How Could Different Obesity Scenarios Alter the Burden of Type 2 Diabetes and Liver Disease in Saudi Arabia?

INTRODUCTION: Obesity is a major risk factor for type 2 diabetes (T2DM) and liver disease, and obesity-attributable liver disease is a common indication for liver transplant. Obesity prevalence in Saudi Arabia (SA) has increased in recent decades. SA has committed to the WHO "halt obesity" target to shift prevalence to 2010 levels by 2025. We estimated the future benefits of reducing obesity in SA on incidence and costs of T2DM and liver disease under two policy scenarios: (1) SA meets the "halt obesity" target; (2) population body mass index (BMI) is reduced by 1% annually from 2020 to 2040. METHODS: We developed a dynamic microsimulation of working-age people (20-59 years) in SA between 2010 and 2040. Model inputs included population demographic, disease and healthcare cost data, and relative risks of diseases associated with obesity. In our two policy scenarios, we manipulated population BMI and compared predicted disease incidence and associated healthcare costs to a baseline "no change" scenario. RESULTS: Adults <35 years are expected to meet the "halt obesity" target, but those ≥35 years are not. Obesity is set to decline for females, but to increase amongst males 35-59 years. If SA's working-age population achieved either scenario, >1.15 million combined cases of T2DM, liver disease, and liver cancer could be avoided by 2040. Healthcare cost savings for the "halt obesity" and 1% reduction scenarios are 46.7 and 32.8 billion USD, respectively. CONCLUSION: SA's younger working-age population is set to meet the "halt obesity" target, but those aged 35-59 are off track. Even a modest annual 1% BMI reduction could result in substantial future health and economic benefits. Our findings strongly support universal initiatives to reduce population-level obesity, with targeted initiatives for working-age people ≥35 years of age.

Old age takes its toll: Long-run projections of health-related public expenditure in Luxembourg.

This paper simulates long-term trends in Luxembourg's public expenditure on healthcare and on long-term care. We combine population projections with micro-simulations of individuals' health status that account for their demographic, socio-economic characteristics and their childhood circumstances. Model equations estimated on data from the SHARE survey and from several branches of Social Security provide a rich framework to study policy-relevant applications. We simulate public expenditure on healthcare and long-term care under different scenarios to evaluate the separate contributions of population ageing, costs of producing health-related services, and the distribution of health status across age cohorts. Results suggest that rising per capita expenditure on healthcare will mostly result from production costs, while rising expenditure on long-term care will mostly reflect population ageing.

Socio-economic inequality and healthcare costs over the life course - A dynamic microsimulation approach.

OBJECTIVES: Although there is well-established evidence for the existence of socio-economic inequalities in virtually all dimensions of health, little is known about the implications of these socio-economic disparities for healthcare costs from a cumulative life course perspective. Accounting for differentials in healthcare use patterns and mortality, we assess how lifetime costs differ between socio-economic groups. STUDY DESIGN: This study used dynamic microsimulation modelling. METHODS: Combining price weights for healthcare services with information on healthcare consumption from the 2014 Austrian Health Interview Survey (n = 15,771), we calculated average cost profiles by gender, age and education consistent with aggregate System of Health Accounts. A dynamic microsimulation model was used to project cumulative healthcare costs over the entire lifecycle for the 2019 birth cohort in four different scenarios to illustrate the influence of the different cost determinants on lifetime costs. RESULTS: Before considering social inequalities in mortality, men with compulsory education have close to 66% higher lifetime costs than men with tertiary education; for women, the difference is close to 20%. Accounting for longevity differentials reduces this gap to approximately 40% for men and 10% for women. Closing the gap in healthcare use and in longevity between socio-economic groups would reduce lifetime healthcare expenditure by 4.1% in the 2019 birth cohort and by 19% in the whole population. CONCLUSIONS: Accounting for mortality differentials between socio-economic groups has a large impact on estimated lifetime healthcare costs. Reducing social inequalities in health can contribute to containing healthcare expenditures against the backdrop of rising life expectancy.

