Analysing Recent Socioeconomic Trends in Coronary Heart Disease Mortality in England, 2000-2007: A Population Modelling Study
Analysing Recent Socioeconomic Trends in Coronary Heart Disease Mortality in England, 2000-2007: A Population Modelling Study
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DOI：
10.1371/journal.pmed.1001237
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发表时间：
2012-06-01
期刊：
影响因子：
15.8
通讯作者：
Capewell, Simon
中科院分区：
文献类型：
--
作者：
Bajekal, Madhavi;Scholes, Shaun;Capewell, Simon
背景：2000年至2007年，英国冠心病（CHD）死亡率每年下降约6%。然而，社会群体之间的比率下降幅度不同，不平等实际上在扩大。我们试图描述在何种程度上减少冠心病死亡率是由于在任何水平的危险因素或治疗吸收的变化，跨和社会经济groups.Methods和调查结果：一个广泛使用和复制的流行病学模型被用来综合估计分层的年龄，性别和地区剥夺五分之一的英国人口年龄在2000年和2007年之间。死亡率下降，2007年冠心病死亡人数减少约38 000人。该模型解释了约86%（95%的不确定性区间：65%-107%）的死亡率下降。主要心血管危险因素的减少对冠心病死亡率的总体下降贡献了约34%（21%-47%）：范围从最贫困人群的约44%（31%-61%）到最富裕人群的29%（16%-42%）。最大的贡献来自未服用高血压药物的人群（29%; 18%-40%）的收缩压大幅下降;贫困地区（37%）比富裕地区（25%）更明显。其他风险因素在所有社会群体中的贡献相对较小：总胆固醇（6%），吸烟（3%）和体力活动（2%）。此外，这些好处部分被体重指数和糖尿病增加导致的死亡率增加所抵消（29%; 217%至23%），特别是在更贫困的五分之一人群中。治疗约占死亡率下降的52%（40%-70%），在所有社会群体中公平分布。降脂（14%），慢性心绞痛治疗（13%），和二级预防（11%）作出了最大的医疗contributions.Conclusions：该模型表明，最近在英格兰冠心病死亡率下降约一半是由于改善治疗吸收。这一好处在所有社会群体中平均发生。然而，主要风险因素的相反趋势意味着它们的净贡献仅占避免的冠心病死亡的三分之一以上;这些因素在社会经济群体中也有很大差异。目前已有强有力和公平的循证全民政策干预措施;现在应紧急实施这些措施，以有效解决持续存在的不平等问题。
Background: Coronary heart disease (CHD) mortality in England fell by approximately 6% every year between 2000 and 2007. However, rates fell differentially between social groups with inequalities actually widening. We sought to describe the extent to which this reduction in CHD mortality was attributable to changes in either levels of risk factors or treatment uptake, both across and within socioeconomic groups.Methods and Findings: A widely used and replicated epidemiological model was used to synthesise estimates stratified by age, gender, and area deprivation quintiles for the English population aged 25 and older between 2000 and 2007. Mortality rates fell, with approximately 38,000 fewer CHD deaths in 2007. The model explained about 86% (95% uncertainty interval: 65%-107%) of this mortality fall. Decreases in major cardiovascular risk factors contributed approximately 34% (21%-47%) to the overall decline in CHD mortality: ranging from about 44% (31%-61%) in the most deprived to 29% (16%-42%) in the most affluent quintile. The biggest contribution came from a substantial fall in systolic blood pressure in the population not on hypertension medication (29%; 18%-40%); more so in deprived (37%) than in affluent (25%) areas. Other risk factor contributions were relatively modest across all social groups: total cholesterol (6%), smoking (3%), and physical activity (2%). Furthermore, these benefits were partly negated by mortality increases attributable to rises in body mass index and diabetes (29%; 217% to 23%), particularly in more deprived quintiles. Treatments accounted for approximately 52% (40%70%) of the mortality decline, equitably distributed across all social groups. Lipid reduction (14%), chronic angina treatment (13%), and secondary prevention (11%) made the largest medical contributions.Conclusions: The model suggests that approximately half the recent CHD mortality fall in England was attributable to improved treatment uptake. This benefit occurred evenly across all social groups. However, opposing trends in major risk factors meant that their net contribution amounted to just over a third of the CHD deaths averted; these also varied substantially by socioeconomic group. Powerful and equitable evidence-based population-wide policy interventions exist; these should now be urgently implemented to effectively tackle persistent inequalities.