The DYNAMO-HIA Model: An Efficient Implementation of a Risk Factor/Chronic Disease Markov Model for Use in Health Impact Assessment (HIA)
Boshuizen, H.C. ; Lhachimi, S.K. ; Baal, P.H.M. van; Hoogenveen, R.T. ; Smit, H.A. ; Mackenbach, J.P. ; Nusselder, W.J. - \ 2012
Demography 49 (2012)4. - ISSN 0070-3370 - p. 1259 - 1283.
sensitivity-analysis - economic-evaluation - life expectancy - population - care - prevalence
In Health Impact Assessment (HIA), or priority-setting for health policy, effects of risk factors (exposures) on health need to be modeled, such as with a Markov model, in which exposure influences mortality and disease incidence rates. Because many risk factors are related to a variety of chronic diseases, these Markov models potentially contain a large number of states (risk factor and disease combinations), providing a challenge both technically (keeping down execution time and memory use) and practically (estimating the model parameters and retaining transparency). To meet this challenge, we propose an approach that combines micro-simulation of the exposure information with macro-simulation of the diseases and survival. This approach allows users to simulate exposure in detail while avoiding the need for large simulated populations because of the relative rareness of chronic disease events. Further efficiency is gained by splitting the disease state space into smaller spaces, each of which contains a cluster of diseases that is independent of the other clusters. The challenge of feasible input data requirements is met by including parameter calculation routines, which use marginal population data to estimate the transitions between states. As an illustration, we present the recently developed model DYNAMO-HIA (DYNAMIC MODEL for Health Impact Assessment) that implements this approach.
Apolipoprotein E Genotype Modifies the Association between Midlife Lung Function and Cognitive Function in Old Age
Giltay, E.J. ; Nissinen, A. ; Giampaoli, S. ; Kromhout, D. - \ 2009
Dementia and Geriatric Cognitive Disorders 28 (2009)5. - ISSN 1420-8008 - p. 433 - 441.
alzheimers-disease - pulmonary-function - risk-factors - atherosclerosis risk - respiratory-function - life expectancy - apoe epsilon-4 - birth cohort - dementia - health
Background/Aims: Because poor lung function may be a risk factor for cognitive decline, we aimed to test the association of respiratory function with cognitive function and dementia later in life, as well as potential effect modification by APOE 4 carrier status. Methods: In a prospective population-based cohort study, forced vital capacity and forced expiratory flow were measured around 1965 in 857 men aged 45-64 years (394 from Finland, 208 from The Netherlands, and 255 from Italy). The Mini-Mental State Examination scores around 1990, 1995 and 2000 were analyzed using multilevel regression models and the Clinical Dementia Rating score around 1990 using multinomial logistic regression analyses. Results: Midlife lung function was positively associated with cognitive function in old age in APOE 4 non-carriers, but not in carriers (p <0.05 for interaction). In Finland and Italy, 18.6% had questionable to mild dementia and 2.8% moderate to severe dementia after 25 years of follow-up. Dementia was inversely related to midlife lung function in APOE 4 non-carriers, but not in carriers (p <0.05 for interaction). Conclusions: Small lung volumes were prospectively associated with an increased risk for poor cognitive function and dementia in non-carriers of the APOE 4 gene.
Long-term lifestyle and dietary habits in relation to cardiovascular mortality and life expectancy: a prospective cohort study
Streppel, M.T. - \ 2009
Wageningen University. Promotor(en): Daan Kromhout; Frans Kok, co-promotor(en): M.C. Ocké. - [S.l. : S.n. - ISBN 9789085853640 - 127
hart- en vaatziekten - mortaliteit - levensverwachting - levensstijl - dieet - tabak roken - alcoholinname - trans-isomeren van vetzuren - visconsumptie - vezel - epidemiologische onderzoeken - omega-3 vetzuren - voedingsvezels - cardiovascular diseases - mortality - life expectancy - lifestyle - diet - tobacco smoking - alcohol intake - trans fatty acids - fish consumption - fibre - epidemiological surveys - omega-3 fatty acids - dietary fibres
Introduction: In prospective cohort studies, information on lifestyle and dietary habits is generally only assessed at the baseline examination, assuming that these habits are relatively constant over the entire study period. Repeated measures can take into account changes in these habits, reduce measurement error due to a reduction in within-subject variation, and can give more insight into the etiology of diseases. The main objective of this thesis is to assess the relationships of recent and long-term exposure to known lifestyle and dietary risk factors with cardiovascular mortality and life expectancy.
Methods: We used data from the Zutphen Study, a prospective cohort study among 1373 men born between 1900 and 1920. These men were examined repeatedly in seven examination rounds between 1960 and 2000. In addition to hazard ratios (HR), we presented some of our results in terms of differences in life expectancy at age 50.
Main findings on lifestyle factors: We found that both the number of cigarettes smoked and smoking duration were strongly associated with mortality risk. Compared to never or long-term former smoking, cigarette smoking decreased life expectancy by about 7 years and exclusive cigar or pipe smoking decreased life expectancy by about 5 years. Stopping smoking cigarettes at age 50 increased life expectancy by 3.3 years. Furthermore, we observed that long-term light alcohol intake, i.e. <20 grams per day, compared to no alcohol intake, lowered cardiovascular (HR: 0.70 [95% confidence interval: 0.55 to 0.89]) and all-cause (HR: 0.75 [0.63 to 0.91]) mortality risk. Compared to men who do not consume alcohol, wine consumers had a 5 years longer life expectancy.
