Bennett
- Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, Dublin, Ireland
| | - B Unal
- Department of Public Health, Dokuz Eylul University, Izmir, Turkey
| | - H C Boshuizen
- Department of Statistics and Mathematical Modelling, National Institute of Public Health and the Environment, Bilthoven, The Netherlands; Department of Human Nutrition, Wageningen University, Wageningen, The Netherlands
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Lhachimi SK, Nusselder WJ, Smit HA, Baili P, Bennett K, Fernández E, Kulik MC, Lobstein T, Pomerleau J, Boshuizen HC, Mackenbach JP. Potential health gains and health losses in eleven EU countries attainable through feasible prevalences of the life-style related risk factors alcohol, BMI, and smoking: a quantitative health impact assessment. BMC Public Health 2016; 16:734. [PMID: 27495151 PMCID: PMC4975898 DOI: 10.1186/s12889-016-3299-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 07/13/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Influencing the life-style risk-factors alcohol, body mass index (BMI), and smoking is an European Union (EU) wide objective of public health policy. The population-level health effects of these risk-factors depend on population specific characteristics and are difficult to quantify without dynamic population health models. METHODS For eleven countries-approx. 80 % of the EU-27 population-we used evidence from the publicly available DYNAMO-HIA data-set. For each country the age- and sex-specific risk-factor prevalence and the incidence, prevalence, and excess mortality of nine chronic diseases are utilized; including the corresponding relative risks linking risk-factor exposure causally to disease incidence and all-cause mortality. Applying the DYNAMO-HIA tool, we dynamically project the country-wise potential health gains and losses using feasible, i.e. observed elsewhere, risk-factor prevalence rates as benchmarks. The effects of the "worst practice", "best practice", and the currently observed risk-factor prevalence on population health are quantified and expected changes in life expectancy, morbidity-free life years, disease cases, and cumulative mortality are reported. RESULTS Applying the best practice smoking prevalence yields the largest gains in life expectancy with 0.4 years for males and 0.3 year for females (approx. 332,950 and 274,200 deaths postponed, respectively) while the worst practice smoking prevalence also leads to the largest losses with 0.7 years for males and 0.9 year for females (approx. 609,400 and 710,550 lives lost, respectively). Comparing morbidity-free life years, the best practice smoking prevalence shows the highest gains for males with 0.4 years (342,800 less disease cases), whereas for females the best practice BMI prevalence yields the largest gains with 0.7 years (1,075,200 less disease cases). CONCLUSION Smoking is still the risk-factor with the largest potential health gains. BMI, however, has comparatively large effects on morbidity. Future research should aim to improve knowledge of how policies can influence and shape individual and aggregated life-style-related risk-factor behavior.
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Affiliation(s)
- Stefan K. Lhachimi
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Research Group for Evidence Based Public Health, Institute for Public Health and Nursing, University Bremen & Leibniz Institute for Epidemiology and Prevention Research, Bremen, Germany
- Department of Statistics and Mathematical Modeling, Expertise Centre for Methodology and Information Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Public Health, Heinrich Heine University, Duesseldorf, Germany
| | - Wilma J. Nusselder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Henriette A. Smit
- Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
- Center for Prevention and Health Services Research (PZO), National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Paolo Baili
- Descriptive Studies and Health Planning Unit, Fondazione IRCCS “Istituto Nazionale Tumori”, Milan, Italy
| | - Kathleen Bennett
- Department of Pharmacology & Therapeutics, Trinity Centre for health sciences, St James’s Hospital, Dublin, Ireland
| | - Esteve Fernández
- Tobacco Control Unit, Institut Català d’Oncologia-IDIBELL, L’Hospitalet de Llobregat Barcelona, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Campus of Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - Margarete C. Kulik
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Center for Prevention and Health Services Research (PZO), National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Tim Lobstein
- IASO -the International Association for the Study of Obesity, IOTF -the International Obesity TaskForce, London, UK
| | - Joceline Pomerleau
- European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK
| | - Hendriek C. Boshuizen
- Department of Statistics and Mathematical Modeling, Expertise Centre for Methodology and Information Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Division of Human Nutrition, Wageningen University, Wageningen, Netherlands
| | - Johan P. Mackenbach
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Alcohol and liver disease in Europe--Simple measures have the potential to prevent tens of thousands of premature deaths. J Hepatol 2016; 64:957-67. [PMID: 26592352 DOI: 10.1016/j.jhep.2015.11.006] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 10/30/2015] [Accepted: 11/03/2015] [Indexed: 12/12/2022]
Abstract
In the World Health Organisation European Region, more than 2,370,000 years of life are lost from liver disease before the age of 50; more than lung cancer, trachea, bronchus, oesophageal, stomach, colon, rectum and pancreatic cancer combined. Between 60-80% of these deaths are alcohol related, a disease for which no pharmaceutical therapy has yet been shown to improve long-term survival. The toxicity of alcohol is dose related at an individual level, and is dose related at a population level; overall liver mortality is largely determined by population alcohol consumption. Trends in alcohol consumption correlate closely with trends in overall liver mortality, with 3-5-fold decreases or increases in liver mortality in different European countries over the last few decades. The evidence base for alcohol control measures aimed at reducing population alcohol consumption has been subjected to rigorous evaluation; most recently by the Organisation for Economic Co-Operation and Development (OECD). Effective alcohol policy measures reduce alcohol mortality, including mortality from liver disease. The most effective and cost effective measures have been summarised by the OECD and the World Health Organisation: regular incremental above inflation tax increases, a minimum price for alcohol, effective protection of children from alcohol marketing and low level interventions from clinicians. Simple, cheap and effective changes to alcohol policy by European Institutions and member states have the potential to dramatically reduce liver mortality in Europe.
