Freia De Bock, Diana Sonntag Mannheim Institute for Public Health - - PowerPoint PPT Presentation

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Note: for non-commercial purposes only Which costs does childhood obesity cause? Implications for obesity prevention in Germany Freia De Bock, Diana Sonntag Mannheim Institute for Public Health (MIPH) Early Nutrition Conference 2014 The

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Which costs does childhood obesity cause? Implications for obesity prevention in Germany

Freia De Bock, Diana Sonntag Mannheim Institute for Public Health (MIPH) Early Nutrition Conference 2014 “The Power of Programming” Munich, 13 – 15 March 2014 Note: for non-commercial purposes only

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Freia de Bock I MIPH I Slide 2 von 24 I 14.03.2014

Which costs are caused by obesity?

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Do overweight and obese children (BMI>25 kg/m2)

cause larger lifetime excess costs during adulthood than normalweight children?

Research question:

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CHILDREN

(Age: 3-17)

ADULTS

(Age: 18-100)

Model I (epidemiology) Model II including normalweight children Model III including

  • bese children
  • Methods (I)
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Methods (II)

NORMAL DEATH OBESE OVERWEIGHT α_child_oa α_child_ao α_child_no α_child_on OVERWEIGHT_post normal NORMAL_post

  • verweight

αDeath_ α_child_no α_child_on αDeath_ αDeath_ αDeath_ αDeath_

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CHILDREN

(Age: 3-17)

ADULTS

(Age: 18-100)

Model I (epidemiology) Model II including normalweight children Model III including obese children

Methods (IV)

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0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 3 8 13 18 23 28 33 38 43 48 53 58 63 68 73 78 83 88 93 98 Proportion of the cohort Age

Female

Dead Proportion of obese individuals who were obese as child Proportion of obese individuals who become obese during adulthood Proportion of overweight individuals who were overweight as child Proportion of overweight individuals who become overweight during adulthood Normalweight

Results (I)

Development of BMI categories taking childhood

  • besity history into account
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Results (II)

Comparison direct/ indirect lifetime excess costs

Cost differences

Costs (€ 2010) without Discounting

Men Women If obese as a child Direct Excess costs

14,524 19,479 X2.99 x3.37

Indirect Excess costs

11,547 6,428 x2.94 x3.85 Costs (€ 2010) with Discounting 3%

If obese as a child Direct Excess costs

4,262 7,028 x3.72 x5.3

Indirect Excess costs

4,206 2,442 x3.15 x4.15

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Literature comparison– obese/non-obese childhood

Sonntag/ De Bock 2013 Fernandes 2009 Brunello 2009 lifetime cost until age 55 Germany USA Europe Proxy for incidence Proxy incidence Incidence-based (long. Data SHARE) Markov Model with Kohorte Monte-Carlo Sim., lifetable Micro-simulation Direct costs m 2.99 4.9 1.37 f 3.37 3.5 Indirect costs m 2.94

  • f

3.85

  • Additional direct

lifetime-costs (3% discount) 4,262- 7,028 Euro $18.999- $26.775 13,840 for obese versus non-obese in adulthood Additional indirect lifetime-costs (3% discount) 2,442 – 4,206 Euro

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Thanks a lot for your attention!

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Additional Slides

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Methods (VII)

  • 1. Estimation of transition probabilities
  • Kinder- und Jugendgesundheitssurvey (KiGGS):

cross-sectional data

  • Adapting of health status „normalweight“,

„overweight“ and „obese“ since two BMI states have been neglected.

  • Since data are not available for each year,

data are adjusted by linear regressions

  • determination of genderspecific transition probabilities
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Freia de Bock I MIPH I Slide 13 von 24 I 14.03.2014

Methods (VIII)

  • Sample Census 2009: cross-sectional data

 Adapting of health status „normalweight“, „overweight and „obese“ since one BMI state has been neglected.  Since data are not available for each year, data are adjusted by linear regressions.  Determination of genderspecific transition probabilities; backward changes between stages have been considered e.g. tracking from obesity to overweight.

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Methods (IX)

  • 2. Further data
  • Mortality rates are used from Federal Statistical Office
  • In order to determine relative risks (RRs) two literature

reviews have been conducted:  Age-specific mortality RR associated with obesity or

  • verweight are used from the European Prospective

Investigation into Cancer and Nutrition (EPIC- Study).  Adult mortality RR associated with obesity or overweight in childhood used from Engeland et al. (2004).

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  • 3. Costs
  • Methodology: PAF

Methods (X)

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Freia de Bock I MIPH I Slide 16 von 24 I 14.03.2014 Cost % difference from base result Men Univariate: Discount rate 5% 2.331

  • 45%

Transitition probabilities factor 0.8 3.948

  • 6%

factor 1.2 4.399 5% RR adult mortality 4.153

  • 1%

Costs 11.339 169% Women Univariate: Discount rate 5% 1.423

  • 42%

Transitition probabilities factor 0.8 2.340

  • 4%

factor 1.2 2.519 3% RR adult mortality 2.372

  • 3%

Costs 5.571 129%

Sensitivity Analysis