Analysing the decline in the British Coronary Heart Disease epidemic

自1980年以来，英国冠心病（CHD）的死亡率下降了一半，但冠心病仍然是最常见的死亡原因。自1980年以来的下降可能是因为现在患冠心病的人越来越少，或者是因为更多的人在经历冠心病后存活下来，或者两者兼而有之。如果现在患冠心病的人减少了，这可能是由于人群中危险因素的变化（例如，现在吸烟的人减少了）。如果冠心病患者的生存率较好，主要是由于医院或家庭医生的治疗更有效，或两者兼而有之。自2000年以来，英国国家医疗服务体系（National Health Service）大幅增加了在冠心病方面的支出，英国的人均支出比其他任何欧洲国家都要高。然而，大部分增加的支出都集中在冠心病患者的医院设施上。因此，了解冠心病在过去二十年中下降的主要原因是很重要的。然后，政府部门将能够做出明智的选择，如何最好地分配未来的支出，以进一步减少冠心病死亡人数。我们将分析三个数据集；(1)英国区域心脏研究，该研究对7000多名英国男性进行了25年的跟踪调查；（二）全科医学研究数据库（以及类似的THIN数据库），该数据库从1990年以来的数百个全科医学实践中收集了关于病人的计算机记录信息；（三）英格兰健康调查，该调查每年调查约19 000人，1994年、1998年和2003年集中调查心血管疾病问题。从这些研究中，我们将描述心脏病发病率、危险因素、治疗率和心脏病后存活率的趋势。使用一个叫做IMPACT的计算机模型，我们将评估风险因素的变化和治疗的增加对减少冠心病流行的贡献。我们将与国家心脏论坛合作，帮助指导我们的分析，并传播我们的研究结果。国家心脏论坛是一个关于政府卫生政策的成熟而有影响力的倡导团体。

Death rates for coronary heart disease (CHD) in the UK have halved since 1980, but CHD is still the commonest cause of death. The decrease since 1980 may be because fewer people now get CHD in the first place, or because more people survive after experiencing CHD, or both. If fewer people now get CHD, this may be due to changes in risk factors in the population (for example, fewer people now smoke). If survival after CHD is better, it will mainly be due to more effective treatment by hospitals or by family doctors, or both. Since 2000, the National Health Service has greatly increased its expenditure on CHD, and the UK spends more per head than any other European country. However most of the spending increase has been concentrated on facilities for people in hospital with CHD. It is therefore important that we understand the main reasons why CHD has fallen in the last two decades. Then government departments will be able to make informed choices about how they best allocate future expenditure, to bring about further decreases in deaths due to CHD. We will analyse three data sets; (i) the British Regional Heart Study which has followed up over 7000 British men for 25 years; (ii) the General Practice Research Database (and the similar THIN database), which has captured computer-recorded information on patients from hundreds of general practices since 1990, and (iii) the Health Survey for England (HSE), which surveys about 19,000 people every year, and in 1994, 1998 and 2003 concentrated on issues concerning cardiovascular disease. From these studies, we will describe trends in heart disease rates, in risk factors, treatment rates, and survival rates after heart disease. Using a computer model called IMPACT, we will then estimate the contribution of changes in risk factors, and increases in treatment, in decreasing the CHD epidemic. We will work with the National Heart Forum, a well-established and influential advocacy group concerning government health policy, to help guide our analysis, and to disseminate our findings.