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Health Impact Assessment for Second-Hand Smoke Exposure in Germany--Quantifying Estimates for Ischaemic Heart Diseases, COPD, and Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:198. [PMID: 26861366 PMCID: PMC4772218 DOI: 10.3390/ijerph13020198] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/21/2016] [Accepted: 02/03/2016] [Indexed: 12/22/2022]
Abstract
Evidence of the adverse health effects attributable to second-hand smoke (SHS) exposure is available. This study aims to quantify the impact of SHS exposure on ischaemic heart diseases (IHD), chronic obstructive pulmonary diseases (COPD), and stroke in Germany. Therefore, this study estimated and forecasted the morbidity for the three outcomes in the German population. Furthermore, a health impact assessment was performed using DYNAMO-HIA, which is a generic software tool applying a Markov model. Overall 687,254 IHD cases, 231,973 COPD cases, and 288,015 stroke cases were estimated to be attributable to SHS exposure in Germany for 2014. Under the assumption that the population prevalence of these diseases and the prevalence of SHS exposure remain constant, the total number of cases will increase due to demographic aging. Assuming a total eradication of SHS exposure beginning in 2014 leads to an estimated reduction of 50% in cases, compared to the reference scenario in 2040 for all three diseases. The results highlight the relevance of SHS exposure because it affects several chronic disease conditions and has a major impact on the population’s health. Therefore, public health campaigns to protect non-smokers are urgently needed.
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Health Impacts of Increased Physical Activity from Changes in Transportation Infrastructure: Quantitative Estimates for Three Communities. BIOMED RESEARCH INTERNATIONAL 2015; 2015:812325. [PMID: 26504832 PMCID: PMC4609517 DOI: 10.1155/2015/812325] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 07/22/2015] [Indexed: 11/21/2022]
Abstract
Recently, two quantitative tools have emerged for predicting the health impacts of projects that change population physical activity: the Health Economic Assessment Tool (HEAT) and Dynamic Modeling for Health Impact Assessment (DYNAMO-HIA). HEAT has been used to support health impact assessments of transportation infrastructure projects, but DYNAMO-HIA has not been previously employed for this purpose nor have the two tools been compared. To demonstrate the use of DYNAMO-HIA for supporting health impact assessments of transportation infrastructure projects, we employed the model in three communities (urban, suburban, and rural) in North Carolina. We also compared DYNAMO-HIA and HEAT predictions in the urban community. Using DYNAMO-HIA, we estimated benefit-cost ratios of 20.2 (95% C.I.: 8.7–30.6), 0.6 (0.3–0.9), and 4.7 (2.1–7.1) for the urban, suburban, and rural projects, respectively. For a 40-year time period, the HEAT predictions of deaths avoided by the urban infrastructure project were three times as high as DYNAMO-HIA's predictions due to HEAT's inability to account for changing population health characteristics over time. Quantitative health impact assessment coupled with economic valuation is a powerful tool for integrating health considerations into transportation decision-making. However, to avoid overestimating benefits, such quantitative HIAs should use dynamic, rather than static, approaches.
