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Dee A.,University College Cork | Callinan A.,University Road | Doherty E.,University Road | O'Neill C.,University Road | And 10 more authors.
BMJ Open

Objectives: The increasing prevalence of overweight and obesity worldwide continues to compromise population health and creates a wider societal cost in terms of productivity loss and premature mortality. Despite extensive international literature on the cost of overweight and obesity, findings are inconsistent between Europe and the USA, and particularly within Europe. Studies vary on issues of focus, specific costs and methods. This study aims to estimate the healthcare and productivity costs of overweight and obesity for the island of Ireland in 2009, using both top-down and bottom-up approaches. Methods: Costs were estimated across four categories: healthcare utilisation, drug costs, work absenteeism and premature mortality. Healthcare costs were estimated using Population Attributable Fractions (PAFs). PAFs were applied to national cost data for hospital care and drug prescribing. PAFs were also applied to social welfare and national mortality data to estimate productivity costs due to absenteeism and premature mortality. Results: The healthcare costs of overweight and obesity in 2009 were estimated at €437 million for the Republic of Ireland (ROI) and €127.41 million for NI. Productivity loss due to overweight and obesity was up to €865 million for ROI and €362 million for NI. The main drivers of healthcare costs are cardiovascular disease, type II diabetes, colon cancer, stroke and gallbladder disease. In terms of absenteeism, low back pain is the main driver in both jurisdictions, and for productivity loss due to premature mortality the primary driver of cost is coronary heart disease. Conclusions: The costs are substantial, and urgent public health action is required in Ireland to address the problem of increasing prevalence of overweight and obesity, which if left unchecked will lead to unsustainable cost escalation within the health service and unacceptable societal costs. © 2015, BMJ. All rights reserved. Source

Keaver L.,University College Cork | Webber L.,UK Health Forum | Dee A.,Health Service Executive | Shiely F.,University College Cork | And 3 more authors.

Background: Given the scale of the current obesity epidemic and associated health consequences there has been increasing concern about the economic burden placed on society in terms of direct healthcare costs and indirect societal costs. In the Republic of Ireland these costs were estimated at €1.13 billion for 2009. The total direct healthcare costs for six major obesity related conditions (coronary heart disease & stroke, cancer, hypertension, type 2 diabetes and knee osteoarthritis) in the same year were estimated at €2.55 billion. The aim of this research is to project disease burden and direct healthcare costs for these conditions in Ireland to 2030 using the established model developed by the Health Forum (UK) for the Foresight: Tackling Obesities project. Methodology: Routine data sources were used to derive incidence, prevalence, mortality and survival for six conditions as inputs for the model. The model utilises a two stage modelling process to predict future BMI rates, disease prevalence and costs. Stage 1 employs a non-linear multivariate regression model to project BMI trends; stage 2 employs a microsimulation approach to produce longitudinal projections and test the impact of interventions upon future incidence of obesity-related disease. Results: Overweight and obesity are projected to reach levels of 89% and 85% in males and females respectively by 2030. This will result in an increase in the obesity related prevalence of CHD & stroke by 97%, cancers by 61% and type 2 diabetes by 21%. The direct healthcare costs associated with these increases will amount to €5.4 billion by 2030. A 5% reduction in population BMI levels by 2030 is projected to result in €495 million less being spent in obesity-related direct healthcare costs over twenty years. Discussion: These findings have significant implications for policy, highlighting the need for effective strategies to prevent this avoidable health and economic burden. © 2013 keaver et al. Source

Cotter N.,Institute of Public Health in Ireland | Monahan E.,Dublin City Council | McAvoy H.,Institute of Public Health in Ireland | Goodman P.,Dublin Institute of Technology
Quality in Ageing and Older Adults

Purpose - Older people are vulnerable to fuel poverty on the island of Ireland. This paper seeks to explore the lived experiences of older people in cold weather with a view to informing fuel poverty policy and service responses. Design/methodology/approach - A postal and online survey utilising an opportunistic sample of older people living in Ireland and linked with a range of services/community and voluntary groups was undertaken in January-April 2011. Data on the experiences of 722 older people in the cold weather of winter 2010/2011 were analysed in the context of socio-economic, health, and housing circumstances. Findings - During the period of extreme cold weather half of the sample reported that they went without other household necessities due to the cost of home-heating. In general, 62 per cent of those surveyed worried about the cost of home-heating. Homes considered "too cold" were more likely to lack central heating and experience damp/draughts. Staying indoors, keeping the heating on, and eating hot food/drinks were common responses to cold weather but a diverse range of behaviours was observed. Associations were observed between living in a cold home and higher levels of chronic illness, falls and loneliness, and fewer social activities. Research limitations/implications - The sample cannot be considered nationally representative; single occupancy and social housing units were overrepresented. Originality/value - This research found significant associations between living in a cold home/difficulty paying for heating, and aspects of ill-health and social exclusion. While no causal association can be assumed, this phenomenon has implications for policies supporting healthy ageing. Copyright © 2012 Emerald Group Publishing Limited. All rights reserved. Source

