1
|
Bhatta DN, Bommer W. Trends in California Cardiovascular Disease Mortality: Sex-Race/Ethnicity Disparity and Income Inequality. Mayo Clin Proc 2024:S0025-6196(24)00104-6. [PMID: 38739073 DOI: 10.1016/j.mayocp.2024.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 02/10/2024] [Accepted: 02/20/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE To examine the cardiovascular disease (CVD)-related death trends and the relationship between CVD deaths and sex, race/ethnicity, and income in California from January 1, 1999, to December 31, 2021. METHODS The age-adjusted death rate (AADR) per 100,000 population attributable to ischemic heart disease (IHD), hypertensive heart disease (HHD) and heart failure (HF), stroke, and CVD combined were calculated using CDC WONDER (Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research) for California, 1999 to 2021. We used a joinpoint log-linear regression model to determine trends in CVD death. Income disparities were assessed using the slope index of inequality and health concentration index. RESULTS Between 1999 and 2021, overall death rates for CVD decreased significantly (average annual percent change, -2.2% [95% confidence interval: -2.6%, -1.7%]), IHD (-3.7% [-4.3%, -3.1%]), and stroke (-2.0% [-2.8%, -1.2%]) and increased for HHD (2.0% [0.6%, 3.5%]) and HF (2.0% [1.3%, 2.7%]). The AADR of combined CVD first decreased significantly (1999-2014; all P<.001), then increased significantly after COVID-19 (P=.02). The AADR of IHD decreased significantly (1999-2019; all P<.001) and then increased after the COVID-19 pandemic but was not statistically significant (P=.15). The AADR of HHD (2014-2021) and HF (2013-2021) increased significantly (all P<.001), and this increase accelerated after COVID-19. The AADR of stroke decreased (1999-2009), then increased after COVID-19 but was not statistically significant (P=.07). Our results revealed significant disparities with CVD death being disproportionately higher among male, non-Hispanic Black, American Indian or Alaska Native, Native Hawaiian or Pacific Islander, Asian, and poorer populations. CONCLUSION All the death rates that were decreasing, stagnant, or increasing prior to the COVID-19 pandemic increased after the pandemic. We found increasingly adverse outcomes among the poor and racial/ethnic minority populations.
Collapse
Affiliation(s)
- Dharma N Bhatta
- Chronic Disease Control Branch, Center for Healthy Communities, California Department of Public Health, Sacramento.
| | - William Bommer
- Department of Medicine, University of California, Davis and Sacramento
| |
Collapse
|
2
|
Feigin VL, Martins SC, Brainin M, Norrving B, Kamenova S, Giniyat A, Kondybayeva A, Aldyngurov DK, Bapayeva M, Zhanuzakov M, Hankey GJ. Twenty years on from the introduction of the high risk strategy for stroke and cardiovascular disease prevention: a systematic scoping review. Eur J Neurol 2024; 31:e16157. [PMID: 38009814 PMCID: PMC11235671 DOI: 10.1111/ene.16157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND PURPOSE Early this century, the high risk strategy of primary stroke and cardiovascular disease (CVD) prevention for individuals shifted away from identifying (and treating, as appropriate) all at-risk individuals towards identifying and treating individuals who exceed arbitrary thresholds of absolute CVD risk. The public health impact of this strategy is uncertain. METHODS In our systematic scoping review, the electronic databases (Scopus, MEDLINE, Embase, Google Scholar, Cochrane Library) were searched to identify and appraise publications related to primary CVD/stroke prevention strategies and their effectiveness published in any language from January 1990 to August 2023. RESULTS No published randomized controlled trial was found on the effectiveness of the high CVD risk strategy for primary stroke/CVD prevention. Targeting high CVD risk individuals excludes a large proportion of the population from effective blood-pressure-lowering and lipid-lowering treatment and effective CVD prevention. There is also evidence that blood pressure lowering and lipid lowering are beneficial irrespective of blood pressure and cholesterol levels and irrespective of absolute CVD risk and that risk-stratified pharmacological management of blood pressure and lipids to only high CVD risk individuals leads to significant underuse of blood-pressure-lowering and lipid-lowering medications in individuals otherwise eligible for such treatment. CONCLUSIONS Primary stroke and CVD prevention needs to be done in all individuals with increased risk of CVD/stroke. Pharmacological management of blood pressure and blood cholesterol should not be solely based on the high CVD risk treatment thresholds. International guidelines and global strategies for primary CVD/stroke prevention need to be revised.
Collapse
Affiliation(s)
- Valery L. Feigin
- National Institute for Stroke and Applied Neurosciences, School of Clinical SciencesAuckland University of TechnologyAucklandNew Zealand
- Institute for Health Metrics EvaluationUniversity of WashingtonSeattleWashingtonUSA
| | - Sheila C. Martins
- Hospital de Clínicas de Porto AlegreHospital Moinhos de VentoPorto AlegreBrazil
| | - Michael Brainin
- Department of Neuroscience and Preventive MedicineDanube University KremsKremsAustria
| | - Bo Norrving
- Department of Clinical SciencesSkåne University Hospital, Lund UniversityLundSweden
- Department of NeurologySkåne University Hospital, Lund UniversityLundSweden
| | - Saltanat Kamenova
- Asfendiyarov Kazakh National Medical UniversityAlmatyRepublic of Kazakhstan
| | - Azhar Giniyat
- Minister of Healthcare of the Republic of KazakhstanAstanaRepublic of Kazakhstan
| | - Aida Kondybayeva
- Asfendiyarov Kazakh National Medical UniversityAlmatyRepublic of Kazakhstan
| | - Daulet K. Aldyngurov
- Department of Science and Human ResourceMinistry of Healthcare of the Republic of KazakhstanAstanaRepublic of Kazakhstan
| | - Magripa Bapayeva
- Department of Internal MedicineKazakhstan Medical University «KSPH»AlmatyRepublic of Kazakhstan
| | - Murat Zhanuzakov
- Higher School of Medicineal‐Farabi Kazakh National UniversityAlmatyRepublic of Kazakhstan
| | - Graeme J. Hankey
- Perron Institute Chair in Stroke Research, Medical SchoolUniversity of Western AustraliaPerthWestern AustraliaAustralia
- Perron Institute for Neurological and Translational SciencePerthWestern AustraliaAustralia
| |
Collapse
|
3
|
Špacírová Z, Kaptoge S, García-Mochón L, Rodríguez Barranco M, Sánchez Pérez MJ, Bondonno NP, Tjønneland A, Weiderpass E, Grioni S, Espín J, Sacerdote C, Schiborn C, Masala G, Colorado-Yohar SM, Kim L, Moons KGM, Engström G, Schulze MB, Bresson L, Moreno-Iribas C, Epstein D. The cost-effectiveness of a uniform versus age-based threshold for one-off screening for prevention of cardiovascular disease. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:1033-1045. [PMID: 36239877 DOI: 10.1007/s10198-022-01533-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
The objective of this article was to assess the cost-effectiveness of screening strategies for cardiovascular diseases (CVD). A decision analytic model was constructed to estimate the costs and benefits of one-off screening strategies differentiated by screening age, sex and the threshold for initiating statin therapy ("uniform" or "age-adjusted") from the Spanish NHS perspective. The age-adjusted thresholds were configured so that the same number of people at high risk would be treated as under the uniform threshold. Health benefit was measured in quality-adjusted life years (QALY). Transition rates were estimated from the European Prospective Investigation into Cancer and Nutrition (EPIC-CVD), a large multicentre nested case-cohort study with 12 years of follow-up. Unit costs of primary care, hospitalizations and CVD care were taken from the Spanish health system. Univariate and probabilistic sensitivity analyses were employed. The comparator was no systematic screening program. The base case model showed that the most efficient one-off strategy is to screen both men and women at 40 years old using a uniform risk threshold for initiating statin treatment (Incremental Cost-Effectiveness Ratio of €3,274/QALY and €6,085/QALY for men and women, respectively). Re-allocating statin treatment towards younger individuals at high risk for their age and sex would not offset the benefit obtained using those same resources to treat older individuals. Results are sensitive to assumptions about CVD incidence rates. To conclude, one-off screening for CVD using a uniform risk threshold appears cost-effective compared with no systematic screening. These results should be evaluated in clinical studies.
