Impact of the NHS Health Check on inequalities in cardiovascular disease risk: a difference-in-differences matching analysis
Impact of the NHS Health Check on inequalities in cardiovascular disease risk: a difference-in-differences matching analysis
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DOI：
10.1136/jech-2018-210961
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发表时间：
2019-01-01
影响因子：
6.3
通讯作者：
Millett, Christopher
中科院分区：
文献类型：
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作者：
Chang, Kiara C-M;Vamos, Eszter P.;Millett, Christopher
我们评估了一项大型的全国性心血管疾病（CVD）风险评估和管理计划对社会人口学群体不平等的影响，包括（1）早期识别高血压，2型糖尿病（T2 D）和慢性肾脏疾病（CKD）;（2）管理高危人群中的全球CVD风险。方法：我们从临床实践研究数据链中随机抽取了138 788例年龄在40-74岁之间的无已知CVD或糖尿病的患者，这些患者在2009年至2013年期间注册了462家诊所。我们使用差异中的差异匹配分析来估计计划的影响，该分析比较了与会者和非与会者之间随时间推移的结果变化。结果138788人中，参加国民保健服务体检的29672人，占21.4%;在男性中发现的高血压和T2 D事件病例数量显著多于女性（例如，男性和女性高血压病例分别增加4.02%，95% CI 3.65%-4.39%和2.08%，1.81%-2.35%）。在生活在最贫困地区的与会者中发现了大量的T2 D事件病例，但在社会经济群体中没有发现高血压和CKD的差异。在社会人口统计学亚组之间，未观察到CVD风险管理的重大差异（例如，计划对男性10年CVD风险评分的影响为-1.13%，-1.48%至-0.78%，女性参与者为-1.53%，-2.36%至-0.71%）。结论2009-2013年期间，该计划的参与率较低，对早期识别疾病和风险管理的总体影响较小。各年龄、性别和社会经济分组似乎获得了类似水平的福利，使现有的不平等状况保持不变。这些发现强调了全民干预措施对解决CVD结果不平等的重要性。
Background We assessed impacts of a large, nationwide cardiovascular disease (CVD) risk assessment and management programme on sociodemographic group inequalities in (1) early identification of hypertension, type 2 diabetes (T2D) and chronic kidney disease (CKD); and (2) management of global CVD risk among high-risk individuals. Methods We obtained retrospective electronic medical records from the Clinical Practice Research Datalink for a randomly selected sample of 138 788 patients aged 40-74 years without known CVD or diabetes, who were registered with 462 practices between 2009 and 2013. We estimated programme impact using a difference-in-differences matching analysis that compared changes in outcome over time between attendees and non-attendees. Results National Health Service Health Check attendance was 21.4% (29 672/138 788). A significantly greater number of hypertension and T2D incident cases were identified in men than women (eg, an additional 4.02%, 95% CI 3.65% to 4.39%, and 2.08%, 1.81% to 2.35% cases of hypertension in men and women, respectively). A significantly greater number of T2D incident cases were identified among attendees living in the most deprived areas, but no differences were found for hypertension and CKD across socioeconomic groups. No major differences in CVD risk management were observed between sociodemographic subgroups (eg, programme impact on 10-year CVD risk score was -1.13%, -1.48% to -0.78% in male and -1.53%, -2.36% to -0.71% in female attendees). Conclusion During 2009-2013, the programme had low attendance and small overall impacts on early identification of disease and risk management. The age, sex and socioeconomic subgroups appeared to have derived similar level of benefits, leaving existing inequalities unchanged. These findings highlight the importance of population-wide interventions to address inequalities in CVD outcomes.