Barron S.,Institute of Public Health in Ireland | Balanda K.,Institute of Public Health in Ireland | Hughes J.,Queens University of Belfast | Fahy L.,Institute of Public Health in Ireland
BMC Public Health

Background: Hypertension is a global public health challenge. National prevalence estimates can conceal important differences in prevalence in subnational areas. This paper aims to develop a consistent set of national and subnational estimates of the prevalence of hypertension in a country with limited data for subnational areas. Methods. A nationally representative cross-sectional Survey of Lifestyle, Attitudes and Nutrition (SLÁN) 2007 was used to identify risk factors and develop a national and a subnational model of the risk of self-reported, doctor-diagnosed hypertension among adults aged 18+ years in the Republic of Ireland. The subnational model's group-specific risk estimates were applied to group-specific population count estimates for subnational areas to estimate the number of adults with doctor-diagnosed hypertension in subnational areas in 2007. A sub-sample of older adults aged 45+ years who also had their blood pressure objectively measured using a sphygmomanometer was used to estimate the national prevalence of diagnosed and undiagnosed hypertension among adults aged 45+ years. Results: The prevalence of self-reported, doctor-diagnosed hypertension among adults aged 18+ years was 12.6% (95% CI = 11.7% - 13.4%). After adjustment for other explanatory variables the risk of self-reported, doctor-diagnosed hypertension was significantly related to age (p < 0.001), body mass index (p < 0.001), smoking (p = 0.001) and fruit and vegetable consumption (p = 0.003). Among adults aged 45+ years the prevalence of undiagnosed hypertension (38.7% (95% CI 34.6% - 42.8%)) was higher than self-reported, doctor-diagnosed hypertension (23.4% (95% CI = 22.0% - 24.7%)). Among adults aged 45+ years, the prevalence of undiagnosed hypertension was higher among men (46.8%, 95% CI 41.2% - 52.4%) than women (31.2%, 95% CI 25.7% - 36.6%). There was no significant variation in the prevalence of self-reported, doctor-diagnosed hypertension across subnational areas. Conclusions: Services need to manage diagnosed hypertension cases and to detect and manage undiagnosed cases. Further population level improvements in lifestyle risk factors for hypertension are key in developing a more integrated approach to prevent cardiovascular disease. Better subnational data on hypertension outcomes and risk factors are needed to better describe the distribution of hypertension risk and hypertension prevalence in subnational areas. © 2014 Barron et al.; licensee BioMed Central Ltd. Source

Balanda K.P.,Institute of Public Health in Ireland | Buckley C.M.,University College Cork | Barron S.J.,Institute of Public Health in Ireland | Fahy L.E.,Institute of Public Health in Ireland | And 4 more authors.

Background:Current estimates of diabetes prevalence in the Republic of Ireland (RoI) are based on UK epidemiological studies. This study uses Irish data to describe the prevalence of doctor-diagnosed diabetes amongst all adults aged 18+ years and undiagnosed diabetes amongst those aged 45+ years.Methods:The survey of lifestyle attitudes and nutrition (SLAN) 2007 is based on a nationally representative sample of Irish adults aged 18+ years (n = 10,364). Self-reported doctor-diagnosed diabetes was recorded for respondents in the full sample. Diabetes medication use, measured height and weight, and non-fasting blood samples were variously recorded in sub-samples of younger (n = 967) and older (n = 1,207) respondents.Results:The prevalence of doctor-diagnosed diabetes amongst adults aged 18+ years was 3.5% (95% CI 3.1% - 3.9%). After adjustment for other explanatory variables; the risk of self-reported doctor-diagnosed diabetes was significantly related to age (p < 0.0001), employment status (p = 0.0003) and obesity (p = 0.0003). Amongst adults aged 45+ years, the prevalence of doctor-diagnosed diabetes was 8.9% (95% CI 7.3% -10.5%) and undiagnosed diabetes was 2.8% (95% CI 1.4% - 4.1%). This represented 31.2% of diabetes cases in this age group.Conclusion:Notwithstanding methodological differences, these prevalence estimates are consistent with those in the UK and France. However, the percentage of undiagnosed cases amongst adults aged 45+ years appears to be higher in the RoI. Increased efforts to improve early detection and population level interventions to address adverse diet and lifestyle factors are urgently needed. © 2013 Balanda et al. Source

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