Collapse
Affiliation(s)
- Zuzana Špacírová
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Avda Monforte de Lemos 3-5, 28029, Madrid, Spain.
- Escuela Andaluza de Salud Pública (EASP), Cuesta del Observatorio 4. Campus Universitario de Cartuja, 18011, Granada, Spain.
- Instituto de Investigación Biosanitaria Ibs.Granada, 18012, Granada, Spain.
| | - Stephen Kaptoge
- Cardiovascular Epidemiology Unit, Strangeways Research Laboratory, Department of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, CB1 8RN, UK
| | - Leticia García-Mochón
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Avda Monforte de Lemos 3-5, 28029, Madrid, Spain
- Escuela Andaluza de Salud Pública (EASP), Cuesta del Observatorio 4. Campus Universitario de Cartuja, 18011, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.Granada, 18012, Granada, Spain
| | - Miguel Rodríguez Barranco
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Avda Monforte de Lemos 3-5, 28029, Madrid, Spain
- Escuela Andaluza de Salud Pública (EASP), Cuesta del Observatorio 4. Campus Universitario de Cartuja, 18011, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.Granada, 18012, Granada, Spain
| | - María José Sánchez Pérez
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Avda Monforte de Lemos 3-5, 28029, Madrid, Spain
- Escuela Andaluza de Salud Pública (EASP), Cuesta del Observatorio 4. Campus Universitario de Cartuja, 18011, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.Granada, 18012, Granada, Spain
- Department of Preventive Medicine and Public Health, University of Granada, 18071, Granada, Spain
| | - Nicola P Bondonno
- The Danish Cancer Society Research Centre, Strandboulevarden 49, 2100, Copenhagen, Denmark
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Dr, Perth, 6027, Australia
| | - Anne Tjønneland
- The Danish Cancer Society Research Centre, Strandboulevarden 49, 2100, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Elisabete Weiderpass
- International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Sara Grioni
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, 20133, Milan, Italy
| | - Jaime Espín
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Avda Monforte de Lemos 3-5, 28029, Madrid, Spain
- Escuela Andaluza de Salud Pública (EASP), Cuesta del Observatorio 4. Campus Universitario de Cartuja, 18011, Granada, Spain
- Instituto de Investigación Biosanitaria Ibs.Granada, 18012, Granada, Spain
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital, Via Santena 7, 10126, Turin, Italy
| | - Catarina Schiborn
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
| | - Giovanna Masala
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network - ISPRO, Florence, Italy
| | - Sandra M Colorado-Yohar
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Avda Monforte de Lemos 3-5, 28029, Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, Murcia, Spain
- Research Group on Demography and Health, National Faculty of Public Health, Univesity of Antioquia, Medellín, Colombia
| | - Lois Kim
- Cardiovascular Epidemiology Unit, Strangeways Research Laboratory, Department of Public Health and Primary Care, University of Cambridge, 2 Worts' Causeway, Cambridge, CB1 8RN, UK
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Trecht University, Utrecht, The Netherlands
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Arthur-Scheunert-Allee 114-116, 14558, Nuthetal, Germany
- German Center for Diabetes Research (DZD), Munich, Germany
- Institute of Nutritional Science, University of Potsdam, Potsdam, Germany
| | - Léa Bresson
- Ubisoft France, Floresco, 2 Avenue Pasteur, 94160, Saint-Mandé, France
| | | | - David Epstein
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- University of Granada, Granada, Spain
| |
Collapse
|
4
|
Chung R, Xu Z, Arnold M, Ip S, Harrison H, Barrett J, Pennells L, Kim LG, Di Angelantonio E, Paige E, Ritchie SC, Inouye M, Usher‐Smith JA, Wood AM. Using Polygenic Risk Scores for Prioritizing Individuals at Greatest Need of a Cardiovascular Disease Risk Assessment. J Am Heart Assoc 2023; 12:e029296. [PMID: 37489768 PMCID: PMC7614905 DOI: 10.1161/jaha.122.029296] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 06/28/2023] [Indexed: 07/26/2023]
Abstract
Background The aim of this study was to provide quantitative evidence of the use of polygenic risk scores for systematically identifying individuals for invitation for full formal cardiovascular disease (CVD) risk assessment. Methods and Results A total of 108 685 participants aged 40 to 69 years, with measured biomarkers, linked primary care records, and genetic data in UK Biobank were used for model derivation and population health modeling. Prioritization tools using age, polygenic risk scores for coronary artery disease and stroke, and conventional risk factors for CVD available within longitudinal primary care records were derived using sex-specific Cox models. We modeled the implications of initiating guideline-recommended statin therapy after prioritizing individuals for invitation to a formal CVD risk assessment. If primary care records were used to prioritize individuals for formal risk assessment using age- and sex-specific thresholds corresponding to 5% false-negative rates, then the numbers of men and women needed to be screened to prevent 1 CVD event are 149 and 280, respectively. In contrast, adding polygenic risk scores to both prioritization and formal assessments, and selecting thresholds to capture the same number of events, resulted in a number needed to screen of 116 for men and 180 for women. Conclusions Using both polygenic risk scores and primary care records to prioritize individuals at highest risk of a CVD event for a formal CVD risk assessment can efficiently prioritize those who need interventions the most than using primary care records alone. This could lead to better allocation of resources by reducing the number of risk assessments in primary care while still preventing the same number of CVD events.
