Why choice of metric matters in public health analyses: a case study of the attribution of credit for the decline in coronary heart disease mortality in the US and other populations.
Why choice of metric matters in public health analyses: a case study of the attribution of credit for the decline in coronary heart disease mortality in the US and other populations.
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DOI：
10.1186/1471-2458-12-88
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发表时间：
2012-01-28
影响因子：
4.5
通讯作者：
Capewell S
中科院分区：
文献类型：
--
作者：
Gouda HN;Critchley J;Powles J;Capewell S
高收入国家冠心病（CHD）死亡率普遍下降的原因存在争议。在这里，我们探讨如何选择这些下降的分析指标的类型影响所获得的答案。我们回顾的分析是使用IMPACT进行的，IMPACT是一个基于Excel的CHD死亡率时间变化决定因素的大型模型。1980年至2000年美国冠心病死亡率下降的评估作为中心案例研究。根据预防死亡人数的指标进行的分析将大约一半的下降归因于治疗（包括预防性药物），一半归因于风险因素的有利变化。然而，当死亡率变化以生命年增长的度量表示时，归因于风险因素变化的份额上升到65%。这是因为风险因素的变化被模拟为减缓疾病进展，因此避免的假设死亡导致比更好的治疗避免的死亡更长的平均剩余寿命。这一结果对治疗和风险因素变化的相对效应量的一系列合理假设具有稳健性。基于时间的指标（如生命年）通常是可取的，因为它们将注意力集中在疾病自然史的变化上，这些变化是由关键健康决定因素的变化引起的。与避免的每一次死亡相关的生命年数也将以一种更好地反映社会偏好的方式来衡量死亡人数。
Reasons for the widespread declines in coronary heart disease (CHD) mortality in high income countries are controversial. Here we explore how the type of metric chosen for the analyses of these declines affects the answer obtained. The analyses we reviewed were performed using IMPACT, a large Excel based model of the determinants of temporal change in mortality from CHD. Assessments of the decline in CHD mortality in the USA between 1980 and 2000 served as the central case study. Analyses based in the metric of number of deaths prevented attributed about half the decline to treatments (including preventive medications) and half to favourable shifts in risk factors. However, when mortality change was expressed in the metric of life-years-gained, the share attributed to risk factor change rose to 65%. This happened because risk factor changes were modelled as slowing disease progression, such that the hypothetical deaths averted resulted in longer average remaining lifetimes gained than the deaths averted by better treatments. This result was robust to a range of plausible assumptions on the relative effect sizes of changes in treatments and risk factors. Time-based metrics (such as life years) are generally preferable because they direct attention to the changes in the natural history of disease that are produced by changes in key health determinants. The life-years attached to each death averted will also weight deaths in a way that better reflects social preferences.
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影响因子：
12.7
作者：
Ünal, B;Critchley, JA;Capewell, S
通讯作者：
Capewell, S
影响因子：
16.2
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Chun, BY;Dobson, AJ;Heller, RF
通讯作者：
Heller, RF
影响因子：
4.4
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Kabir, Zubair;Bennett, Kathleen;Capewell, Simon
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Capewell, Simon
影响因子：
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作者：
Coast, Joanna;Smith, Richard D.;Lorgelly, Paula
通讯作者：
Lorgelly, Paula
影响因子：
6.3
作者：
Bennett, K;Kabir, Z;Capewell, S
通讯作者：
Capewell, S