Lung Thomas, Killedar Anagha, Howard Kirsten, Wen Li Ming, Kelly Patrick, Dickson Michelle, Sherriff Simone, Baur Louise, Hayes Alison
Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
Med Decis Making. 2025 Jul 13:272989X251351030. doi: 10.1177/0272989X251351030.
ObjectivesAboriginal and Torres Strait Islander children and adolescents are at higher risk of overweight and obesity, highlighting an inequitable public health concern. The aim of this study was to estimate transition probabilities and validate a model predicting the epidemiologic trajectory of overweight and obesity in Australian Aboriginal and Torres Strait Islander children.MethodsAn individual-level state-transition Markov model was developed to model transitions between healthy weight, overweight, and obesity for Aboriginal and Torres Strait Islander children aged between 2 and 14 y. Age-specific annual transition probabilities were derived from semi-parametric survival analyses using the Longitudinal Study of Indigenous Children. The model used annual cycles over a 12-y time horizon, and the epidemiological predictions of the model were validated using both internal and external data, according to best practice guidelines. The starting age of the model was 2 to 4 y and 4 to 5 y for the internal and external validation, respectively. Aboriginal and Torres Strait Islander children from the Longitudinal Study of Australian Children were used as the external validation cohort.ResultsA total of 1,643 children with 11,514 complete anthropometric measurements were used to estimate transition probabilities. The model predictions showed both good internal and external validity, with most predictions falling within the 95% confidence intervals of measured data. The model was able to reliably capture the epidemiology of overweight and obesity prevalence in early childhood.ConclusionsOur model predictions showed good internal and external validity, ensuring our model is fit for purpose to use to evaluate Aboriginal and Torres Strait Islander-led programs to achieve a healthy weight.HighlightsAboriginal and Torres Strait Islander children experience high rates of overweight and obesity; hence, there is a need for high-quality evidence on both effectiveness and cost-effectiveness of Aboriginal and Torres Strait Islander-led childhood obesity prevention programs to ensure they offer value for money.This is the first study to develop and validate a predictive model using anthropometric data from Aboriginal and Torres Strait Islander children to inform decision making on childhood obesity programs.Our model predictions showed good internal and external validity, ensuring our model is fit for purpose to use to evaluate Aboriginal and Torres Strait Islander-led programs to achieve a healthy weight.The model provides a framework to assist policy makers in identifying when best to intervene in childhood as well as the most effective approaches for maintaining a healthy weight for Aboriginal and Torres Strait Islander children.
目标
原住民及托雷斯海峡岛民儿童和青少年超重及肥胖风险更高，这凸显了一个不公平的公共卫生问题。本研究的目的是估计转变概率，并验证一个预测澳大利亚原住民及托雷斯海峡岛民儿童超重和肥胖流行病学轨迹的模型。
方法
开发了一个个体水平的状态转变马尔可夫模型，用于模拟2至14岁原住民及托雷斯海峡岛民儿童在健康体重、超重和肥胖之间的转变。特定年龄的年度转变概率来自使用原住民儿童纵向研究的半参数生存分析。该模型在12年的时间范围内使用年度周期，并且根据最佳实践指南，使用内部和外部数据对模型的流行病学预测进行了验证。模型的起始年龄在内部验证中为2至4岁，在外部验证中为4至5岁。来自澳大利亚儿童纵向研究的原住民及托雷斯海峡岛民儿童被用作外部验证队列。
结果
共有1643名儿童提供了11514次完整的人体测量数据，用于估计转变概率。模型预测显示出良好的内部和外部有效性，大多数预测落在实测数据的95%置信区间内。该模型能够可靠地捕捉幼儿期超重和肥胖患病率的流行病学情况。
结论
我们的模型预测显示出良好的内部和外部有效性，确保我们的模型适合用于评估由原住民及托雷斯海峡岛民主导的旨在实现健康体重的项目。
要点
原住民及托雷斯海峡岛民儿童超重和肥胖率很高；因此，需要有关于由原住民及托雷斯海峡岛民主导的儿童肥胖预防项目的有效性和成本效益的高质量证据，以确保这些项目物有所值。
这是第一项利用原住民及托雷斯海峡岛民儿童的人体测量数据开发并验证预测模型，为儿童肥胖项目决策提供信息的研究。
我们的模型预测显示出良好的内部和外部有效性，确保我们的模型适合用于评估由原住民及托雷斯海峡岛民主导的旨在实现健康体重的项目。
该模型提供了一个框架，以协助政策制定者确定何时对儿童进行最佳干预，以及为原住民及托雷斯海峡岛民儿童维持健康体重的最有效方法。