Collapse
Affiliation(s)
- Ryan Chung
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
| | - Zhe Xu
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
| | - Matthew Arnold
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
| | - Samantha Ip
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
| | - Hannah Harrison
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
| | - Jessica Barrett
- Medical Research Council Biostatistics UnitUniversity of CambridgeUnited Kingdom
| | - Lisa Pennells
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
| | - Lois G. Kim
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and BehaviourUniversity of CambridgeUnited Kingdom
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and BehaviourUniversity of CambridgeUnited Kingdom
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeUnited Kingdom
- Health Data Research UK CambridgeWellcome Genome Campus and University of CambridgeUnited Kingdom
- Health Data Science Research CentreHuman TechnopoleMilanItaly
| | - Ellie Paige
- National Centre for Epidemiology and Population HealthAustralian National UniversityCanberraAustralia
- The George Institute for Global HealthUNSW SydneyAustralia
| | - Scott C. Ritchie
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeUnited Kingdom
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
| | - Michael Inouye
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeUnited Kingdom
- Health Data Research UK CambridgeWellcome Genome Campus and University of CambridgeUnited Kingdom
- The George Institute for Global HealthUNSW SydneyAustralia
- Cambridge Baker Systems Genomics InitiativeBaker Heart and Diabetes InstituteMelbourneVictoriaAustralia
| | - Juliet A. Usher‐Smith
- Primary Care Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
| | - Angela M. Wood
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeUnited Kingdom
- Heart and Lung Research InstituteUniversity of CambridgeUnited Kingdom
- National Institute for Health and Care Research Blood and Transplant Research Unit in Donor Health and BehaviourUniversity of CambridgeUnited Kingdom
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeUnited Kingdom
- Health Data Research UK CambridgeWellcome Genome Campus and University of CambridgeUnited Kingdom
- Cambridge Centre of Artificial Intelligence in MedicineUniversity of CambridgeUnited Kingdom
| |
Collapse
|
5
|
Doble A, Bescos R, Witton R, Shivji S, Ayres R, Brookes Z. A Case-Finding Protocol for High Cardiovascular Risk in a Primary Care Dental School-Model with Integrated Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4959. [PMID: 36981868 PMCID: PMC10049228 DOI: 10.3390/ijerph20064959] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND National Health Service (NHS) strategies in the United Kingdom (UK) have highlighted the need to maximise case-finding opportunities by improving coverage in non-traditional settings with the aim of reducing delayed diagnosis of non-communicable diseases. Primary care dental settings may also help to identify patients. METHODS Case-finding appointments took place in a primary care dental school. Measurements of blood pressure, body mass index (BMI), cholesterol, glucose and QRisk were taken along with a social/medical history. Participants with high cardiometabolic risk were referred to their primary care medical general practitioner (GP) and/or to local community health self-referral services, and followed up afterwards to record diagnosis outcome. RESULTS A total of 182 patients agreed to participate in the study over a 14-month period. Of these, 123 (67.5%) attended their appointment and two participants were excluded for age. High blood pressure (hypertension) was detected in 33 participants, 22 of whom had not been previous diagnosed, and 11 of whom had uncontrolled hypertension. Of the hypertensive individuals with no previous history, four were confirmed by their GP. Regarding cholesterol, 16 participants were referred to their GP for hypercholesterolaemia: 15 for untreated hypercholesterolaemia and one for uncontrolled hypercholesterolaemia. CONCLUSIONS Case-finding for hypertension and identifying cardiovascular risk factors has high acceptability in a primary dental care setting and supported by confirmational diagnoses by the GP.
Collapse
Affiliation(s)
- Amazon Doble
- Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
| | - Raul Bescos
- School of Health Professions, University of Plymouth, Plymouth PL4 8AA, UK
| | - Robert Witton
- Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
| | - Shabir Shivji
- Office of the Chief Dental Officer, London SE1 6LH, UK
| | - Richard Ayres
- Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
| | - Zoë Brookes
- Faculty of Health, University of Plymouth, Plymouth PL4 8AA, UK
| |
Collapse
|
6
|
Jackson C, Zapata-Diomedi B, Woodcock J. Bayesian multistate modelling of incomplete chronic disease burden data. JOURNAL OF THE ROYAL STATISTICAL SOCIETY. SERIES A, (STATISTICS IN SOCIETY) 2023; 186:1-19. [PMID: 36883132 PMCID: PMC7614284 DOI: 10.1093/jrsssa/qnac015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
A widely-used model for determining the long-term health impacts of public health interventions, often called a "multistate lifetable", requires estimates of incidence, case fatality, and sometimes also remission rates, for multiple diseases by age and gender. Generally, direct data on both incidence and case fatality are not available in every disease and setting. For example, we may know population mortality and prevalence rather than case fatality and incidence. This paper presents Bayesian continuous-time multistate models for estimating transition rates between disease states based on incomplete data. This builds on previous methods by using a formal statistical model with transparent data-generating assumptions, while providing accessible software as an R package. Rates for people of different ages and areas can be related flexibly through splines or hierarchical models. Previous methods are also extended to allow age-specific trends through calendar time. The model is used to estimate case fatality for multiple diseases in the city regions of England, based on incidence, prevalence and mortality data from the Global Burden of Disease study. The estimates can be used to inform health impact models relating to those diseases and areas. Different assumptions about rates are compared, and we check the influence of different data sources.
Collapse
Affiliation(s)
| | - Belen Zapata-Diomedi
- Healthy Liveable Cities Lab, Centre for Urban Research, RMIT University, Melbourne
| | | |
Collapse
|
7
|
Scarborough P, Kaur A, Cobiac LJ. Forecast of myocardial infarction incidence, events and prevalence in England to 2035 using a microsimulation model with endogenous disease outcomes. PLoS One 2022; 17:e0270189. [PMID: 35771859 PMCID: PMC9246106 DOI: 10.1371/journal.pone.0270189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 06/07/2022] [Indexed: 11/18/2022] Open
Abstract
Background Models that forecast non-communicable disease rates are poorly designed to predict future changes in trend because they are based on exogenous measures of disease rates. We introduce microPRIME, which forecasts myocardial infarction (MI) incidence, events and prevalence in England to 2035. microPRIME can forecast changes in trend as all MI rates emerge from competing trends in risk factors and treatment. Materials and methods microPRIME is a microsimulation of MI events within a sample of 114,000 agents representative of England. We simulate 37 annual time points from 1998 to 2035, where agents can have an MI event, die from an MI, or die from an unrelated cause. The probability of each event is a function of age, sex, BMI, blood pressure, cholesterol, smoking, diabetes and previous MI. This function does not change over time. Instead population-level changes in MI rates are due to competing trends in risk factors and treatment. Uncertainty estimates are based on 450 model runs that use parameters calibrated against external measures of MI rates between 1999 and 2011. Findings Forecasted MI incidence rates fall for men and women of different age groups before plateauing in the mid 2020s. Age-standardised event rates show a similar pattern, with a non-significant upturn by 2035, larger for men than women. Prevalence in men decreases for the oldest age groups, with peaks of prevalence rates in 2019 for 85 and older at 25.8% (23.3–28.3). For women, prevalence rates are more stable. Prevalence in over 85s is estimated as 14.5% (12.6–16.5) in 2019, and then plateaus thereafter. Conclusion We may see an increase in event rates from MI in England for men before 2035 but increases for women are unlikely. Prevalence rates may fall in older men, and are likely to remain stable in women over the next decade and a half.
