Bohora Shweta, Mishra Shiva Raj, Wilson Tim, Blakely Tony
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
NHMRC Clinical Trials Center, Faculty of Medicine and Public Health, University of Sydney, Australia.
Lancet Reg Health West Pac. 2024 Jul 17;49:101148. doi: 10.1016/j.lanwpc.2024.101148. eCollection 2024 Aug.
We estimated the health gains and health inequality impacts for the Australian population alive in 2021 (n = 25.0 million) in the next 20 years and over their remaining lifespan, from shifting everyone above a BMI of 25 kg/m to 25 kg/m compared to the BMI distribution in 2021 persisting into the future.
National Health Survey 2017-2018 was used to estimate BMI distributions by sex, age and, socio-economic status (Socio-Economic Indexes for Areas; SEIFA). A proportional multistate life table linking BMI to 19 associated diseases and allowing for time lags and competing morbidity and mortality, was used to estimate the future stream of health adjusted life years (HALYs) gained from eradicating high BMI.
Undiscounted health gains in the first 20 years and lifetime of the population were, respectively, 2.00 million (95% uncertainty interval 1.70-2.32) and 20.4 million (17.0-24.2) (at a 3% annual discount rate, HALY gains were 1.37 and 5.77 million, respectively). Reductions in the incidence of cardio metabolic diseases contributed 61% (95% UI: 54%-68%) of the undiscounted health gains in the first 20 years, musculoskeletal diseases contributed 26% (20%-32%) and cancer 5% (3%-8%). HALY gains in the first 20 years and lifetime, per person alive in 2021, were 2.5 (2.4-2.5) and 1.9 (1.9-2.0) times higher for the most compared to the least deprived SEIFA quintile.
The total theoretical envelope of health gains, and health inequality reductions, through eradication of BMI is substantial. Our modeling infrastructure can be used to estimate the health impacts and cost effectiveness of many actual interventions.
No funding was received for the study.
我们估计了到2041年仍存活的澳大利亚人口（n = 2500万）在未来20年及其剩余寿命期间，若将所有人的体重指数（BMI）从高于25kg/m²调整到25kg/m²（与2021年持续至未来的BMI分布相比）所带来的健康收益和健康不平等影响。
利用2017 - 2018年全国健康调查来估计按性别、年龄和社会经济地位（地区社会经济指数；SEIFA）划分的BMI分布。使用一个将BMI与19种相关疾病相联系的比例多状态生命表，并考虑时间滞后以及并存的发病率和死亡率，来估计消除高BMI所带来的未来健康调整生命年（HALY）流。
在最初20年以及整个人口中，未贴现的健康收益分别为200万（95%不确定性区间170 - 232万）和2040万（1700 - 2420万）（按3%的年贴现率，HALY收益分别为137万和577万）。心血管代谢疾病发病率的降低在最初20年未贴现的健康收益中占61%（95% UI：54% - 68%），肌肉骨骼疾病占26%（20% - 32%），癌症占5%（3% - 8%）。对于2021年仍存活的人，在最初20年和整个人口中，最贫困的SEIFA五分位数组与最不贫困的相比，HALY收益分别高出2.5（2.4 - 2.5）倍和1.9（1.9 - 2.0）倍。
通过消除BMI所获得的健康收益以及健康不平等减少的总体理论范围是巨大的。我们的建模框架可用于估计许多实际干预措施的健康影响和成本效益。
本研究未获得资金支持。
