Projections for obesity, smoking and hypertension based on multiple imputation

Abstract

Aims: Information on the future development of prevalences of risk factors and health indicators is needed to prepare for the forthcoming burden of disease in the population and to allocate resources properly for prevention. We aim to present how multiple imputation can be used flexibly to project future prevalences. Methods: The proposed approach uses data on repeated cross-sectional surveys from different years. We create future samples with age and sex distributions corresponding to the official national population forecasts. Then, the risk factors are simulated using multiple imputation by chained equations. Finally, the imputations are pooled to obtain the prevalences of interest. Covariates, such as sociodemographic variables as well as their possible interactions and non-linear terms, can be included in the modelling. The future development of these covariates is also projected simultaneously. We apply the procedure to data from five Finnish health examination surveys conducted between 1997 and 2017, and project the prevalences of obesity, smoking and hypertension to 2020 and 2025. Results: The prevalence of obesity is projected to increase to 24% for both men and women in 2025. The prevalences of hypertension and smoking are expected to continue decreasing, and the differences between men and women are projected to remain so that men will have higher prevalences. Conclusions: Simulation of future observations by multiple imputation can be used as a flexible yet relatively easy-to-use projection method.

Association of adiposity with morbidity in Finnish adults: A register-based follow-up study

“…The rising trend in obesity has received a lot of attention in Finland and has led to health policy activities such as a sweets and ice cream excise tax experiment and the establishment of a national obesity programme. Unfortunately, these measures have not been sufficient to halt the progression of obesity, and it has been estimated that the proportion of people with obesity will continue to increase [ 35 ]. There is a need for continued focus on the primary prevention of obesity and the maintenance of a healthy weight to promote healthy life years and to prevent a large disease burden in the future.…”

Development of non-communicable disease risk factors in Finland: projections up to 2040

“…After the imputation, the predicted risk factor values were pooled to obtain the prevalence. This projection method has been described in more detail elsewhere [14,15]…”

“…After the imputation, the predicted risk factor values were pooled to obtain the prevalence. This projection method has been described in more detail elsewhere [14,15] The unobserved samples of the years from 2020 to 2040 were created to consist of 10,000 participants. The age and sex distributions were matched to the distributions of the national population projections in Finland for the corresponding years [16] to take into account the changing population structure.…”