Collapse
Affiliation(s)
- Peter Scarborough
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- National Institute of Health and Care Research Biomedical Research Centre at Oxford, Oxford, United Kingdom
- * E-mail:
| | - Asha Kaur
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Linda J. Cobiac
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Griffith University, Queensland, Australia
| |
Collapse
|
8
|
Kontto J, Paalanen L, Sund R, Sainio P, Koskinen S, Demakakos P, Tolonen H, Härkänen T. Using multiple imputation and intervention-based scenarios to project the mobility of older adults. BMC Geriatr 2022; 22:311. [PMID: 35397525 PMCID: PMC8994920 DOI: 10.1186/s12877-022-03008-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Projections of the development of mobility limitations of older adults are needed for evidence-based policy making. The aim of this study was to generate projections of mobility limitations among older people in the United States, England, and Finland.
Methods
We applied multiple imputation modelling with bootstrapping to generate projections of stair climbing and walking limitations until 2026. A physical activity intervention producing a beneficial effect on self-reported activities of daily living measures was identified in a comprehensive literature search and incorporated in the scenarios used in the projections. We utilised the harmonised longitudinal survey data from the Ageing Trajectories of Health – Longitudinal Opportunities and Synergies (ATHLOS) project (N = 24,982).
Results
Based on the scenarios from 2012 to 2026, the prevalence of walking limitations will decrease from 9.4 to 6.4%. A physical activity intervention would decrease the prevalence of stair climbing limitations compared with no intervention from 28.9 to 18.9% between 2012 and 2026.
Conclusions
A physical activity intervention implemented on older population seems to have a positive effect on maintaining mobility in the future. Our method provides an interesting option for generating projections by incorporating intervention-based scenarios.
Collapse
|
9
|
Social Deprivation and Peripheral Artery Disease. Can J Cardiol 2021; 38:612-622. [PMID: 34971734 DOI: 10.1016/j.cjca.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/08/2021] [Accepted: 12/22/2021] [Indexed: 12/24/2022] Open
Abstract
The link between peripheral artery disease and socioeconomic status is complex. The objective of this narrative review is to explore this relationship in detail, including how social factors impact the development, management, and outcomes of peripheral artery disease. Although the current literature on this topic is limited, some patterns do emerge. Populations of low socioeconomic status appear to be at increased risk for the development of peripheral artery disease, due to factors such as increased prevalence of cardiovascular risk factors (i.e. cigarette smoking) and decreased access to care. However, variables that are more difficult to quantify, such as chronic stress and health literacy, also likely play a significant role. Among those who are living with peripheral artery disease, socioeconomic status can also affect disease management. Secondary prevention strategies, such as medication use, smoking cessation, and exercise therapy, are underutilized in socially deprived populations. This underutilization of evidence-based management leads to adverse outcomes in these groups, including increased rates of amputation and decreased post-operative survival. The recognition of the importance of social factors in prognosis is an important first step towards addressing this health disparity. Moving forward, interventions that help to identify those who are at high risk and help to improve access to care in populations of low socioeconomic status, will be critical to improving outcomes.
Collapse
|
10
|
Mertens E, Genbrugge E, Ocira J, Peñalvo JL. Microsimulation Modelling in Food Policy: A Scoping Review of Methodological Aspects. Adv Nutr 2021; 13:S2161-8313(22)00080-1. [PMID: 34694330 PMCID: PMC8970827 DOI: 10.1093/advances/nmab129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Food policies for the prevention and management of diet-related non-communicable diseases (NCDs) have been increasingly relying on microsimulation models (MSMs) to assess effectiveness. Given the increased uptake of MSMs, this review aims to provide an overview of the characteristics of MSMs that link diets with NCDs. A comprehensive review was conducted in PubMed and Web of Knowledge. Inclusion criteria were: (i) findings from a MSM, (ii) diets, foods or nutrients as main exposure of interest, (iii) NCDs, such as overweight/obesity, type 2 diabetes, coronary heart disease, stroke or cancer as disease outcome for impact assessment. This review included information from 33 studies using MSM in analyzing diet and diverse food policies on NCDs. Hereby, most models employed stochastic, discrete-time, dynamic microsimulation techniques to calculate anticipated (cost-)effectiveness of strategies based on food pricing, food reformulation or dietary (lifestyle) interventions. Currently available models differ in the methodology used for quantifying the effect of the dietary changes on disease, and in the method for modelling disease incidence and mortality. However, all studies provided evidence that the models were sufficiently capturing the close-to-reality situation by justifying their choice of model parameters and validating externally their modelled disease incidence and mortality with observed or predicted event data. With the increasing use of various MSMs, between-model comparisons, facilitated by open access models and good reporting practices, would be important for judging model's accuracy, leading to continued improvement in the methodologies for developing and applying MSMs, and subsequently a better understanding of the results by policymakers. A STATEMENT OF SIGNIFICANCE Given the advancement in the application of microsimulation modelling in evaluating food policies and measuring diet-related disease burdens, the present scoping review serves as an exercise to inform future modelling, hereby highlighting the need for transparency in model development, application and dissemination to advance and safeguard accuracy and relevance in modelling efforts.
