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Biological Assessment and Risk Comparison (BARC) Study: Teaching RRFSS to BARC A presentation to the: RRFSS Workshop, Toronto, Canada 20 June 2007.

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Presentation on theme: "Biological Assessment and Risk Comparison (BARC) Study: Teaching RRFSS to BARC A presentation to the: RRFSS Workshop, Toronto, Canada 20 June 2007."— Presentation transcript:

1 Biological Assessment and Risk Comparison (BARC) Study: Teaching RRFSS to BARC A presentation to the: RRFSS Workshop, Toronto, Canada 20 June 2007

2 Investigators Dr. Pete Kavsak - McMaster University, ON Dr. Andrew MacRae - Cadham Provincial Laboratory, MB Kathy Moran - Epidemiologist, Durham Region Health Department David Northrup - Institute for Social Research, York University Dr. Donna Reynolds - University of Toronto, ON

3 Study Team Evelyn Moreau - Study Coordinator, Lakeridge Health, ON Team of Study Nurses - Bernadette Riordan - Heather O’Neill - Francine Dion - Kim James

4 Acknowledgment Funding provided by the Canadian Institutes of Health Research pilot project grant – Population and Public Health Methods and Tools grant

5 Background WHO STEPwise approach for noncommunicable disease surveillance - Step I: self-reported information (core: socio- economic data, tobacco, alcohol, nutritional status, physical inactivity) - Step II: physical measures (height, weight, waist circumference, blood pressure) - Step III: biochemical measures (blood cholesterol, fasting blood glucose)

6 BARC Objectives To determine the feasibility of collecting physical and biochemical measures To assess the validity of RRFSS modules - Validity of chronic diseases module (included self- report blood cholesterol), current smokers To obtain prevalence estimates of: - High waist circumference - High risk for cardiovascular disease/Metabolic syndrome

7 Recruited from completions in RRFSS Respondents consented to a follow up telephone call from the Study Coordinator Appointment scheduled in the follow up call from the Study Coordinator Assessment completed by the Study Nurse BARC Methods

8 Procedure Manual Equipment Inventory - Calibration procedures - Care and maintenance Physical measures protocol Biochemical measures protocol - Cholestech LDX point-of-care device - Correlation study Quality control - Nurses training - Data entry screens - Data coding rules Safety Procedures - Participants - Study Nurses - Out of range results

9 Recruitment RRFSS - June – December 2006 - All adults 18 years and older were eligible, excluded pregnant women (n=1,386) - ~180 completions/month - Standard recruitment scripts for interviewers and the Study Coordinator Received weekly list of potential participants 359/1,386 (25.9%) RRFSS completions consented to a follow up call 18/1,386 (1.2%) RRFSS completions consented to a study package only

10 Study Package 357/359 consented to received a study package - Letter - Information Sheets - Blood cholesterol/glucose - Blood pressure - Body Mass Index/Waist Circumference - Respondent Booklet

11 Assessment Measures - Physical measures - sBP, dBP, height, weight, waist circumference - Biochemical measures - Fasting – total cholesterol (TC), High density lipoprotein (HDL), triglycerides, low density lipoprotein (LDL), glucose Interview - Age - History of heart disease, diabetes, chronic kidney disease - Medication Use - Current smoking status

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17 Assessment con’t Obtained signed consent ~1 hour (+ travel time of up to 1 hour) 250/359 (69.5%) completed an assessment - 81/359 (22.6%) did not participate - 28/359 (7.8%) called and informed the study had ended Response rate ~11% 25/250 (10.0%) assessments completed at the Health Department 44/250 (17.6%) did not receive the information package Median time from the RRFSS interview to assessment was 38 days (21-68 days)

18 Study Population Male= 38%, Female= 62% Mean age = 52.3 years (sd 15.52) - Median = 50 years 18-44= 35% 45-64= 41% 65+= 24%

19 Study Population { "@context": "http://schema.org", "@type": "ImageObject", "contentUrl": "http://images.slideplayer.com/13/4102237/slides/slide_19.jpg", "name": "Study Population

