1. 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

2. 2 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.

3. 3 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.

4. 4 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

5. 5 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

6. 6 Consensus Conference  To be held May 15-16 th 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

7. 7 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

8. 8 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

9. 9 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

10. 10 RISK/ PROTECTIVE FACTORS CHRONIC CONDITION ArthritisCardiovascular Disease DiabetesMental Illness: -depression -bipolar disorder -schizophrenia -brain disorders -anxiety Respiratory Diseases: -asthma -COPD Stress Co-morbidities Obesity and overweight Healthy lifestyle factors: -Tobacco smoking - ↑ Physical activity -  Alcohol consumption - ↑ Healthy diet (  sodium, N-3 fatty acids, glycemic load,  trans fats, Vitamins D & E) RR PAR AR Etc… Metabolic factors: -High blood pressure - high blood cholesterol - high blood sugar Suicide attempts Life cycles Family History Ethnicity Disability Sex Socio-economic status

11. 11 Preliminary Focus: Columns and Rows 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

12. 12 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)

13. 13 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

14. 14 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

15. 15 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

16. 16 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