Collapse
Affiliation(s)
| | - Els Genbrugge
- Unit of Non-communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Junior Ocira
- Unit of Non-communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - José L Peñalvo
- Unit of Non-communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
11
|
Gidlow CJ, Ellis NJ, Cowap L, Riley V, Crone D, Cottrell E, Grogan S, Chambers R, Clark-Carter D. Cardiovascular disease risk communication in NHS Health Checks using QRISK®2 and JBS3 risk calculators: the RICO qualitative and quantitative study. Health Technol Assess 2021; 25:1-124. [PMID: 34427556 DOI: 10.3310/hta25500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The NHS Health Check is a national cardiovascular disease prevention programme. There is a lack of evidence on how health checks are conducted, how cardiovascular disease risk is communicated to foster risk-reducing intentions or behaviour, and the impact on communication of using different cardiovascular disease risk calculators. OBJECTIVES RIsk COmmunication in Health Check (RICO) study aimed to explore practitioner and patient understanding of cardiovascular disease risk, the associated advice or treatment offered by the practitioner, and the response of the patients in health checks supported by either the QRISK®2 or the JBS3 lifetime risk calculator. DESIGN This was a qualitative study with quantitative process evaluation. SETTING Twelve general practices in the West Midlands of England, stratified on deprivation of the local area (bottom 50% vs. top 50%), and with matched pairs randomly allocated to use QRISK2 or JBS3 during health checks. PARTICIPANTS A total of 173 patients eligible for NHS Health Check and 15 practitioners. INTERVENTIONS The health check was delivered using either the QRISK2 10-year risk calculator (usual practice) or the JBS3 lifetime risk calculator, with heart age, event-free survival age and risk score manipulation (intervention). RESULTS Video-recorded health checks were analysed quantitatively (n = 173; JBS3, n = 100; QRISK2, n = 73) and qualitatively (n = 128; n = 64 per group), and video-stimulated recall interviews were undertaken with 40 patients and 15 practitioners, with 10 in-depth case studies. The duration of the health check varied (6.8-38 minutes), but most health checks were short (60% lasting < 20 minutes), with little cardiovascular disease risk discussion (average < 2 minutes). The use of JBS3 was associated with more cardiovascular disease risk discussion and fewer practitioner-dominated consultations than the use of QRISK2. Heart age and visual representations of risk, as used in JBS3, appeared to be better understood by patients than 10-year risk (QRISK2) and, as a result, the use of JBS3 was more likely to lead to discussion of risk factors and their management. Event-free survival age was not well understood by practitioners or patients. However, a lack of effective cardiovascular disease risk discussion in both groups increased the likelihood of a maladaptive coping response (i.e. no risk-reducing behaviour change). In both groups, practitioners often missed opportunities to check patient understanding and to tailor information on cardiovascular disease risk and its management during health checks, confirming apparent practitioner verbal dominance. LIMITATIONS The main limitations were under-recruitment in some general practices and the resulting imbalance between groups. CONCLUSIONS Communication of cardiovascular disease risk during health checks was brief, particularly when using QRISK2. Patient understanding of and responses to cardiovascular disease risk information were limited. Practitioners need to better engage patients in discussion of and action-planning for their cardiovascular disease risk to reduce misunderstandings. The use of heart age, visual representation of risk and risk score manipulation was generally seen to be a useful way of doing this. Future work could focus on more fundamental issues of practitioner training and time allocation within health check consultations. TRIAL REGISTRATION Current Controlled Trials ISRCTN10443908. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 50. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Christopher J Gidlow
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Naomi J Ellis
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Lisa Cowap
- Centre for Psychological Research, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Victoria Riley
- Centre for Health and Development, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| | - Diane Crone
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Elizabeth Cottrell
- School of Primary, Community and Social Care, Keele University, Keele, Newcastle-under-Lyme, UK
| | - Sarah Grogan
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Ruth Chambers
- Stoke-on-Trent Clinical Commissioning Group, Stoke-on-Trent, UK
| | - David Clark-Carter
- Centre for Psychological Research, School of Life Sciences and Education, Staffordshire University, Stoke-on-Trent, UK
| |
Collapse
|
12
|
刘 秋, 陈 汐, 王 佳, 刘 晓, 司 亚, 梁 靖, 沈 鹏, 林 鸿, 唐 迅, 高 培. [Effectiveness of different screening strategies for cardiovascular diseases prevention in a community-based Chinese population: A decision-analytic Markov model]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53:460-466. [PMID: 34145845 PMCID: PMC8220034 DOI: 10.19723/j.issn.1671-167x.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the potential effectiveness of different screening strategies for cardiovascular diseases prevention in a community-based Chinese population from economically developed area of China. METHODS Totally 202 179 adults aged 40 to 74 years without cardiovascular diseases at baseline (January 1, 2010) were enrolled from the Chinese electronic health records research in Yinzhou (CHERRY) study. Three scenarios were considered: the screening strategy based on risk charts recommended by the 2020 Chinese guideline on the primary prevention of cardiovascular diseases in Chinese adults aged 40-74 years (Strategy 1); the screening strategy based on the prediction for atherosclerotic cardiovascular disease risk in China (China-PAR) models recommended by the 2019 Guideline on the assessment and management of cardiovascular risk in China in Chinese adults aged 40-74 years (Strategy 2); and the screening strategy based on the China-PAR models in Chinese adults aged 50-74 years (Strategy 3). According to the guidelines, individuals who were classified into medium- or high-risk groups after cardiovascular risk assessment by the corresponding strategies would be introduced to lifestyle intervention, while high-risk population would take medication in addition. Markov model was used to simulate different screening scenarios for 10 years (cycles), using parameters mainly from the CHERRY study, as well as published data, Meta-analyses and systematic reviews for Chinese populations. The life year gained, quality-adjusted life year (QALY) gained, number of cardiovascular disease events/deaths could be prevented and number needed to be screened (NNS) were calculated to compare the effectiveness between the different strategies. One-way sensitivity analysis on uncertainty of cardiovascular disease incidence rate and probabilistic sensitivity analysis on uncertainty of distributions for the hazard ratios were conducted. RESULTS Compared with non-screening strategy, QALYs gained were 1 433 [95% uncertainty interval (UI): 969-1 831], 1 401 (95%UI: 936-1 807), and 716 (95%UI: 265-1 111) for the Strategies 1, 2, and 3; and the NNS per QALY in the above strategies were 141 (95%UI: 110-209), 144 (95%UI: 112-216), and 198 (95%UI: 127-529), respectively. The Strategies 1 and 2 based on different guidelines showed similar effectiveness, while more benefits were found for screening using China-PAR models in adults aged 40-74 years than those aged 50-74 years. The results were consistent in the sensitivity analyses. CONCLUSION Screening for cardiovascular diseases in Chinese adults aged above 40 years seems effective in coastal developed areas of China, and the different screening strategies based on risk charts by the 2020 Chinese guideline on the primary prevention of cardiovascular diseases or China-PAR models by the 2019 Guideline on the assessment and management of cardiovascular risk in China may have similar effectiveness.
