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Text Equivalents - Health Promotion and Chronic Disease Prevention in Canada - Research, Policy and Practice

Figure 1: PRISMA 2009 flow diagram showing the selection process to identify relevant systematic reviews

Figure 1 depicts the flow of the selection process to identify relevant systematic reviewers. The search strategy identified 4103 records after duplicates were removed. After screening abstracts and titles 3957 records were excluded and 146 articles were retrieved for full-text screening. We excluded 135 systematic reviews because the interventions used one-way communication (e.g. one-way reminders for appointments) or used the Internet for treatment (e.g. cognitive-based therapy by Internet) or for one-way education or information messages, with no interaction among users or user-generated content.

Return to Figure 1: PRISMA 2009 flow diagram showing the selection process to identify relevant systematic reviews

Figure 1. Prevalence of excess weight in British Columbia, by excess weight Category and HSDA, 2011/12

Figure 1 shows that the prevalence of excess weight varies by HSDA, from a low of 29.5% in the Vancouver HSDA to a high of 56.7% in the Northwest HSDA (B.C. average = 41.6%).

Return to Figure 1. Prevalence of excess weight in British Columbia, by excess weight Category and HSDA, 2011/12

Figure 2. Prevalence of physical inactivity in British Columbia, by HSDA, 2011/12

Figure 2 shows that the prevalence of physical inactivity varies from a low of 27.1% in the Kootenay Boundary HSDA to a high of 43.8% in the Fraser North HSDA (B.C. average = 37.9%).

Return to Figure 2: Figure 2. Prevalence of physical inactivity in British Columbia, by HSDA, 2011/12

Figure 3. Prevalence of smoking in British Columbia, by smoking intensity and HSDA, 2011/12

Figure 3 shows that the prevalence of tobacco smoking varies from a low of 8.8% in the Richmond HSDA to a high of 21.3% in the Northeast HSDA (B.C. average = 13.2%).

Return to Figure 3. Prevalence of smoking in British Columbia, by smoking intensity and HSDA, 2011/12

Figure 4. Economic burden per capita in British Columbia: smoking, excess weight and physical inactivity, by HSDA, 2013

Figure 4 shows that the variable prevalence rates of the three risk factors in each HSDA results in a varying economic burden per capita in each region. The Richmond HSDA has the lowest per capita economic burden at $738, while the Northwest HSDA has the highest at $1766, more than double that of the Richmond HSDA. The provincial average per capita economic burden is $1222.

Return to Figure 4. Economic burden per capita in British Columbia: smoking, excess weight and physical inactivity, by HSDA, 2013

Figure 5. Changes in annual per capita economic burden in British Columbia based on best risk factor rates, by HSDA and direct/indirect costs ($Millions), 2013

Figure 5 shows that applying the lowest sex- and age-specific prevalence rates for excess weight from the Vancouver HSDA, for tobacco smoking from the Richmond HSDA and for physical inactivity from the Kootenay Boundary HSDA to the population of each remaining HSDAs in the province would reduce the per capita annual economic burden by between $60 (in the Richmond HSDA) and $651 (in the Northwest HSDA).

Changes in Annual Per Capita Economic Burden ($Millions)	Health service delivery area (HSDA)
	BC	E. Kootenay	Kootenay Boundary	Okanagan	Thompson	Fraser E.	Fraser N.	Fraser S.	Vancouver	Richmond	N. Shore	S. Van. Island	Central Van. Island	N. Van. Island	Northwest	N. Interior	Northeast
Note: Sensitivity analysis suggests that these costs may vary by +/−17%. Abbreviations: BC British Columbia HSDA health service delivery area
Indirect	−$199	−$357	−$238	−$251	−$264	−$309	−$179	−$178	−$67	−$40	−$64	−$168	−$290	−$274	−$439	−$423	−$315
Direct	−$98	−$177	−$122	−$126	−$132	−$154	−$88	−$84	−$35	−$20	−$30	−$80	−$145	−$141	−$211	−$214	−$157

Return to Figure 5. Changes in annual per capita economic burden in British Columbia based on best risk factor rates, by HSDA and direct/indirect costs ($Millions), 2013

Figure 6. Changes in annual economic burden in British Columbia based on best risk factor rates, by HSDA and direct/indirect costs ($Millions), 2013

Figure 6 shows that the total annual reduction in economic burden would range between $12.1 million in the Richmond HSDA to $200.1 million in the Fraser South HSDA. If all HSDAs were to achieve the best prevalence rates for the three risk factors, then $1362.2 million in economic burden could be avoided annually, comprising $449.8 million in direct costs and $912.4 million in indirect costs.

Health service delivery area (HSDA)	Changes in Annual Economic Burden ($Millions)
	E. Kootenay	Kootenay Boundary	Okanagan	Thompson	Fraser E.	Fraser N.	Fraser S.	Vancouver	Richmond	N. Shore	S. Van. Island	Central Van. Island	N. Van. Island	Northwest	N. Interior	Northeast
Note: Sensitivity analysis suggests that these costs may vary by +/−17%. Abbreviation: HSDA health service delivery area
Indirect	−$27.1	−$18.3	−$87.1	−$57.4	−$88.8	−$114.1	−$136.6	−$44.3	−$8.1	−$17.8	−$62.5	−$76.0	−$32.6	−$31.9	−$60.0	−$21.9
Direct	−$13.5	−$9.3	−$43.5	−$28.8	−$44.2	−$55.9	−$64.6	−$23.0	−$4.0	−$8.4	−$29.6	−$38.0	−$16.8	−$15.4	−$30.3	−$10.9

Return to Figure 6. Changes in annual economic burden in British Columbia based on best risk factor rates, by HSDA and direct/indirect costs ($Millions), 2013