TOWARD AN INVENTORY OF RISK FACTORS ASSOCIATED WITH CHRONIC CONDITIONS Presentation to the Association of Public Health Epidemiologists of Ontario [APHEO] Toronto ON February 8, 2007 Marie DesMeules, Director Evidence and Risk Assessment Division Centre for Chronic Disease Prevention and Control Public Health Agency of Canada
Main Objectives • to determine the best relative risks (RR’s) and population attributable risks (PAR’s) of major risk factors and their associated chronic diseases / conditions. • to reach a consensus of the “best” RR’s and PAR’s to be used within Public Health Agency of Canada (PHAC) to estimate the burden of chronic diseases in Canada.
Expected Outcome • an inventory of established and emerging risk factors associated with chronic diseases / conditions in Canada • to be housed on the Canadian Best Practices Portal for Health Promotion and Chronic Disease Prevention.
Purpose • The resulting inventory will be used to generate information: • for Departmental evidence-based policy and program decision making • to fill in public health information gaps
Consultation Workshop • Held November 23, 2007 • ~30 key experts and stakeholders developed a proposed strategic plan for developing an inventory of established and emerging risk factors for key chronic diseases • Identified priority risk factors, determinants, diseases, indicators • Identified information gaps: methodological issues, literature reviews, environmental scans
Consensus Conference • To be held May 15-16th 2008 • To involve broader participation • Reach consensus on inventory structure and content • More work is needed to inform discussions in preparation for a consensus conference • A Risk Factor Inventory Working Group was struck
Working Group • 12 key experts who took part in the Consultation workshop – 9 external; 3 PHAC • Provide recommendations in developing a mock-up inventory structure and content
Working Group Recommendations • Present the inventory using a matrix structure • Focus on key areas for preliminary content: • Diseases / conditions • Risk / protective factors • Evidence of Risk / Indicators of risk • Conduct an environmental Scan to identify if there are any existing inventories of risk factors associated with chronic conditions that include measures of association • Conduct a sample of reviews to identify existing evidence of risk to populate the inventory mock-up • Priority Indicators of Risk, Burden and Impact from Existing Systematic Reviews/meta-analyses
Matrix Structure • Began with a conceptual matrix design showing the cross-over between risk and condition. • An actual matrix will be more complex, with a cell for each condition / risk factor • Each cell will contain evidence of risk: • known indicators of risk
Diseases / conditions Diabetes CHD and stroke Asthma Respiratory diseases Mental health/illness Arthritis Risk / protective factors and determinants Stress Co-morbidities Obesity Healthy lifestyle factors Metabolic factors Suicide Life cycles Family history Ethnicity Disability Sex SES Preliminary Focus: Columns and Rows
Evidence of Risk Indicators: Cells • By age, sex and timeframe: • Relative risk [RR] • Population attributable risk [PAR] • Attributable risk [AR] • Mortality rates • Incidence rates • Prevalence rates • Disability-adjusted life-years [DALY’s] • Hospitalization rates • Economic burden • Other (eg: OR)
Current Reviews • Priority Indicators of Risk, Burden and Impact from Existing Systematic Reviews/meta-analyses on: • Coronary Heart Disease, Stroke and Diabetes; and Respiratory Diseases • Relationships between Alcohol Consumption and Key Chronic Diseases • Suicide • Psychological risk factors for cardiovascular diseases (CVD) • Chronic Obstructive Pulmonary Disease (COPD) • Asthma • Sex- and gender-related features and the development / progression of major chronic conditions • Work stress and mental illness • Stress as a Risk Factor for Anxiety Disorders
Consensus Conference • Consensus is needed to support on-going, long-term development of an inventory of established and emerging risk factors associated with chronic disease • A Conference Planning Advisory Committee has been struck to inform conference proceedings. • APHEO potential involvement: • More work is needed to develop the inventory ‘structure’ or ‘mock-up’ before and after the conference
Potential APHEO Involvement • April 1 – May 15, 2008 before Consensus Conference • Further develop a mock-up inventory structure using recommendations from the working group • Begin to populate the mock-up inventory with evidence derived from current reviews • Present these results at the conference to obtain participant feedback • May 15 – September 30, 2008 after Consensus Conference • Refine the inventory mock-up structure based on the participant input
Next Steps • October 1 – March 31, 2009 • Create the inventory from the mock-up • Field-test the inventory • Make changes as a result of the field-test