Impact of BMI and BMI Change      on BP Percentile and Change in      BP Percentile in Those Age 3-17                   Ye...
Duality of Interest: Dr. O’Connor• No duality of Interest• Funded by NIH, NHLBI R01 HL093345
Significance• Overweight (BMI 85-95th percentile) and  obesity (BMI >= 95th percentile) are massive  problems in children ...
Design, Study Sites, Data Sources• Retrospective Cohort Study• 3-HMO sites: KP Colorado, KP Northern  California, HealthPa...
Study Subjects• Age 3-17 years• In 2007-2011, have at least one outpatient  visit with an eligible BP measure• Eligible BP...
Blood Pressure Percentile• BP value is adjusted for gender, age, and  height using a standard CDC equation to  compute BP ...
Existing Hypertension• Hypertension diagnosis: was there 1+ HT  diagnosis code (401.xx) within first year• Hypertension tr...
Covariates•   Age•   Sex•   Race•   SES (geocoded)•   Baseline BMI percentile•   Baseline BP percentile
Dependent Variables• BP percentile (cross sectional with baseline  BMI percentile)• Change in BP percentile (function of b...
Analysis Plan• Consistency of data across sites• Distributions of BP and BMI data• BP percentile (cross sectional with bas...
SBP % over time as function of       baseline BMI %                 100                  90                  80           ...
100                                    3-5 year olds                  90                  80                  70          ...
100                                    6-8 year olds                  90                  80                  70          ...
100                                    9-11 year olds                  90                  80                  70         ...
100                                    12-14 year olds                  90                  80                  70        ...
100                               15-17 year olds                  90                  80                  70             ...
BMI % over time as a function of                 120                         baseline SBP %                 100           ...
120                                     3-5 year olds                 100                  80BMI percentile               ...
120                                     6-8 year olds                 100                  80BMI percentile               ...
120                                     9-11 year olds                 100                  80BMI percentile              ...
120                                     12-14 year olds                 100                  80BMI percentile             ...
120                                     15-17 year olds                 100                  80BMI percentile             ...
Table 1. Data from Two Study Sites                    Total N            3-5 years           6-8 years            9-11 yea...
Table 2. Data From Two Sites, Girls                  Total N   3-5 years   6-8 years   9-11 years   12-14 years   15-17 ye...
Table 3. Data From Two Sites, Boys                  Total N   3-5 years   6-8 years   9-11 years   12-14 years   15-17 yea...
Conclusions—1
Conclusions—2
Conclusions—3
More Information?Please Contact:Patrick.j.oconnor@healthpartners.com
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Prevalence of Elevated Blood Pressure and BMI in US Children and Adolescents OCONNOR

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Prevalence of Elevated Blood Pressure and BMI in US Children and Adolescents OCONNOR