Collapse
Affiliation(s)
- 秋萍 刘
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 汐瑾 陈
- 北京大学临床研究所真实世界证据评价中心,北京 100191Center for Real-world Evidence Evaluation, Peking University Clinical Research Institute, Beijing 100191, China
| | - 佳敏 王
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 晓非 刘
- 北京大学临床研究所真实世界证据评价中心,北京 100191Center for Real-world Evidence Evaluation, Peking University Clinical Research Institute, Beijing 100191, China
| | - 亚琴 司
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 靖媛 梁
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 鹏 沈
- 宁波市鄞州区疾病预防控制中心,浙江宁波 315101Yinzhou District Center for Disease Control and Prevention, Ningbo 315101, Zhejiang, China
| | - 鸿波 林
- 宁波市鄞州区疾病预防控制中心,浙江宁波 315101Yinzhou District Center for Disease Control and Prevention, Ningbo 315101, Zhejiang, China
| | - 迅 唐
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 培 高
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
- 北京大学临床研究所真实世界证据评价中心,北京 100191Center for Real-world Evidence Evaluation, Peking University Clinical Research Institute, Beijing 100191, China
| |
Collapse
|
13
|
刘 秋, 陈 汐, 王 佳, 刘 晓, 司 亚, 梁 靖, 沈 鹏, 林 鸿, 唐 迅, 高 培. [Effectiveness of different screening strategies for cardiovascular diseases prevention in a community-based Chinese population: A decision-analytic Markov model]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53:460-466. [PMID: 34145845 PMCID: PMC8220034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Indexed: 11/08/2023]
Abstract
OBJECTIVE To evaluate the potential effectiveness of different screening strategies for cardiovascular diseases prevention in a community-based Chinese population from economically developed area of China. METHODS Totally 202 179 adults aged 40 to 74 years without cardiovascular diseases at baseline (January 1, 2010) were enrolled from the Chinese electronic health records research in Yinzhou (CHERRY) study. Three scenarios were considered: the screening strategy based on risk charts recommended by the 2020 Chinese guideline on the primary prevention of cardiovascular diseases in Chinese adults aged 40-74 years (Strategy 1); the screening strategy based on the prediction for atherosclerotic cardiovascular disease risk in China (China-PAR) models recommended by the 2019 Guideline on the assessment and management of cardiovascular risk in China in Chinese adults aged 40-74 years (Strategy 2); and the screening strategy based on the China-PAR models in Chinese adults aged 50-74 years (Strategy 3). According to the guidelines, individuals who were classified into medium- or high-risk groups after cardiovascular risk assessment by the corresponding strategies would be introduced to lifestyle intervention, while high-risk population would take medication in addition. Markov model was used to simulate different screening scenarios for 10 years (cycles), using parameters mainly from the CHERRY study, as well as published data, Meta-analyses and systematic reviews for Chinese populations. The life year gained, quality-adjusted life year (QALY) gained, number of cardiovascular disease events/deaths could be prevented and number needed to be screened (NNS) were calculated to compare the effectiveness between the different strategies. One-way sensitivity analysis on uncertainty of cardiovascular disease incidence rate and probabilistic sensitivity analysis on uncertainty of distributions for the hazard ratios were conducted. RESULTS Compared with non-screening strategy, QALYs gained were 1 433 [95% uncertainty interval (UI): 969-1 831], 1 401 (95%UI: 936-1 807), and 716 (95%UI: 265-1 111) for the Strategies 1, 2, and 3; and the NNS per QALY in the above strategies were 141 (95%UI: 110-209), 144 (95%UI: 112-216), and 198 (95%UI: 127-529), respectively. The Strategies 1 and 2 based on different guidelines showed similar effectiveness, while more benefits were found for screening using China-PAR models in adults aged 40-74 years than those aged 50-74 years. The results were consistent in the sensitivity analyses. CONCLUSION Screening for cardiovascular diseases in Chinese adults aged above 40 years seems effective in coastal developed areas of China, and the different screening strategies based on risk charts by the 2020 Chinese guideline on the primary prevention of cardiovascular diseases or China-PAR models by the 2019 Guideline on the assessment and management of cardiovascular risk in China may have similar effectiveness.
Collapse
Affiliation(s)
- 秋萍 刘
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 汐瑾 陈
- 北京大学临床研究所真实世界证据评价中心,北京 100191Center for Real-world Evidence Evaluation, Peking University Clinical Research Institute, Beijing 100191, China
| | - 佳敏 王
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 晓非 刘
- 北京大学临床研究所真实世界证据评价中心,北京 100191Center for Real-world Evidence Evaluation, Peking University Clinical Research Institute, Beijing 100191, China
| | - 亚琴 司
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 靖媛 梁
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 鹏 沈
- 宁波市鄞州区疾病预防控制中心,浙江宁波 315101Yinzhou District Center for Disease Control and Prevention, Ningbo 315101, Zhejiang, China
| | - 鸿波 林
- 宁波市鄞州区疾病预防控制中心,浙江宁波 315101Yinzhou District Center for Disease Control and Prevention, Ningbo 315101, Zhejiang, China
| | - 迅 唐
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 培 高
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
- 北京大学临床研究所真实世界证据评价中心,北京 100191Center for Real-world Evidence Evaluation, Peking University Clinical Research Institute, Beijing 100191, China
| |
Collapse
|
14
|
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death for Chinese migrants around the world. Chinese CVD patients rely heavily on their native Chinese language, cultural values and beliefs, which adds challenges for the healthcare providers to offer primary healthcare services with standard protocol. The inappropriate treatment could lead to life loss, mistrust in doctor-patient relationship and heavy burden for healthcare funding. METHODS 28 participants were included for focus group study with the grounded theory methodology. RESULTS There is considerable misunderstanding among the Chinese community about the role of primary care doctors in the treatment of cardiovascular disease resulting in the variable use of primary care services. CONCLUSION Chinese CVD patients or identified risk factors for CVD arguably need closer management, culturally sensitive advice, support and robust follow-up compared to the general population. Doctors and nurses should enhance their practice and give them confidence in their interaction with Chinese patients on the basis of how they think and behave in relation to help seeking.
Collapse
|
15
|
O'Flaherty M, Lloyd-Williams F, Capewell S, Boland A, Maden M, Collins B, Bandosz P, Hyseni L, Kypridemos C. Modelling tool to support decision-making in the NHS Health Check programme: workshops, systematic review and co-production with users. Health Technol Assess 2021; 25:1-234. [PMID: 34076574 DOI: 10.3310/hta25350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Local authorities in England commission the NHS Health Check programme to invite everyone aged 40-74 years without pre-existing conditions for risk assessment and eventual intervention, if needed. However, the programme's effectiveness, cost-effectiveness and equity impact remain uncertain. AIM To develop a validated open-access flexible web-based model that enables local commissioners to quantify the cost-effectiveness and potential for equitable population health gain of the NHS Health Check programme. OBJECTIVES The objectives were as follows: (1) co-produce with stakeholders the desirable features of the user-friendly model; (2) update the evidence base to support model and scenario development; (3) further develop our computational model to allow for developments and changes to the NHS Health Check programme and the diseases it addresses; (4) assess the effectiveness, cost-effectiveness and equity of alternative strategies for implementation to illustrate the use of the tool; and (5) propose a sustainability and implementation plan to deploy our user-friendly computational model at the local level. DESIGN Co-production workshops surveying the best-performing local authorities and a systematic literature review of strategies to increase uptake of screening programmes informed model use and development. We then co-produced the workHORSE (working Health Outcomes Research Simulation Environment) model to estimate the health, economic and equity impact of different NHS Health Check programme implementations, using illustrative-use cases. SETTING Local authorities in England. PARTICIPANTS Stakeholders from local authorities, Public Health England, the NHS, the British Heart Foundation, academia and other organisations participated in the workshops. For the local authorities survey, we invited 16 of the best-performing local authorities in England. INTERVENTIONS The user interface allows users to vary key parameters that represent programme activities (i.e. invitation, uptake, prescriptions and referrals). Scenarios can be compared with each other. MAIN OUTCOME MEASURES Disease cases and case-years prevented or postponed, incremental cost-effectiveness ratios, net monetary