The Impact of Health and Education on Labor Force Participation in Aging Societies: Projections for the United States and Germany from Dynamic Microsimulations.

We project the labor force in the United States to 2060 and contrast the outcomes with comparative projections for Germany. In both countries, the population will age, but the demographic dynamics are fundamentally different. According to our dynamic microsimulations, the labor force in the U.S. will increase by 17 percent between 2020 and 2060 (about 29 million workers) despite population aging. In contrast, the labor force in Germany will decline by 11 percent (about 4.5 million workers). Our baseline projections indicate that an expansion of education will increase the labor force by about 3 million persons in the United States and about half a million persons in Germany by 2060. In several what-if scenarios, we examine the effects of further expanding education and of removing health barriers on labor force participation. Higher educational attainment among those with currently low education has the largest impact on labor force participation, relative to the additional years of schooling. However, health improvements and the labor market integration of people with health limitations suggest a larger increase in labor force participation rates. Using Sweden as a benchmark, we show that reducing the health participation gap would increase the U.S. labor force by as much as 13 million people in 2060 (+6.8 percent compared to our baseline).

Factores de riesgo y enfermedades cardiometabólicas en Risaralda 2017 proyectada a 2050 / Risk factors and cardiometabolic disease in Risaralda 2017 to 2050

Resumen Objetivo: Proyectar el comportamiento de factores de riesgo y de la incidencia de dos enfermedades cardiometabólicas, en una población colombiana entre 2017 y 2050. Metodología: Diseño de cohorte abierta basado en un modelo de microsimulación dinámica para la población adulta de Risaralda, Colombia. Los factores de riesgo analizados son tabaquismo, obesidad global, obesidad central y colesterol total. Se creó una población sintética que replica las características demográficas y de salud de Risaralda en 2010, utilizando algoritmos de emparejamiento e imputación estadística. La evolución a lo largo del curso de vida se simuló basada en reglas derivadas de la literatura, con ecuaciones estocásticas y modelos econométricos. Se calcula la incidencia de diabetes tipo II y de eventos cerebrovasculares isquémicos de 2017 a 2050. Resultados: En 2050, 16.7 % serán fumadores, la tercera parte de ellos presentarán obesidad global y más de la mitad presentarán obesidad central. El promedio de colesterol total aumentará 5 mg/dL. Adicionalmente, se espera que entre 2017 y 2050 se presenten 204.966 casos nuevos de diabetes y 65.758 eventos cerebrovasculares isquémicos. Conclusiones: Los estilos de vida y el envejecimiento poblacional, llevarán a mayor exposición a riesgo y aumentarán la velocidad a la que los risaraldenses se enfermarán de Diabetes y experimentarán eventos cerebrovasculares. La obesidad global y central son factores que explicarían esta tendencia. Se requieren intervenciones intersectoriales que protejan a la población y reduzcan cargas fiscales por condiciones evitables.

Abstract Objective: predict the behavior of the risk factors and the incidence of two cardiometabolic diseases in a population from Colombia between 2017 and 2050. Methodology: Follow up of individual's cohort of an artificial society of Risaralda, Colombia, based on a microsimulation model. The risk factors analyzed in this study are tobacco use, obesity, central obesity and total cholesterol. A synthetic population was created to replicate demographic and health characteristics of Risaralda in 2010, using pairing algorithms and statistical imputation. The evolution along the life course was simulated based on rules from scientific literature, with stochastic equations and econometric estimates. The incidence of type II diabetes and ischemic stroke is calculated for the adult population between 2017 to 2050. Results: 16.7% of the adults by 2050 is expected to be smokers, a third of them will have global obesity and more than half will have central obesity. The average level of serum total cholesterol would increase by 5 mg/dL. Additionally, is expected that between 2017 and 2050 there will be 204.966 incident cases of diabetes and 65.758 first-ever ischemic stroke events. Conclusions: Lifestyles and expected population aging will lead to greater risk of disease and will increase the rate at which local people will get diabetes and ischemic stroke. Risk factors like global and central obesity explain this trend. Effective intersectoral interventions are needed to protect the population and reduce tax burden due to preventable conditions.