  1. 1. Impact of BMI and BMI Change on BP Percentile and Change in BP Percentile in Those Age 3-17 YearsPatrick J. O’Connor MD MA MPH1, Emily D. Parker Ph.D. 1,Joan Lo MD.2 Alan Sinako MD, Matt Daley MD MPH, Elyse Kharbanda MD MPH,Nicole K. Trower BS,1, Heather Tavel BS, Malini Chandra Ph.D., Jay R. Desai MPH1 ,Karen L. Margolis MD MPH1, David J. Magid MD MPH31HealthPartnersResearch Foundation, Minneapolis, MN;2Kaiser Permanente of Northern California, Oakland, CA3Kaiser Permanente of Colorado, Denver, CO; Division of Research,
  2. 2. Duality of Interest: Dr. O’Connor• No duality of Interest• Funded by NIH, NHLBI R01 HL093345
  3. 3. Significance• Overweight (BMI 85-95th percentile) and obesity (BMI >= 95th percentile) are massive problems in children and adolescents• BMI increases may be driving increased prevalence of elevated Bp in these age groups• EMRs enable surveillance of patterns in BP and BMI over time
  4. 4. Design, Study Sites, Data Sources• Retrospective Cohort Study• 3-HMO sites: KP Colorado, KP Northern California, HealthPartners• Pediatric Hypertension Superset for Project• Years of Data: 2007-2011, more coming• Used about 10 Data Tables: demo, vitals, Dx, Rx, diagnoses, enrollment, utilization, etc.
  5. 5. Study Subjects• Age 3-17 years• In 2007-2011, have at least one outpatient visit with an eligible BP measure• Eligible BP measure means BP with a height +/- 90 days of BP (to compute BP percentile)• About XXX study subjects in analysis• About XXX person-years of data
  6. 6. Blood Pressure Percentile• BP value is adjusted for gender, age, and height using a standard CDC equation to compute BP percentile
  7. 7. Existing Hypertension• Hypertension diagnosis: was there 1+ HT diagnosis code (401.xx) within first year• Hypertension treatment: 1+ fills for HT medication• Excluded clonidine, used mostly for behavioral reasons
  8. 8. Covariates• Age• Sex• Race• SES (geocoded)• Baseline BMI percentile• Baseline BP percentile
  9. 9. Dependent Variables• BP percentile (cross sectional with baseline BMI percentile)• Change in BP percentile (function of baseline BMI percentile)• Change in BP percentile (function of change in BMI percentile over time)
  10. 10. Analysis Plan• Consistency of data across sites• Distributions of BP and BMI data• BP percentile (cross sectional with baseline BMI percentile) (adjusted and unadjusted)• Change in BP percentile (function of baseline BMI percentile) (adjusted and unadjusted)• Change in BP percentile (function of change in BMI percentile over time)(adjusted and unadjusted)
  11. 11. SBP % over time as function of baseline BMI % 100 90 80 70 60SBP percentile BMI <85th 50 BMI 85th-<95th 40 BMI >=95th 30 20 10 0 0 6 12 24 36 48 months
  12. 12. 100 3-5 year olds 90 80 70 60SBP percentile 50 BMI <85th BMI 85th-<95th 40 BMI >=95th 30 20 10 0 0 6 12 24 36 48 months
  13. 13. 100 6-8 year olds 90 80 70 60SBP percentile 50 BMI <85th BMI 85th-<95th 40 BMI >=95th 30 20 10 0 0 6 12 24 36 48 months
  14. 14. 100 9-11 year olds 90 80 70 60SBP percentile 50 BMI <85th BMI 85th-<95th 40 BMI >=95th 30 20 10 0 0 6 12 24 36 48 months
  15. 15. 100 12-14 year olds 90 80 70 60SBP percentile 50 BMI <85th BMI 85th-<95th 40 BMI >=95th 30 20 10 0 0 6 12 24 36 48 months
  16. 16. 100 15-17 year olds 90 80 70 60SBP percentile 50 BMI <85th BMI 85th-<95th 40 BMI >=95th 30 20 10 0 0 6 12 24 36 months
  17. 17. BMI % over time as a function of 120 baseline SBP % 100 80BMI percentile SBP <90th 60 SBP 90th-<95th SBP 95th-99th SBP >99th 40 20 0 0 0.5 1 2 3 4 months
  18. 18. 120 3-5 year olds 100 80BMI percentile SBP <90th 60 SBP 90th-<95th SBP 95th-99th SBP >99th 40 20 0 0 0.5 1 2 3 4 months
  19. 19. 120 6-8 year olds 100 80BMI percentile SBP <90th 60 SBP 90th-<95th SBP 95th-99th SBP >99th 40 20 0 0 0.5 1 2 3 4 months
  20. 20. 120 9-11 year olds 100 80BMI percentile SBP <90th 60 SBP 90th-<95th SBP 95th-99th SBP >99th 40 20 0 0 0.5 1 2 3 4 months
  21. 21. 120 12-14 year olds 100 80BMI percentile SBP <90th 60 SBP 90th-<95th SBP 95th-99th SBP >99th 40 20 0 0 0.5 1 2 3 4 months
  22. 22. 120 15-17 year olds 100 80BMI percentile SBP <90th 60 SBP 90th-<95th SBP 95th-99th SBP >99th 40 20 0 0 0.5 1 2 3 4 months
  23. 23. Table 1. Data from Two Study Sites Total N 3-5 years 6-8 years 9-11 years 12-14 years 15-17 years 79838 14919 12301 15703 18018 18897Normal BP 47843 9658 7563 9634 10595 10393Pre-HT 30731 5169 4631 5903 7051 7977HT 1264 92 107 166 372 527Normal Weight 56289 12228 8810 10438 11979 12834Overweight 11930 1571 1681 2504 2990 3184Obese 11619 1120 1810 2761 3049 2879No Risk factors 37314 8137 5932 7152 7988 8105One of the 2 risk 29504 5612 4509 5768 6598 7017factorsBoth Risk Factors 13020 1170 1860 2783 3432 3775** Tables 1, 2, 3: Data in these tables came from two study sites. Each subjet counted in the table had at least 3blood pressure measurements taken (2007-2009). Hypertension is defined by at least 3 or more elevated bloodpressures >=95th percentile. Normal weight, overweight and obese were defined by the baseline BMI percentile.
  24. 24. Table 2. Data From Two Sites, Girls Total N 3-5 years 6-8 years 9-11 years 12-14 years 15-17 years 40900 7052 5748 7663 9238 11199Normal BP 24578 4651 3524 4752 5721 5930Pre-HT 15735 2354 2175 2838 3356 5012HT 587 47 49 73 161 257Normal Weight 29304 5787 4216 5316 6232 7753Overweight 6231 764 757 1182 1619 1909Obese 5365 501 775 1165 1387 1537No Risk factors 19507 3946 2830 3657 4355 4719One of the 2 14868 2546 2080 2754 3243 4245risk factorsBoth Risk 6525 560 838 1252 1640 2235Factors
  25. 25. Table 3. Data From Two Sites, Boys Total N 3-5 years 6-8 years 9-11 years 12-14 years 15-17 years 38938 7867 6553 8040 8780 7698Normal BP 23265 5007 4039 4882 4874 4463Pre-HT 14996 2815 2456 3065 3695 2965HT 677 45 58 93 211 270Normal Weight 26985 6441 4594 5122 5747 5081Overweight 5699 807 924 1322 1371 1275Obese 6254 619 1035 1596 1662 1342No Risk factors 17807 4191 3102 3495 3633 3386One of the 2 risk 14636 3066 2429 3014 3355 2772factorsBoth Risk 6495 610 1022 1531 1792 1540Factors
  26. 26. Conclusions—1
  27. 27. Conclusions—2
  28. 28. Conclusions—3
  29. 29. More Information?Please Contact:Patrick.j.oconnor@healthpartners.com

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