benefit and change in slope index of inequality. RESULTS The survey of best-performing local authorities revealed a diversity of effective approaches to maximise the coverage and uptake of NHS Health Check programme, with no distinct 'best buy'. The umbrella literature review identified a range of effective single interventions. However, these generally need to be combined to maximally improve uptake and health gains. A validated dynamic, stochastic microsimulation model, built on robust epidemiology, enabled service options analysis. Analyses of three contrasting illustrative cases estimated the health, economic and equity impact of optimising the Health Checks, and the added value of obtaining detailed local data. Optimising the programme in Liverpool can become cost-effective and equitable, but simply changing the invitation method will require other programme changes to improve its performance. Detailed data inputs can benefit local analysis. LIMITATIONS Although the approach is extremely flexible, it is complex and requires substantial amounts of data, alongside expertise to both maintain and run. CONCLUSIONS Our project showed that the workHORSE model could be used to estimate the health, economic and equity impact comprehensively at local authority level. It has the potential for further development as a commissioning tool and to stimulate broader discussions on the role of these tools in real-world decision-making. FUTURE WORK Future work should focus on improving user interactions with the model, modelling simulation standards, and adapting workHORSE for evaluation, design and implementation support. STUDY REGISTRATION This study is registered as PROSPERO CRD42019132087. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 35. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | | | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Angela Boland
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Brendan Collins
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Lirije Hyseni
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Chris Kypridemos
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| |
Collapse
|
16
|
NHS Health Checks: an observational study of equity and outcomes 2009-2017. Br J Gen Pract 2021; 71:e701-e710. [PMID: 33587723 PMCID: PMC8216267 DOI: 10.3399/bjgp.2020.1021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/29/2021] [Indexed: 12/25/2022] Open
Abstract
Background The NHS Health Check cardiovascular prevention programme is now 10 years old. Aim To describe NHS Heath Check attendance, new diagnoses, and treatment in relation to equity indicators. Design and setting A nationally representative database derived from 1500 general practices from 2009–2017. Method The authors compared NHS Health Check attendance and new diagnoses and treatments by age, sex, ethnic group, and deprivation. Results In 2013–2017, 590 218 (16.9%) eligible people aged 40–74 years attended an NHS Health Check and 2 902 598 (83.1%) did not attend. South Asian ethnic groups were most likely to attend compared to others, and females more than males. New diagnoses were more likely in attendees than non-attendees: hypertension 25/1000 in attendees versus 9/1000 in non-attendees; type 2 diabetes 8/1000 versus 3/1000; and chronic kidney disease (CKD) 7/1000 versus 4/1000. In people aged ≥65 years, atrial fibrillation was newly diagnosed in 5/1000 attendees and 3/1000 non-attendees, and for dementia 2/1000 versus 1/1000, respectively. Type 2 diabetes, hypertension, and CKD were more likely in more deprived groups, and in South Asian, Black African, and Black Caribbean ethnic groups. Attendees were more likely to be prescribed statins (26/1000) than non-attendees (8/1000), and antihypertensive medicines (25/1000 versus 13/1000 non-attendees). However, of the 117 963 people with ≥10% CVD risk who were eligible for statins, only 9785 (8.3%) were prescribed them. Conclusion Uptake of NHS Health Checks remains low. Attendees were more likely than non-attendees to be diagnosed with type 2 diabetes, hypertension, and CKD, and to receive treatment with statins and antihypertensives. Most attendees received neither treatment nor referral. Of those eligible for statins, <10% were treated. Policy reviews should consider a targeted approach prioritising those at highest CVD risk for face-to-face contact and consider other options for those at lower CVD risk.
Collapse
|
17
|
Affiliation(s)
- Pricila H Mullachery
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA.,Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
18
|
Cookson R, Griffin S, Norheim OF, Culyer AJ, Chalkidou K. Distributional Cost-Effectiveness Analysis Comes of Age. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:118-120. [PMID: 33431145 PMCID: PMC7813213 DOI: 10.1016/j.jval.2020.10.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/06/2020] [Indexed: 05/23/2023]
Affiliation(s)
- Richard Cookson
- Centre for Health Economics, University of York, York, England, UK.
| | - Susan Griffin
- Centre for Health Economics, University of York, York, England, UK
| | - Ole F Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Anthony J Culyer
- Centre for Health Economics, University of York, York, England, UK
| | - Kalipso Chalkidou
- Faculty of Medicine, School of Public Health, Imperial College London, London, England, UK
| |
Collapse
|
19
|
Head A, Fleming K, Kypridemos C, Pearson-Stuttard J, O'Flaherty M. Multimorbidity: the case for prevention. J Epidemiol Community Health 2020; 75:242-244. [PMID: 33020144 PMCID: PMC7892394 DOI: 10.1136/jech-2020-214301] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/08/2020] [Accepted: 09/18/2020] [Indexed: 01/13/2023]
Abstract
Multimorbidity is of increasing concern for healthcare systems globally, particularly in the context of ageing population structures, such as in the European Union and the UK. Although there is growing attention on developing strategies to manage the health and healthcare burden of older patients with multimorbidity, little research or policy focus has been placed on how to best prevent the development of multimorbidity in future generations. In this research agenda piece, we argue for a shift from a sole focus on the management of multimorbidity in old age to a multimorbidity agenda that considers prevention and management throughout the life-course.
Collapse
Affiliation(s)
- Anna Head
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Kate Fleming
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Chris Kypridemos
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | | | - Martin O'Flaherty
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| |
Collapse
|
20
|
Gidlow CJ, Ellis NJ, Cowap L, Riley VA, Crone D, Cottrell E, Grogan S, Chambers R, Clark-Carter D. Quantitative examination of video-recorded NHS Health Checks: comparison of the use of QRISK2 versus JBS3 cardiovascular risk calculators. BMJ Open 2020; 10:e037790. [PMID: 32978197 PMCID: PMC7520846 DOI: 10.1136/bmjopen-2020-037790] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Quantitatively examine the content of National Health Service Health Check (NHSHC), patient-practitioner communication balance and differences when using QRISK2 versus JBS3 cardiovascular disease (CVD) risk calculators. DESIGN RIsk COmmunication in NHSHC was a qualitative study with quantitative process evaluation, comparing NHSHC using QRISK2 or JBS3. We present data from the quantitative process evaluation. SETTING AND PARTICIPANTS Twelve general practices in the West Midlands (England) conducted NHSHC using JBS3 or QRISK2 (6/group). Patients were eligible for NHSHC based on national criteria (aged 40-74, no existing cardiovascular-related diagnoses, not taking statins). Recruitment was stratified by patients' age, gender and ethnicity. METHODS Video recordings of NHSHC were coded, second-by-second, to quantify who was speaking and what was being discussed. Outcomes included consultation duration, practitioner verbal dominance (ratio of practitioner:patient speaking time (pr:pt ratio)) and proportion of time discussing CVD risk, risk factors and risk management. RESULTS 173 video-recorded NHSHC were analysed (73 QRISK, 100 JBS3). The sample was 51% women, 83% white British, with approximately equal proportions across age groups. NHSHC duration varied greatly (6.8-38.0 min). Most (60%) lasted less than 20 min. On average, CVD risk was discussed for less than 2 min (9.06%±4.30% of consultation time). There were indications that, compared with NHSHC using JBS3, those with QRISK2 involved less CVD risk discussion (JBS3 M=10.24%, CI: 8.01-12.48 vs QRISK2 M=7.44%, CI: 5.29-9.58) and were more verbally dominated by practitioners (pr:pt ratio JBS3 M=3.21%, CI: 2.44-3.97 vs QRISK2=2.35%, CI: 1.89-2.81). The largest proportion of NHSHC time was spent discussing causal risk factors (M=37.54%, CI: 32.92-42.17). CONCLUSIONS There was wide variation in NHSHC duration. Many were short and practitioner-dominated, with little time discussing CVD risk. JBS3 appears to extend CVD risk discussion and patient contribution. Qualitative examination of how it is used is necessary to fully understand the potential benefits of these differences. TRIAL REGISTRATION NUMBER ISRCTN10443908.
