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.
