MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
Population Health Innovation Lab, Department of Public Health, Environments & Society, London School of Hygiene & Tropical Medicine,, London, WC1H 9SH, UK.
BMC Med. 2024 Nov 19;22(1):545. doi: 10.1186/s12916-024-03739-8.
In England, the number of takeaway food outlets ('takeaways') has been increasing for over two decades. Takeaway management zones around schools are an effective way to restrict the growth of new takeaways but their impacts on population health have not been estimated.
To model the impact of takeaway management zones on health, we used estimates of change in and exposure to takeaways (across home, work, and commuting buffers) based on a previous evaluation suggesting that 50% of new outlets were prevented from opening because of management zones. Based on previous cross-sectional findings, we estimated changes in body mass index (BMI) from changes in takeaway exposure, from 2018 to 2040. We used PRIMEtime, a proportional multistate lifetable model, and BMI change to estimate the impact of the intervention, in a closed-cohort of adults (25-64 years), on incidence of 12 non-communicable diseases, obesity prevalence, quality-adjusted life years (QALYs), and healthcare costs saved by 2040 in six local authorities (LAs) across the rural-urban spectrum in England (Wandsworth, Manchester, Blackburn with Darwen, Sheffield, North Somerset, and Fenland).
By 2031, compared to no intervention, reductions in outlet exposure ranged from 3 outlets/person in Fenland to 28 outlets/person in Manchester. This corresponded to mean per person reductions in BMI of 0.08 and 0.68 kg/m, respectively. Relative to no intervention, obesity prevalence was estimated to be reduced in both sexes in all LAs, including by 2.3 percentage points (PP) (95% uncertainty interval:2.9PP, 1.7PP) to 1.5PP (95%UI:1.9PP, 1.1PP) in males living in Manchester and Wandsworth by 2040, respectively. Model estimates showed reductions in incidence of disease, including type II diabetes (e.g. 964 (95% UI: 1565, 870) fewer cases/100,000 population for males in Manchester)), cardiovascular diseases, asthma, certain cancers, and low back pain. Savings in healthcare costs (millions) ranged from £1.65 (95% UI: £1.17, £2.25)/100,000 population in North Somerset to £2.02 (95% UI: £1.39, £2.83)/100,000 population in Wandsworth. Gains in QALYs/100,000 person were broadly similar across LAs.
Takeaway management zones in England have the potential to meaningfully contribute towards reducing obesity prevalence and associated healthcare burden in the adult population, at the local level and across the rural-urban spectrum.
在英国，外卖餐馆（“外卖”）的数量在过去二十多年中一直在增加。学校周边的外卖管理区是限制新外卖店增长的有效方法，但尚未评估其对人口健康的影响。
为了模拟外卖管理区对健康的影响，我们根据之前的评估结果，利用外卖店（家庭、工作和通勤缓冲区）的变化和暴露情况的估计值，该评估表明，有 50%的新门店因管理区的设立而无法开业。基于之前的横断面研究结果，我们估计了从 2018 年到 2040 年，由于外卖店的暴露变化，体重指数（BMI）的变化。我们使用 PRIMEtime，一种比例多状态生命表模型，以及 BMI 变化来估计该干预措施对英格兰农村-城市范围内六个地方当局（沃恩斯沃思、曼彻斯特、布莱克本和达文、谢菲尔德、北萨默塞特和芬兰） 25-64 岁成年人队列中 12 种非传染性疾病的发病率、肥胖患病率、质量调整生命年（QALY）和到 2040 年节省的医疗保健成本的影响。
到 2031 年，与无干预相比，芬兰的每个个体的门店暴露量减少了 3 个，而曼彻斯特则减少了 28 个。这分别对应于每个个体 BMI 的平均减少量为 0.08 和 0.68kg/m。与无干预相比，预计所有地方当局的男性和女性肥胖患病率都会下降，包括在曼彻斯特和沃恩斯沃思生活的男性肥胖患病率分别下降 2.3 个百分点（95%置信区间：2.9 个百分点，1.7 个百分点）至 1.5 个百分点（95%置信区间：1.9 个百分点，1.1 个百分点），到 2040 年。模型估计显示，疾病发病率下降，包括 2 型糖尿病（例如，曼彻斯特男性每 10 万人中减少 964 例（95%置信区间：1565，870））、心血管疾病、哮喘、某些癌症和腰痛。医疗保健成本节省（百万英镑）从北萨默塞特每 10 万人中节省 1.65 英镑（95%置信区间：1.17 英镑，2.25 英镑）到沃恩斯沃思每 10 万人中节省 2.02 英镑（95%置信区间：1.39 英镑，2.83 英镑）不等。每个地区的 QALY/100,000 人收益大致相似。
英格兰的外卖管理区有可能在地方层面和整个农村-城市范围内，对降低成年人口的肥胖患病率和相关的医疗保健负担产生有意义的影响。
