Rates of obesity are increasing with extraordinary rapidity in Mexico, with over 40 million people now overweight or obese by WHO criteria. Diabetes prevalence in adults in now at 14% (over twice the level in the US) and rates of other heart disease risk factors are also increasing. In the near future, Mexico will face an enormous increase in cardiovascular mortality and morbidity with commensurate economic and social costs. Mexico's policy makers and public health community need reliable, evidence-based tools with which to plan public health programs and allocate resources. Clinically relevant, evidence-based, policy decision making is exceptionally important and feasible in Mexico, as more than half the population are currently insured through a government health plan. Models that estimate the impact of public health policy or clinical policy changes on cardiovascular outcomes are available, but none has been adapted for use in Mexico. We propose to collaborate with an outstanding team in Mexico to create an integrated new computer simulation model of the Coronary Heart Disease (CHD) Policy Model that will include additional effect modifiers and additional disease states and will be adapted to simulate disease in Mexico, the CVD Policy Model- Mexico (Specific Aim 1), to use the process of the creation of the CVD Policy Model-Mexico to increase capacity within Mexico to understand the epidemiological and healthcare data sources that will provide the inputs to the model and the principles of dynamic disease-specific computer models (Specific Aim 2), and to apply the newly created CVD Policy Model-Mexico to public health issues of relevance in Mexico and to develop comparative policy evaluations of
to the US and Mexico (Specific Aim 3). Through this innovative approach, we will create both a useful tool for the evaluation of clinical and public health interventions in Mexico, build capacity within Mexico for the further development and use of this tool within the Mexican context, and develop collaborations for future comparative work of public health interventions in Mexico and the US. This research will be done primarily in Mexico at the Instituto Nacional de Salud Publica in collaboration with Dr. Simon Barquera, as an extension of Grant-in-Aid from the American Heart Association that will serve as the parent grant for this application. The parent grant, entitled 'Adaption of the Coronary Heart Disease Policy Model to US Subpopulations' (09 GRNT2060096). FIRCA eligibility is established through R01 from the NIDDK (Grant # R01DK090272). PUBLIC HEALTH RELEVANCE: Mexico's policy makers and public health community need reliable, evidence based tools with which to plan public health programs and allocate resources to reduce cardiovascular disease, particularly in light of recent increases in obesity and diabetes. Computer models that estimate the impact of public health policy or clinical policy interventions on cardiovascular outcomes are available, but none has been adapted for use in Mexico. This project brings together teams from the University of California, San Francisco and from the Instituto Nacional de Salud Publica, Cuernavaca, to build a CVD Policy Model-Mexico and to create capacity within Mexico to use the Model to conduct Mexico and global comparative policy oriented research.
