Background
Methods
The model structure
Risk factor model
Diabetes sub-model
Hypertension sub-model
Smoking sub-model
CVD sub-model
No risk | Diabetes | Hypertension | Smoking | Diabetes Hypertension | |
---|---|---|---|---|---|
No risk | 1% | ||||
Diabetes | 20% | 29% | 5% | ||
Hypertension | 10% | 15% | |||
Smoking | 5% | 15% |
Data
Parameters | Values | Unit | Sources |
---|---|---|---|
Diabetes sub model
| |||
Baseline incidence rate | 0.0328368 | Dimensionless/year | Calibration |
Baseline progression rate [managed] | 0.0134 | Dimensionless/year | [49] |
Baseline progression rate [unmanaged] | 0.0556 | Dimensionless/year | |
Baseline pre-diabetes regression rate | 0.193 | Dimensionless/year | [50] |
Uptake rate of management | 0.05 | Dimensionless/year | Calibration |
Hypertension sub-model
| |||
Baseline incidence rate | 0.0237906 | Dimensionless/year | Calibration |
Baseline progression rate [unmanaged] | [51] | ||
Female | 0.06975 | Dimensionless/year | |
Male | 0.080125 | Dimensionless/year | |
Effect of management on progression | 0.33 | Dimensionless/year | [52] |
Baseline prehypertension regression rate | 0.25 | Dimensionless/year | [53] |
Uptake rate of management | 0.035 | Dimensionless/year | Calibration |
Smoking sub-model
| |||
Baseline smoking initiation rate | 0.0082388 | Dimensionless/year | Calibration |
Baseline smoking relapse rate | 0.1 | Dimensionless/year | [56] |
Baseline smoking cessation rate | 0.162 | Dimensionless/year | [55] |
Demographics
| |||
Birth rate | Time series | Dimensionless/year | [47] |
Net migration | Time series | Dimensionless/year | Calibration |
Age specific mortality rate | Time series | Dimensionless/year | [47] |
CVD Model
| |||
Smoking risk | [58] | ||
Female | 0.5419 | Dimensionless | |
Male | 0.5224 | Dimensionless | |
Age risk | |||
Female | 0.0699 | Dimensionless | |
Male | 0.0488 | Dimensionless | |
Diabetes risk | |||
Female | 0.5604 | Dimensionless | |
Male | 0.3492 | Dimensionless | |
Hypertension risk | |||
Female | 0.0161 | Dimensionless | |
Male | 0.0152 | Dimensionless | |
CVD beta | Calibration | ||
Normal | −11.968 | Dimensionless | |
Diabetes only | −5.53323 | Dimensionless | |
Hypertension only | −6.91289 | Dimensionless | |
Smoking only | −5.33926 | Dimensionless | |
Diabetes and hypertension | −6.74229 | Dimensionless | |
Diabetes and smoking | −8.09581 | Dimensionless | |
Hypertension smoking | −7.10026 | Dimensionless | |
Diabetes and hypertension and smoking | −8.18119 | Dimensionless | |
Relative risk of CVD event Diabetes Management | 0.8 | Dimensionless | [61] |
Relative risk of CVD event Hypertension Management | 0.5 | Dimensionless | [62] |
Relative risk of CVD event Smoking Cessation | 0.5 | Dimensionless | Calibrated |
CVD event death rate | 0.2 | Dimensionless | Calibrated |
Relative risk of death CVD | 1.6 | Dimensionless | [63] |
Effect of treatment on mortality | 0.13 | Dimensionless | [67] |
Fraction of post-CVD population receiving treatment of risk factors | 1 | Dimensionless | Expert opinion |