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Milner J, Chalabi Z, Vardoulakis S, Wilkinson P. Housing interventions and health: Quantifying the impact of indoor particles on mortality and morbidity with disease recovery. ENVIRONMENT INTERNATIONAL 2015; 81:73-79. [PMID: 25958127 DOI: 10.1016/j.envint.2015.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 04/10/2015] [Accepted: 04/28/2015] [Indexed: 06/04/2023]
Abstract
Housing interventions for energy efficiency and greenhouse gas emission reduction have the potential to reduce exposure to indoor air pollution if they are implemented correctly. This work assessed the health impacts of home energy efficiency measures in England and Wales resulting in a reduction in average indoor PM2.5 exposures of 3 μg m(-3). The assessment was performed using a new multistate life table model which allows transition into and between multiple morbid states, including recovery to disease-free status and relapse, with transition rates informed by age- and cause-specific disease prevalence, incidence and mortality data. Such models have not previously included disease recovery. The results demonstrate that incorporation of recovery in the model is necessary for conditions such as asthma which have high incidence in early life but likelihood of recovery in adulthood. The impact assessment of the home energy efficiency intervention showed that the reduction in PM2.5 exposure would be associated with substantial benefits for mortality and morbidity from asthma, coronary heart disease and lung cancer. The overall impact would be an increase in life expectancy of two to three months and approximately 13 million QALYs gained over the 90 year follow-up period. Substantial quality-of-life benefits were also observed, with a decrease in asthma over all age groups and larger benefits due to reduced coronary heart disease and lung cancer, particularly in older age groups. The multistate model with recovery provides important additional information for assessing the impact on health of environmental policies and interventions compared with mortality-only life tables, allowing more realistic representation of diseases with substantial non-mortality burdens.
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Affiliation(s)
- James Milner
- Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
| | - Zaid Chalabi
- Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
| | - Sotiris Vardoulakis
- Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK; Centre for Radiation, Chemical & Environmental Hazards, Public Health England, Harwell Campus, OX11 0RQ, UK.
| | - Paul Wilkinson
- Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
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McLean S, Barbour V, Wild S, Simpson C, Sheikh A. Models for estimating projections for disease prevalence and burden: a systematic review focusing on chronic obstructive pulmonary disease. J Health Serv Res Policy 2015; 20:246-53. [PMID: 25836652 DOI: 10.1177/1355819615579232] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Epidemiological models for estimating the prevalence and burden of disease inform health policy and service planning decisions. Our aim was to describe the challenges in evaluating such models using the example of epidemiological models for chronic obstructive pulmonary disease (COPD). METHODS Two reviewers searched Medline, Embase, CAB Abstracts and World Health Organization (WHO) Databases from 1980 to November 2013 for epidemiological models of COPD prevalence and burden. Two reviewers extracted data and assessed the quality of the studies. We then undertook a descriptive and narrative synthesis of data. RESULTS We identified 22 models employing a variety of techniques to calculate the prevalence and/or burden of COPD. Models calculated prevalence and/or mortality or other facet of disease burden using demographics and risk factors or trends, Markov-type modelling and microsimulation modelling. The six models which scored highly on the quality framework were: the Peabody model, which generated estimates of COPD prevalence; the WHO DISMOD II model which produced burden estimates in terms of disability adjusted life years with COPD and life years lost to COPD; the Atsou model which gave the life expectancy gains of individual smokers who quit smoking and associated costs; two Dutch COPD models which produced estimates of mortality and health care costs related to COPD; and the Pichon-Riviere model which gave the costs and cost effectiveness of smoking quit programmes. CONCLUSIONS The field of chronic disease modelling is burgeoning. As a result, policy makers need to understand how to interpret epidemiological models and their data sources.
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Affiliation(s)
- Susannah McLean
- PhD Student, Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, UK
| | - Victoria Barbour
- Research Fellow, Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, UK
| | - Sarah Wild
- Professor of Epidemiology, Centre for Population Health Sciences, The University of Edinburgh, UK
| | - Colin Simpson
- Senior Lecturer, Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, UK
| | - Aziz Sheikh
- Professor of Primary Care Research and Development, Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, UK
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Health gain by salt reduction in europe: a modelling study. PLoS One 2015; 10:e0118873. [PMID: 25826317 PMCID: PMC4380413 DOI: 10.1371/journal.pone.0118873] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 01/09/2015] [Indexed: 11/19/2022] Open
Abstract
Excessive salt intake is associated with hypertension and cardiovascular diseases. Salt intake exceeds the World Health Organization population nutrition goal of 5 grams per day in the European region. We assessed the health impact of salt reduction in nine European countries (Finland, France, Ireland, Italy, Netherlands, Poland, Spain, Sweden and United Kingdom). Through literature research we obtained current salt intake and systolic blood pressure levels of the nine countries. The population health modeling tool DYNAMO-HIA including country-specific disease data was used to predict the changes in prevalence of ischemic heart disease and stroke for each country estimating the effect of salt reduction through its effect on blood pressure levels. A 30% salt reduction would reduce the prevalence of stroke by 6.4% in Finland to 13.5% in Poland. Ischemic heart disease would be decreased by 4.1% in Finland to 8.9% in Poland. When salt intake is reduced to the WHO population nutrient goal, it would reduce the prevalence of stroke from 10.1% in Finland to 23.1% in Poland. Ischemic heart disease would decrease by 6.6% in Finland to 15.5% in Poland. The number of postponed deaths would be 102,100 (0.9%) in France, and 191,300 (2.3%) in Poland. A reduction of salt intake to 5 grams per day is expected to substantially reduce the burden of cardiovascular disease and mortality in several European countries.
