TOWARD AN INVENTORY OF RISK FACTORS ASSOCIATED WITH CHRONIC CONDITIONS

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. 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. 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. 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. 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. 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

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. 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. 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. Conceptual Matrix

11. 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

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. 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. 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. 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. 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