Main findings on dietary factors: We observed that average trans unsaturated fatty acid intake decreased from 7 to about 1 percent of energy intake between 1960 and 2000 and that each additional 2 percent of long-term energy intake from trans unsaturated fatty acids was positively associated with sudden coronary death (HR: 1.62 [1.01 to 2.60]). In contrast, long-term fatty fish consumption was inversely associated with sudden coronary death (HR: 0.46 [0.27 to 0.78]). The strength of the association between long-term total fish consumption and coronary heart disease (CHD) death decreased from age 50 (HR: 0.32 [0.13 to 0.80]) until age 80 (HR: 1.34 [0.58 to 3.12]). We observed no clear dose-response relationship between the intake of the n-3 fatty acids EPA and DHA, and (sudden) coronary death. Finally, we found that each additional 10 grams of recent dietary fiber intake was associated with a lower risk of CHD (HR: 0.83 [0.70 to 0.98]) and all-cause (HR: 0.91 [0.82 to 1.00]) mortality.
Conclusions: The studies described in this thesis emphasize the importance of lifestyle and diet for public health. Our results suggest that non-smoking and a low level of wine consumption decrease the risk of (cardiovascular) mortality and will increase life expectancy at age 50. The long-term consumption of fatty fish and the reduction in long-term trans unsaturated fatty acid intake may prevent sudden coronary deaths, and a higher recent dietary fiber intake may reduce both CHD and all-cause mortality risk.
Nutritional analysis and intervention in the captive woolly monkey (Lagothric lagotricha)
Ange-van Heugten, K.D. - \ 2008
Wageningen University. Promotor(en): Martin Verstegen, co-promotor(en): P. Ferket. - [S.l.] : S.n. - ISBN 9789085049012 - 191
apen - diervoeding - diergezondheid - dierziekten - diëten - voedingsstoffen - levensverwachting - bloedserum - bloedchemie - diabetes mellitus - hydrocortison - voedselsupplementen - dierentuinen - dieren in gevangenschap - voeding en gezondheid - monkeys - animal nutrition - animal health - animal diseases - diets - nutrients - life expectancy - blood serum - blood chemistry - diabetes mellitus - hydrocortisone - food supplements - zoological gardens - captive animals - nutrition and health
Woolly monkeys (Lagothrix ssp.) are a threatened species in the wild and are extremely difficult to breed and successfully maintain in captivity. The majority of health complications in woolly monkeys (WM) may be of nutritional origin. The objectives of this thesis were to: 1) determine the current status of the captive WM, 2) isolate potential nutritional causes for primary disorders in captive WM, and 3) investigate the effects that diet nutrients have on WM serum chemistry and cortisol concentrations. Our studies showed that the number of captive WM have decreased by 11% in the past 16 years. The number of institutions holding WM decreased and the birth to death ratio is 0.65 compared to 1.26 for their close relative the spider monkey (SM) (Ateles spp.). Lack of genetic diversity in captive WM also may negatively influence their success. Serum chemistry from 30 WM housed at two zoos were similar to previously reported concentrations for howler (Aloutta sp.) and SM; however, serum glucose was above the baseline range compared to humans and SM. Fasting concentrations of glucose, insulin, fructosamine, glycated hemoglobin, circulating lipids and urinary glucose were within normal ranges in six WM with known hypertension problems compared to other monkeys and humans. Potential stressors, such as unnatural diet, can contribute to the low success of endangered primates via noted health abnormalities. Fecal and salivary cortisol concentrations in WM and SM, at multiple zoological institutions showed that zoos with the highest dietary total carbohydrates, total sugars, glucose and fruit content had the highest cortisol. Supplementation of WM and SM diets with inulin-type fructans numerically decreased fecal cortisol after 4 weeks of supplementation, primarily in SM. The lifespan and reproductive success of captive primates will improve if stressors and negative effects of nutrition on the health status can be reduced and dietary nutrients can be optimized.
Relation of dietary quality, physical activity, and smoking habits to 10-year changes in health status in older europeans in the SENECA Study
Haveman-Nies, A. ; Groot, C.P.G.M. de; Staveren, W.A. van - \ 2003
American Journal of Public Health 93 (2003)2. - ISSN 0090-0036 - p. 318 - 323.
self-rated health - elderly people - functional status - life expectancy - mortality - community - men - respondents - population - morbidity
Objectives. This study investigated the effect of healthy lifestyle behaviors on self-rated health and self-care ability over a 10-year follow-up period in older persons in the SENECA study. Methods. Health status and lifestyle behaviors were examined in 1988/1989, 1993, and 1999 in 216 men and 264 women, born between 1913 and 1918, from 7 European countries. Results. Self-rated health and self-care ability declined in men and women with healthy and unhealthy lifestyle habits over the 10-year follow-up period. Inactive and smoking persons had an increased risk for a decline in health status as compared with active and nonsmoking people, No effect of a healthy, Mediterranean-like diet on the deterioration in health status was observed. Conclusions. Being physically active and nonsmoking delayed deterioration in health status in older participants aged 70 to 75 years in the SENECA study.