Model validation and sensitivity analysis
Policy experimentation
Results
Risk factors
CVD outcomes
Outcomes | 2010 | 2020 | 2030 | 2040 | % change 2010–2040 |
---|---|---|---|---|---|
Base-case | |||||
CVD Events | 33,292 (33,292-33,292) | 52,171 (51,982-52,360) | 70,102 (69,542-70,662) | 86,592 (85,588-87,594) | 160% (157–163%) |
CVD Deaths | 5329 (5329-5329) | 7046 (7043-7049) | 10,551 (10,528-10,574) | 14,714 (14,631-14,797) | 176% (174–177.6%) |
Post-CVD Population | 112,606 (112,606-112,606) | 138,507 (138,366-138,647) | 173,896 (173,137-174,654) | 204,689 (202,857-206,522) | 81.7% (80–83.4%) |
Age-Adjusted Incidence Rate | 0.88% (0.88–0.88%) | 1.293% (1.289–1.298%) | 1.60% (1.59–1.61%) | 1.84% (1.82–1.86%) | 109% (106–111%) |
Diabetes Management Scenario | |||||
CVD Events | 33,292 (33,292-33,292) | 52,171 (51,982-52,360) | 63,857 (63,391-64,322) | 75,647 (74,819-76,475) | 127% (124–129%) |
CVD Deaths | 5329 (5329-5329) | 7046 (7043-7049) | 10,331 (10,311-10,352) | 13,875 (13,804-13,946) | 160% (159–161%) |
Post-CVD Population | 112,606 (112,606-112,606) | 138,507 (138,366-138,647) | 168,088 (167,410-168,766) | 186,460 (184,923-187,997) | 65.5% (64–66.9%) |
Age-Adjusted Incidence Rate | 0.88% (0.88–0.88%) | 1.293% (1.289–1.298%) | 1.46% (1.45–1.47%) | 1.61% (1.59–1.62%) | 82.9% (80.6–84%) |
Hypertension Management Scenario | |||||
CVD Events | 33,292 (33,292-33,292) | 52,171 (51,982-52,360) | 66,500 (65,979-67,021) | 79,812 (78,912-80,712) | 139.7% (137–142%) |
CVD Deaths | 5329 (5329-5329) | 7046 (7043-7049) | 10,383 (10,361-10,405) | 14,130 (14,053-14,206) | 165% (163.7–166%) |
Post-CVD Population | 112,606 (112,606-112,606) | 138,507 (138,366-138,647) | 170,720 (169,991-171,449) | 194,710 (193,019-196,401) | 71.9% (71.4–74%) |
Age-Adjusted Incidence Rate | 0.88% (0.88–0.88%) | 1.293% (1.289–1.298%) | 1.52% (1.51–1.53%) | 1.70% (1.68–1.72%) | 93% (90–95%) |
Smoking Cessation Scenario | |||||
CVD Events | 33,292 (33,292-33,292) | 52,171 (51,982-52,360) | 67,036 (66,505-67,567) | 82,973 (82,013-83,933) | 149% (146–152%) |
CVD Deaths | 5329 (5329-5329) | 7046 (7043-7049) | 10,413 (10,391-10,434) | 14,322 (14,243-14,400) | 168% (167–170%) |
Post-CVD Population | 112,606 (112,606-112,606) | 138,507 (138,366-138,647) | 170,178 (169,451-170,905) | 196,800 (195,048-198,551) | 74.7% (73–76%) |
Age-Adjusted Incidence Rate | 0.88% (0.88–0.88%) | 1.293% (1.289–1.298%) | 1.536% (1.524–1.548%) | 1.768% (1.748–1.788%) | 100.9% (98–103%) |
Diabetes/Hypertension/Smoking Scenario | |||||
CVD Events | 33,292 (33,292-33,292) | 52,171 (51,982-52,360) | 57,347 (56,947-57,747) | 65,584 (64,897-66,271) | 96.9% (94.9–99%) |
CVD Deaths | 5329 (5329-5329) | 7046 (7043-7049) | 10,029 (10,010-10,048) | 12,918 (12,856-12,979) | 142% (141–143.5%) |
Post-CVD Population | 112,606 (112,606-112,606) | 138,507 (138,366-138,647) | 161,321 (160,702-161,939) | 169,112 (167,789-170,434) | 50% (49–51.3%) |
Age-Adjusted Incidence Rate | 0.88% (0.88–0.88%) | 1.293% (1.289–1.298%) | 1.313% (1.304–1.322%) | 1.396% (1.381–1.410%) | 58.6% (56%-60) |