Cardiovascular screening to reduce the burden from cardiovascular disease: microsimulation study to quantify policy options.
Cardiovascular screening to reduce the burden from cardiovascular disease: microsimulation study to quantify policy options.
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心血管筛查以减轻心血管疾病的负担：微仿真研究以量化政策选择。
DOI：
10.1136/bmj.i2793
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发表时间：
2016-06-08
期刊：
影响因子：
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通讯作者：
O'Flaherty M
中科院分区：
文献类型：
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作者：
Kypridemos C;Allen K;Hickey GL;Guzman-Castillo M;Bandosz P;Buchan I;Capewell S;O'Flaherty M
目的评估心血管疾病一级预防的全民筛查（国家卫生服务健康检查）对英格兰疾病负担和社会经济健康不平等的潜在影响，并将全民筛查与其他可行策略进行比较。设计一个接近现实的合成人口的微观模拟研究。考虑了五种情况：这些方案包括：基线方案，假设风险因素的当前趋势今后将继续下去;普遍筛查;筛查仅集中在最贫困地区;结构性全民干预;全民干预与集中筛查相结合。设置与英国社区居住人口特征相似的合成人口。参与者合成人的特征，通过健康调查英格兰。主要结果测量到2030年预防或推迟的心血管疾病病例和死亡，使用多重剥夺指数按社会经济地位的五分之一分层。结果与基线方案相比，全民筛查可预防或推迟约19000例病例（四分位数范围11 000-28 000）和3 000例死亡（− 1 000 - 6 000）;集中筛查17 000例（9，000 -26，000）和2，000例死亡（− 1 000 - 5 000）;全民干预67 000例（57 000-77 000）和8 000人死亡（4 000 -11 000）;全人群干预与集中筛查相结合的方法82000例（73000 ~ 93000），死亡9000例（6000 ~ 13000）。最公平的策略是将全民干预与集中筛查相结合，其次是单独集中筛查和全民干预。普遍筛查对健康方面的社会经济不平等影响最小。结论：当比较减少心血管疾病负担和不平等的一级预防策略时，普遍筛查似乎不如纳入全民方法的替代策略有效。需要进一步的研究来确定人群范围和风险针对性CVD策略的最佳组合，以最大限度地提高成本效益并最大限度地减少不平等。
Objectives To estimate the potential impact of universal screening for primary prevention of cardiovascular disease (National Health Service Health Checks) on disease burden and socioeconomic inequalities in health in England, and to compare universal screening with alternative feasible strategies. Design Microsimulation study of a close-to-reality synthetic population. Five scenarios were considered: baseline scenario, assuming that current trends in risk factors will continue in the future; universal screening; screening concentrated only in the most deprived areas; structural population-wide intervention; and combination of population-wide intervention and concentrated screening. Setting Synthetic population with similar characteristics to the community dwelling population of England. Participants Synthetic people with traits informed by the health survey for England. Main outcome measure Cardiovascular disease cases and deaths prevented or postponed by 2030, stratified by fifths of socioeconomic status using the index of multiple deprivation. Results Compared with the baseline scenario, universal screening may prevent or postpone approximately 19 000 cases (interquartile range 11 000-28 000) and 3000 deaths (−1000-6000); concentrated screening 17 000 cases (9000-26 000) and 2000 deaths (−1000-5000); population-wide intervention 67 000 cases (57 000-77 000) and 8000 deaths (4000-11 000); and the combination of the population-wide intervention and concentrated screening 82 000 cases (73 000-93 000) and 9000 deaths (6000-13 000). The most equitable strategy would be the combination of the population-wide intervention and concentrated screening, followed by concentrated screening alone and the population-wide intervention. Universal screening had the least apparent impact on socioeconomic inequalities in health. Conclusions When primary prevention strategies for reducing cardiovascular disease burden and inequalities are compared, universal screening seems less effective than alternative strategies, which incorporate population-wide approaches. Further research is needed to identify the best mix of population-wide and risk targeted CVD strategies to maximise cost effectiveness and minimise inequalities.