20 Criteria Sensitivity and Specificity - ≥80% = high validity - ≥60% to <80% moderate validity - <60% low validity Correlation Coefficient - ≥0.60 = high validity - ≥0.40 to <0.60 moderate validity - <0.40 low validity Kappa - ≥0.60 = high agreement - ≥0.40 to <0.60 moderate agreement - <0.40 low agreement

21 Prevalence of Hypertension RRFSS: Have you ever been told by a doctor or other health care professional that you have high blood pressure? - Yes/no/dk/r BARC: 2007 recommendations from the Canadian Hypertension Education Program - ≥180/90 mmHg or ≥ 130/80 mmHg in individuals with diabetes or chronic kidney disease, or individuals on antihypertensive medication

22 Results: Hypertension OverallSelf-reportDirectSensitivitySpecificityKappa (n=250/250)% hypertension23.239.6*55.698.00.577 Males (n=96/96)% hypertension22.947.9*45.798.00.446 Females (n=154/154)% hypertension23.434.464.298.00.673 *significant difference between self-report and quantitative measures, p < 0.05

23 Conclusions: Hypertension Poor validity overall and for males Moderate validity for females

24 Prevalence of Hypercholesterolemia RRFSS: Have you ever been told by a doctor or other health care professional that your blood cholesterol is high? (if required, cholesterol is a fatty substance in your blood that can build up on the insides of your blood vessels)? - Yes/no/dk/r BARC: Prevalence of hypercholesterolemia was based on TC > 5.2 mmol/L or individuals taking cholesterol-lower medication

25 Results: Hypercholesterolemia OverallSelf-reportDirectSensitivitySpecificityKappa (n=244/248)% hypercholesterolemia31.651.6*51.088.20.392 Males (n=92/96)% hypercholesterolemia35.959.4*53.789.50.399 Females (n=152/152)% hypercholesterolemia28.946.1*49.387.70.379 *significant difference between self-report and quantitative measures, p < 0.05

26 Conclusions: Hypercholesterolemia Poor validity in all three groups

27 Prevalence of Diabetes RRFSS: Have you ever been told by a doctor or other health care professional that you have diabetes? - Yes/no/dk/r BARC: 2003 recommendations from the Canadian Diabetes Association - Fasting blood glucose (FBG) >= 7.00 mmol/L or individuals currently diagnosed with diabetes or taking insulin

28 Results: Diabetes OverallSelf-reportDirectSensitivitySpecificityKappa (n=249/240)% diabetes9.610.492.099.50.932 *significant difference between self-report and quantitative measures, p < 0.05

29 Diabetes Conclusions High validity in estimating diabetes - overall

30 Height, Weight, Body Mass Index (BMI) RRFSS: How tall are you without shoes? - Feet/inches/centimetres/dk/r RRFSS: How much do you weigh? - -pounds/kilograms/dk/r BARC – direct measures of height and weight BMI categories – International definitions

31 Results: Height, Weight, BMI OverallSelf-reportDirectSpearman’s rho (n=249/250)mean height (m)1.681.670.964 (n=239/250)mean weight (kg)74.5477.400.975 (n=238/250)mean BMI (kg/m 2 )26.1727.67*0.946 Males (n=95/96)mean height (m)1.771.75*0.951 (n=95/96)mean weight (kg)83.4084.270.957 (n=94/96)mean BMI (kg/m 2 )26.6527.440.934 Females (n=154/154)mean height (m)1.62 0.934 (n=144/154)mean weight (kg)68.6973.12*0.973 (n=144/154)mean BMI (kg/m 2 )25.8627.82*0.943 *significant difference between self-report and quantitative measures, p < 0.05

32 Results: BMI Categories OverallSelf-reportDirectSensitivitySpecificity (n=238/250)% acceptable weight (BMI >= 18.5 and < 25.0) 45.035.2*93.182.8 (n=238/250)% overweight/obese (BMI >= 25.0) 55.064.083.993.3 Males (n=94/96)% acceptable weight (BMI >= 18.5 and < 25.0) 31.925.082.684.5 (n=94/96)% overweight/obese (BMI >= 25.0) 68.172.987.084.0 Females (n=144/154)% acceptable weight (BMI >= 18.5 and < 25.0) 53.541.696.981.3 (n=144/154)% overweight/obese (BMI >= 25.0) 46.558.481.380.5 *significant difference between self-report and quantitative measures, p < 0.05