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Scarborough P, Harrington RA, Mizdrak A, Zhou LM, Doherty A. The Preventable Risk Integrated ModEl and Its Use to Estimate the Health Impact of Public Health Policy Scenarios. SCIENTIFICA 2014; 2014:748750. [PMID: 25328757 PMCID: PMC4195430 DOI: 10.1155/2014/748750] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 09/08/2014] [Indexed: 05/14/2023]
Abstract
Noncommunicable disease (NCD) scenario models are an essential part of the public health toolkit, allowing for an estimate of the health impact of population-level interventions that are not amenable to assessment by standard epidemiological study designs (e.g., health-related food taxes and physical infrastructure projects) and extrapolating results from small samples to the whole population. The PRIME (Preventable Risk Integrated ModEl) is an openly available NCD scenario model that estimates the effect of population-level changes in diet, physical activity, and alcohol and tobacco consumption on NCD mortality. The structure and methods employed in the PRIME are described here in detail, including the development of open source code that will support a PRIME web application to be launched in 2015. This paper reviews scenario results from eleven papers that have used the PRIME, including estimates of the impact of achieving government recommendations for healthy diets, health-related food taxes and subsidies, and low-carbon diets. Future challenges for NCD scenario modelling, including the need for more comparisons between models and the improvement of future prediction of NCD rates, are also discussed.
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Affiliation(s)
- Peter Scarborough
- British Heart Foundation Centre on Population Approaches to Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Richard A. Harrington
- British Heart Foundation Centre on Population Approaches to Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Anja Mizdrak
- British Heart Foundation Centre on Population Approaches to Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | | | - Aiden Doherty
- British Heart Foundation Centre on Population Approaches to Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
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42
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Holm AL, Brønnum-Hansen H, Robinson KM, Diderichsen F. Assessment of health impacts of decreased smoking prevalence in Copenhagen: Application of the DYNAMO-HIA model. Scand J Public Health 2014; 42:409-16. [DOI: 10.1177/1403494814530048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: Tobacco smoking is among the leading risk factors for chronic disease and early death in developed countries, including Denmark, where smoking causes 14% of the disease burden. In Denmark, many public health interventions, including smoking prevention, are undertaken by the municipalities, but models to estimate potential health effects of local interventions are lacking. The aim of the current study was to model the effects of decreased smoking prevalence in Copenhagen, Denmark. Methods: The DYNAMO-HIA model was applied to the population of Copenhagen, by using health survey data and data from Danish population registers. We modelled the effects of four intervention scenarios aimed at different target groups, compared to a reference scenario. The potential effects of each scenario were modelled until 2040. Results: A combined scenario affecting both initiation rates among youth, and cessation and re-initiation rates among adults, which reduced the smoking prevalence to 4% by 2025, would have large beneficial effects on incidence and prevalence of smoking-related diseases and mortality. Health benefits could also be obtained through interventions targeting only cessation or re-initiation rates, whereas an intervention targeting only initiation among youth had marginal effects on morbidity and mortality within the modelled time frame. Conclusions: By modifying the DYNAMO-HIA model, we were able to estimate the potential health effects of four interventions to reduce smoking prevalence in the population of Copenhagen. The effect of the interventions on future public health depended on population subgroup(s) targeted, duration of implementation and intervention reach.
