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Preliminary findings from POHEM-OA: BMI interventions

Preliminary findings from POHEM-OA: BMI interventions. STAR Meeting in Ottawa, ON July 7-8, 2010 By Eric C. Sayre. Abbreviations. OA=osteoarthritis SROA=self-reported OA BMI=body mass index HUI=Health Utilities Index Mark 3 HALE=health-adjusted life years

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Preliminary findings from POHEM-OA: BMI interventions

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  1. Preliminary findings from POHEM-OA: BMI interventions STAR Meeting in Ottawa, ON July 7-8, 2010 By Eric C. Sayre

  2. Abbreviations • OA=osteoarthritis • SROA=self-reported OA • BMI=body mass index • HUI=Health Utilities Index Mark 3 • HALE=health-adjusted life years • HRQoL=health-related quality of life • CCHS=Canadian Community Health Survey • POHEM-OA=Population Health Model for OA

  3. BMI, OA and HRQoL • Higher BMI increases rates of OA and directly decreases HRQoL (HUI/HALE) • OA also decreases HRQoL • POHEM-OA begins with age 20+ 2001 CCHS values of age, BMI and HUI, with baseline SROA->baseline OA stage in POHEM-OA • POHEM-OA includes a trend model that increases mean BMI over time

  4. BMI, OA and HRQoL • BMI categories in POHEM-OA • Underweight (<18.5) • Normal weight (<25.0) • Overweight (<30.0) • Obese (>=30) • OA stages in POHEM-OA • No OA • OA • 1-k visits to surgeon • 1-4 joint replacement surgeries

  5. Intervention: Lower BMI • POHEM-OA allows us to • Lower BMI in 2001 for everyone in-scope in 2001 but not new births/immigrants after 2001 • Lower BMI every year by some amount but this puts everyone in underweight by 2031 • Study closed population and intervene in 2001 only: lowering 2001 BMI by 5 if BMI>=25 • BMI trend model remains active; effect on BMI is constant

  6. POHEM-OA Models • Hazard ratios for BMI->OA • Coefficients for BMI->HUI Not applicable since applied on transition as difference of coefficients

  7. POHEM-OA Models • Incident OA->HUI (detrimental) ΔHUI=-0.1037*NewOA-0.0408*Male • Last visit to surgeon->HUI (detrimental) HUI=0.2828-0.1171*Male+ 0.2988*(age<60)+ 0.2625*(ageЄ[60,70))+0.1897*(ageЄ[70,80))+ Normal(0,0.28032) • Surgery->HUI (beneficial) ΔHUI=0.6971-.5447*PreviousHUI-.0027*Age

  8. Results Intervals represent Monte Carlo error only

  9. Results py=Person-years Intervals represent Monte Carlo error only

  10. Results Intervals represent Monte Carlo error only

  11. Summary • 5-point targeted reduction in BMI in 2001 does by 2031 • Reduced OA incidence/prevalence • Limited benefit on HRQoL through OA • Large drop in % obese -> large direct benefit (not measured in current POHEM-OA)

  12. Future improvements POHEM-OA/BMI • Option for direct HRQoL benefits of reduced BMI (treat initial reduction as “transition”) • Support for BMI interventions applicable to open populations (e.g., reduce BMI on entry, for pre-existing persons/births/immigrants) • Account for additional sources of error, such as around parameter estimates • Vary the magnitude/target of the intervention

  13. Acknowledgments • Jacek Kopec • Bill Flanagan and Philippe Fines • Behnam Sharif • The STAR team

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