Coronary heart disease risk factors in Canada: a Microsimulation predictive model

Doug Manuel, MD, MSc, William M. Flanagan, BM, Meltem Tuna, PhD, Anya Okhmatovskaia, PhD, Philippe Finès, PhD; Carol Bennett, MSc

Simulated Technology for Applied Research (STAR)

Behnam Sharif, MSc, Jacek A. Kopec, MD, PhD, Hubert Wong, PhD, Aslam Anis , PhD, Eric C. Sayre, PhD, M. Mushfiqur Rahman, MSc, David Buckeridge, MD, PhD, Jillian Oderkirk, MSc, Michal Abrahamowicz, PhD, Sam Harper, PhD,Michael C. Wolfson, PhD

• A Canadian Institute for Health Research New Emerging Team including:

Chronic Diseases

Major cause of death and disability worldwide.

Reason of more than 55 thousand deaths in Canada so far this year.

57% of those under 65 live with at least one chronic condition.

An additional chronic disease raises the risk of hospitalization by 44% among people under age 60.

Risk Factors

Behavioural Smoking Physical Inactivity

Biophysical Obesity Elevated Cholesterol Blood Pressure

POHEM: Population Health Model

ModGen(Developed in C++)

Interacting Agent models

Non-Interacting Agent models

Child Vaccination (CVMM)

HIVMM

LifePaths

PopSim

POHEM

Micro-simulation at Statistics Canada

Characteristics of POHEM

case-by-case, longitudinal, continuous time, stochastic, Monte Carlo microsimulation

directly encompasses competing risks and comorbidity

longitudinal risk factor and disease sub-modules projects population forward in continuous time generates plausible health biographies over the

life course of synthetic individuals from empirical observations

Process for projecting coronary heart disease risks in Canada, 2001 to 2020

Canadian population (2001)

Canadian Community Health Survey (2001)

Update yearly (2002 – 2009)

Update for births, deaths, immigration, emigration and change in CAD risks

Validate (2002 – 2009)

Compare births, deaths, immigration , emigration and prevalence of CAD.

Generate predictive estimates (2010 – 2020)

Data sources

Births and DeathsYearly Updates

Immigration and Emigration Yearly Updates

Socioeconomic Yearly Updates

CAD Risks Yearly Updates

Coronary heart disease risk factors, prevalence in 2001

Sex Million %Blood Pressure

Million %

Male 11.5 0.49 Optimal 15.7 0.66

Female 12 0.51 Normal 4.1 0.18

High-normal 2.3 0.1

Mean Median Hypertensive Stage I 1.3 0.05

Age 46.8 45 Hypertensive Stage II-IV 0.3 0.01

Smoking Million % Total Cholesterol Million %

Current 6.3 0.28 Low 4.4 0.19

Former 8.7 0.39 Low-Medium 8.5 0.37

Never 7.4 0.33 Medium 7.3 0.32

Medium-High 2.3 0.1

High 0.6 0.02

Observed vs. Predicted

0

0.05

0.1

0.15

0.2

0.25

0.3

2001 2003 2005 2007 2009 2011 2013 2015 2017 2019 2021

POHEM-Diabetes CCHS-Diabetes

POHEM-Smoking CCHS-Smoking

POHEM-BMI CCHS_BMI

Multiple Risk Factors: Diabetes – Obesity - Smoking

Predicted and observed risk factors, 2009 Canada

Projected Observed

Diabetes

Obesity

Smoking

References

M.C. Wolfson , POHEM—a framework for understanding and modelling the health of human populations. Wld. Hlth. Statist. Quart. 47 (1994), pp. 157–176

Statistics Canada. Canadian Community Health Surveys, Cycles 1.1-4.1, 2009-2010.