Population Health Intervention Research Unit, School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada.
PLoS One. 2018 Nov 8;13(11):e0206877. doi: 10.1371/journal.pone.0206877. eCollection 2018.
A high-quality diet is associated with a reduced of risk of chronic disease and all-cause mortality. In this study, we assessed changes in diet quality and the associated economic burden in the Canadian population between 2004 and 2015. We used a prevalence-based cost-of-illness approach. We first calculated the diet quality using the Healthy Eating Index-Canada-2010 (HEI-C-2010) and 24-hour recall data from the Canadian Community Health Surveys (CCHS) on nutrition (CCHS 2004 cycle 2.2 and the CCHS-NU 2015). We then retrieved relative risks of HEI-2010 quintiles for chronic diseases from meta-analyses. Based on the proportions of the population following diets of varying qualities and these relative risks, we computed the population-attributable fractions and attributable costs (direct health care and indirect costs) by survey year (2004 and 2015) as well as by age and sex group. Costs were estimated in 2017 Canadian dollars for comparison purposes. We observed that on average the diet quality of Canadians improved between 2004 and 2015: the proportion of the Canadian population that did not eat a diet of high quality decreased from 83% to 76%. This improvement in diet quality translated in a decrease in economic burden of $133 million, down from $13.21 billion in 2004 to $13.08 billion in 2015. The economic burden decreased by $219 million among males but increased by $86 million among females. It also decreased among people under the age of 65 years ($333 million) but increased among those over 65 years ($ 200 million). Our findings suggest that, despite some temporal improvements, the diet of the majority of Canadians is of poor quality resulting in a high attributable economic burden. Policy and decision makers are encouraged to expand nutrition programs and policies and to specifically target the elderly in order to prevent chronic diseases and reduce health care costs.
高质量的饮食与降低慢性病和全因死亡率的风险有关。在这项研究中，我们评估了 2004 年至 2015 年加拿大人口饮食质量的变化及其相关的经济负担。我们使用基于患病率的疾病成本法。我们首先使用加拿大社区健康调查（CCHS）中的健康饮食指数-加拿大-2010（HEI-C-2010）和 24 小时膳食回忆数据来计算饮食质量（CCHS 2004 周期 2.2 和 CCHS-NU 2015）。然后，我们从荟萃分析中检索了 HEI-2010 五分位数与慢性病的相对风险。根据不同饮食质量人群的比例和这些相对风险，我们计算了按调查年份（2004 年和 2015 年）、年龄和性别组计算的人群归因分数和归因成本（直接医疗保健和间接成本）。为了进行比较，成本以 2017 年加元计算。我们观察到，2004 年至 2015 年期间，加拿大人的饮食质量平均有所提高：饮食质量不佳的加拿大人的比例从 83%下降到 76%。饮食质量的提高导致经济负担减少了 1.33 亿美元，从 2004 年的 132.1 亿美元降至 2015 年的 130.8 亿美元。男性的经济负担减少了 2.19 亿美元，但女性的经济负担增加了 8600 万美元。65 岁以下人群的经济负担减少了 3.33 亿美元，但 65 岁以上人群的经济负担增加了 2 亿美元。我们的研究结果表明，尽管在某些方面有所改善，但大多数加拿大居民的饮食质量仍然较差，导致经济负担高。鼓励政策制定者和决策者扩大营养计划和政策，并特别针对老年人，以预防慢性病和降低医疗保健成本。
