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Preliminary findings from POHEM-OA: BMI interventions

This presentation by Eric C. Sayre at the STAR Meeting discusses the preliminary findings from the POHEM-OA study, which models the impact of Body Mass Index (BMI) on osteoarthritis (OA) and health-related quality of life (HRQoL). Key observations indicate that higher BMI leads to increased OA rates and lowers HRQoL. The study explores BMI categories, intervention strategies to lower BMI, and implications for OA incidence and prevalence by 2031. A targeted 5-point BMI reduction is proposed, offering potential benefits for OA management and future health interventions.

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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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