33 Conclusions: Height, Weight, BMI High validity for mean height, weight and BMI in all three groups – overall, males and females High validity for BMI categorized as acceptable and combined overweight/obese in all three groups

34 Why Combine? OverallSelf-reportDirectSensitivitySpecificity (n=238/250)% overweight (BMI >= 25.0 and < 30.0) 37.838.070.782.9 (n=238/250)% obese (BMI >= 30.0) 17.226.0*66.798.3 Males (n=94/96)% overweight (BMI >= 25.0 and < 30.0) 53.253.180.077.3 (n=94/96)% obese (BMI >= 30.0) 14.919.8*68.498.7 Females (n=144/154)% overweight (BMI >= 25.0 and < 30.0) 27.828.659.585.3 (n=144/154)% obese (BMI >= 30.0) 18.829.9*65.898.1 *significant difference between self-report and quantitative measures, p < 0.05

35 Current Smoking RRFSS: Have you smoked at least 100 cigarettes in your lifetime? - Yes/no/dk/r RRFSS: Currently do you smoke cigarettes everyday, some days, or not at all? - Everyday/some days/not at all/dk/r BARC: Are you currently smoking? - Yes/no

36 Current Smoking: Results OverallSelf-reportDirectSensitivitySpecificityKappa (n=250/250)% current smoking 10.4%12.8%78.199.50.844 *significant difference, p < 0.05

37 Waist Circumference (WC) 1998 recommendations from the National Institutes of Health High WC - Males: ≥ 102 cm (40”) - Females: ≥ 88 cm (35”)

38 Results: Waist Circumference Normal WC (%)High WC (%)Total (n) Males84.415.696 Females59.7*40.3154 Total69.230.8250 *significant difference, p < 0.05

39 Cardiovascular Risk Framingham Risk Score (FRS) Metabolic Syndrome (MetS) - National Cholesterol Education Program - Adult Treatment Panel III (ATP III) - International Diabetes Federation (IDF)

40 Framingham Risk Score Clinical tool for evaluating a person’s 10-year risk of coronary artery disease Model to estimate risk based on the data from the Framingham Heart Study Identifies three risk categories based on age, sex, TC, smoking status, HDL, sBP and previous history of disease Reference: Genest J, Frohlick J, Fodor G and McPherson R. Recommendations for the management of dyslipidemia and the prevention of cardiovascular disease: 2003 update. CMAJ October 28, 2003; 169(9): online 1-10

41 Metabolic Syndrome Clustering of cardiovascular risk factors to identify individuals at high risk for Type 2 Diabetes and cardiovascular disease - Abdominal obesity (WC) - Hypertension - Hyperlipidemia (TC, HDL) - Insulin resistance (FBG)

42 MetS: Definitons National Cholesterol Education Program - Adult Treatment Panel III (ATP III) - Grundy S, Brewer B, Cleeman J, Smith S and Lenfant C. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association on scientific issues related to definition. Circulation 2004; 109: 433-438 International Diabetes Federation (IDF) - Alberti K, Zimmet P and Shaw J. The metabolic syndrome - a new worldwide definition. Lancet 2005; 366: 1059-1062

43 Results: Cardiovascular Risk % high risk (FRS)% MetS (ATP III)% MetS (IDF)Kappa (ATP III & IDF) Overall (n=250) 26.623.224.00.689 Males (n=96)38.526.022.90.409 Females (n=154) 19.1*21.424.70.872 *significant difference, p < 0.05

44 Next Steps Analysis pending - Non-response study - Costing - Weighting Implications for RRFSS questions: influenza analysis Physical and Biochemical measures: Model for: - Further validation studies – smoking, alcohol, physical activity - Expand to other regions and subpopulations - ethnicity Implications for Public Health - Hypertension, hyperlipidemia, cardiovascular risk, MetS - Opportunity to partner with LHINs

45 Q & A’s


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