Estimating the contribution of overweight and obesity to ethnic inequalities in cardio-metabolic diseases in the Netherlands: a simulation study

W J Nusselder; D Long; W E Waterlander; K Stronks; H C Boshuizen

doi:10.1016/j.puhe.2024.04.015

Estimating the contribution of overweight and obesity to ethnic inequalities in cardio-metabolic diseases in the Netherlands: a simulation study

Public Health. 2024 May 10:232:45-51. doi: 10.1016/j.puhe.2024.04.015. Online ahead of print.

Authors

W J Nusselder¹, D Long², W E Waterlander³, K Stronks³, H C Boshuizen⁴

Affiliations

¹ Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands. Electronic address: w.nusselder@erasmusmc.nl.
² Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
³ Department of Public and Occupational Health, Academic Medical Centers Amsterdam/Universiteit of Amsterdam, Amsterdam, the Netherlands.
⁴ Department Statistics, Data Science and Mathematical Modelling, National Institute of Public Health and the Environment, Bilthoven, the Netherlands.

PMID: 38733960
DOI: 10.1016/j.puhe.2024.04.015

Abstract

Objectives: Overweight and obesity (OWOB) starts in childhood, influences adult cardiovascular risk, and is not equally distributed across ethnic groups. It is unclear which effects can be expected from reductions in OWOB across the life course on inequalities in cardio-metabolic diseases in a multi-ethnic population. This study aims to estimate the effects of three scenarios of changes in OWOB (the Normal-Weight-for-All scenario, the No-Ethnic-Difference-over-the-Life-Course scenario, the and No-Ethnic-Differences-in-Childhood scenario).

Study design: A simulation study.

Methods: We combine data from multiple data sources and use the Dynamic Modeling for Health Impact Assessment (DYNAMO-HIA) model to estimate the effects of three scenarios on the cumulative incidence of diabetes mellitus, ischaemic heart disease (IHD) and stroke between 18 and 70 years in the five largest ethnic groups in the Netherlands.

Results: In the scenario where all individuals have normal weight, the cumulative incidence decreased in all ethnic minority groups for all diseases, with largest decreases among South-Asian Surinamese, where the reduction of diabetes incidence exceeded 50%. In the scenario where the prevalence of OWOB in each ethnic-minority group was reduced to the current level among the Dutch-origin population, ethnic inequalities in cardio-metabolic diseases were substantially reduced, particularly when lowered prevalence of OWOB persisted across the lifespan. Reductions were the largest for diabetes and for the Asian Surinamese population.

Conclusions: A substantial part of the well-known ethnic inequalities in incidence of diabetes, IHD, and stroke can be attributed to OWOB. Interventions aimed at reducing OWOB have clear potential to reduce the health inequalities in these outcomes, especially for diabetes, in particular when they have an impact across the lifespan.

Keywords: Cardiovascular disease; Diabetes mellitus; Ethnicity; Health inequalities; Overweight and obesity; Simulation modelling.