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Affiliation(s)
| | | | | | - Finn Diderichsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Mesa-Frias M, Chalabi Z, Foss AM. Quantifying uncertainty in health impact assessment: a case-study example on indoor housing ventilation. ENVIRONMENT INTERNATIONAL 2014; 62:95-103. [PMID: 24189198 DOI: 10.1016/j.envint.2013.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 10/08/2013] [Accepted: 10/09/2013] [Indexed: 06/02/2023]
Abstract
Quantitative health impact assessment (HIA) is increasingly being used to assess the health impacts attributable to an environmental policy or intervention. As a consequence, there is a need to assess uncertainties in the assessments because of the uncertainty in the HIA models. In this paper, a framework is developed to quantify the uncertainty in the health impacts of environmental interventions and is applied to evaluate the impacts of poor housing ventilation. The paper describes the development of the framework through three steps: (i) selecting the relevant exposure metric and quantifying the evidence of potential health effects of the exposure; (ii) estimating the size of the population affected by the exposure and selecting the associated outcome measure; (iii) quantifying the health impact and its uncertainty. The framework introduces a novel application for the propagation of uncertainty in HIA, based on fuzzy set theory. Fuzzy sets are used to propagate parametric uncertainty in a non-probabilistic space and are applied to calculate the uncertainty in the morbidity burdens associated with three indoor ventilation exposure scenarios: poor, fair and adequate. The case-study example demonstrates how the framework can be used in practice, to quantify the uncertainty in health impact assessment where there is insufficient information to carry out a probabilistic uncertainty analysis.
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Affiliation(s)
- Marco Mesa-Frias
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
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Lhachimi SK, Nusselder WJ, Lobstein TJ, Smit HA, Baili P, Bennett K, Kulik MC, Jackson-Leach R, Boshuizen HC, Mackenbach JP. Modelling obesity outcomes: reducing obesity risk in adulthood may have greater impact than reducing obesity prevalence in childhood. Obes Rev 2013; 14:523-31. [PMID: 23601528 DOI: 10.1111/obr.12029] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 02/01/2013] [Accepted: 02/19/2013] [Indexed: 11/30/2022]
Abstract
A common policy response to the rise in obesity prevalence is to undertake interventions in childhood, but it is an open question whether this is more effective than reducing the risk of becoming obese during adulthood. In this paper, we model the effect on health outcomes of (i) reducing the prevalence of obesity when entering adulthood; (ii) reducing the risk of becoming obese throughout adult life; and (iii) combinations of both approaches. We found that, while all approaches reduce the prevalence of chronic diseases and improve life expectancy, a given percentage reduction in obesity prevalence achieved during childhood had a smaller effect than the same percentage reduction in the risk of becoming obese applied throughout adulthood. A small increase in the probability of becoming obese during adulthood offsets a substantial reduction in prevalence of overweight/obesity achieved during childhood, with the gains from a 50% reduction in child obesity prevalence offset by a 10% increase in the probability of becoming obese in adulthood. We conclude that both policy approaches can improve the health profile throughout the life course of a cohort, but they are not equivalent, and a large reduction in child obesity prevalence may be reversed by a small increase in the risk of becoming overweight or obese in adulthood.
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Affiliation(s)
- S K Lhachimi
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Lhachimi SK, Cole KJ, Nusselder WJ, Smit HA, Baili P, Bennett K, Pomerleau J, McKee M, Charlesworth K, Kulik MC, Mackenbach JP, Boshuizen H. Health impacts of increasing alcohol prices in the European Union: a dynamic projection. Prev Med 2012; 55:237-43. [PMID: 22713346 DOI: 10.1016/j.ypmed.2012.06.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Revised: 04/29/2012] [Accepted: 06/09/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Western Europe has high levels of alcohol consumption, with corresponding adverse health effects. Currently, a major revision of the EU excise tax regime is under discussion. We quantify the health impact of alcohol price increases across the EU. DATA AND METHOD We use alcohol consumption data for 11 member states, covering 80% of the EU-27 population, and corresponding country-specific disease data (incidence, prevalence, and case-fatality rate of alcohol related diseases) taken from the 2010 published Dynamic Modelling for Health Impact Assessment (DYNAMO-HIA) database to dynamically project the changes in population health that might arise from changes in alcohol price. RESULTS Increasing alcohol prices towards those of Finland (the highest in the EU) would postpone approximately 54,000 male and approximately 26,100 female deaths over 10 years. Moreover, the prevalence of a number of chronic diseases would be reduced: in men by approximately 97,800 individuals with diabetes, 65,800 with stroke and 62,200 with selected cancers, and in women by about 19,100, 23,500, and 27,100, respectively. CONCLUSION Curbing excessive drinking throughout the EU completely would lead to substantial gains in population health. Harmonisiation of prices to the Finnish level would, for selected diseases, achieve more than 40% of those gains.
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Affiliation(s)
- Stefan K Lhachimi
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, The Netherlands.
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