Collapse
Affiliation(s)
| | - Naomi J Ellis
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Lisa Cowap
- Department of Psychology, Staffordshire University, Stoke on Trent, UK
| | - Victoria A Riley
- Centre for Health and Development, Staffordshire University, Stoke-on-Trent, UK
| | - Diane Crone
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Elizabeth Cottrell
- School of Primary, Community and Social Care, Keele University, Staffordshire, UK
| | - Sarah Grogan
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Ruth Chambers
- Stoke-on-Trent Clinical Commissioning Group, Stoke on Trent, UK
| | | |
Collapse
|
21
|
Thomas C, Brennan A, Goka E, Squires HY, Brenner G, Bagguley D, Buckley Woods H, Gillett M, Leaviss J, Clowes M, Heathcote L, Cooper K, Breeze P. What are the cost-savings and health benefits of improving detection and management for six high cardiovascular risk conditions in England? An economic evaluation. BMJ Open 2020; 10:e037486. [PMID: 32912949 PMCID: PMC7488844 DOI: 10.1136/bmjopen-2020-037486] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To estimate the cost savings and health benefits of improving detection of individuals at high risk of cardiovascular disease (CVD) in England, to determine to which patient subgroups these benefits arise, and to compare different strategies for subsequent management. DESIGN An economic analysis using the School for Public Health Research CVD Prevention Model. SETTING England 2018. PARTICIPANTS Adults aged 16 and older with one or more high cardiovascular risk conditions, including hypertension, diabetes, non-diabetic hyperglycaemia, atrial fibrillation, chronic kidney disease and high cholesterol. INTERVENTIONS Detection of 100% of individuals with CVD high risk conditions compared with current levels of detection in England. Detected individuals are assumed to be managed either according to current levels of care or National Institute of Health and Care Excellence (NICE) guidelines. MAIN OUTCOME MEASURES Incremental and cumulative costs, savings, quality adjusted life years (QALYs), CVD cases, and net monetary benefit, from a UK NHS and Personal Social Services perspective. RESULTS £68 billion could be saved, 4.9 million QALYs gained and 3.4 million cases of CVD prevented over 25 years if all individuals in England with the six CVD high risk conditions were diagnosed and subsequently managed at current levels. Additionally, if all detected individuals were managed according to NICE guidelines, total savings would be £61 billion, 8.1 million QALYs would be gained and 5.2 million CVD cases prevented. Most benefits come from detection of high cholesterol in the short term and diabetes in the long term. CONCLUSIONS Substantial cost savings and health benefits would accrue if all individuals with conditions that increase CVD risk could be diagnosed, with detection of undiagnosed diabetes producing greatest benefits. Ensuring all conditions are managed according to NICE guidelines would further increase health benefits. Projected cost-savings could be invested in developing acceptable and cost-effective solutions for improving detection and management.
Collapse
Affiliation(s)
- Chloe Thomas
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Alan Brennan
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Edward Goka
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Hazel Y Squires
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Gilly Brenner
- Rotherham Metropolitan Borough Council, Rotherham, Rotherham, UK
| | - David Bagguley
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | | | - Michael Gillett
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Joanna Leaviss
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Mark Clowes
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Laura Heathcote
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Katy Cooper
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | - Penny Breeze
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| |
Collapse
|
22
|
Shah NS, Molsberry R, Rana JS, Sidney S, Capewell S, O'Flaherty M, Carnethon M, Lloyd-Jones DM, Khan SS. Heterogeneous trends in burden of heart disease mortality by subtypes in the United States, 1999-2018: observational analysis of vital statistics. BMJ 2020; 370:m2688. [PMID: 32816805 PMCID: PMC7424397 DOI: 10.1136/bmj.m2688] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To describe trends in the burden of mortality due to subtypes of heart disease from 1999 to 2018 to inform targeted prevention strategies and reduce disparities. DESIGN Serial cross sectional analysis of cause specific heart disease mortality rates using national death certificate data in the overall population as well as stratified by race-sex, age, and geography. SETTING United States, 1999-2018. PARTICIPANTS 12.9 million decedents from total heart disease (49% women, 12% black, and 19% <65 years old). MAIN OUTCOME MEASURES Age adjusted mortality rates (AAMR) and years of potential life lost (YPLL) for each heart disease subtype, and respective mean annual percentage change. RESULTS Deaths from total heart disease fell from 752 192 to 596 577 between 1999 and 2011, and then increased to 655 381 in 2018. From 1999 to 2018, the proportion of total deaths from heart disease attributed to ischemic heart disease decreased from 73% to 56%, while the proportion attributed to heart failure increased from 8% to 13% and the proportion attributed to hypertensive heart disease increased from 4% to 9%. Among heart disease subtypes, AAMR was consistently highest for ischemic heart disease in all subgroups (race-sex, age, and region). After 2011, AAMR for heart failure and hypertensive heart disease increased at a faster rate than for other subtypes. The fastest increases in heart failure mortality were in black men (mean annual percentage change 4.9%, 95% confidence interval 4.0% to 5.8%), whereas the fastest increases in hypertensive heart disease occurred in white men (6.3%, 4.9% to 9.4%). The burden of years of potential life lost was greatest from ischemic heart disease, but black-white disparities were driven by heart failure and hypertensive heart disease. Deaths from heart disease in 2018 resulted in approximately 3.8 million potential years of life lost. CONCLUSIONS Trends in AAMR and years of potential life lost for ischemic heart disease have decelerated since 2011. For almost all other subtypes of heart disease, AAMR and years of potential life lost became stagnant or increased. Heart failure and hypertensive heart disease account for the greatest increases in premature deaths and the largest black-white disparities and have offset declines in ischemic heart disease. Early and targeted primary and secondary prevention and control of risk factors for heart disease, with a focus on groups at high risk, are needed to avoid these suboptimal trends beginning earlier in life.
Collapse
Affiliation(s)
- Nilay S Shah
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N St Clair Street, Suite 600, Chicago, IL, USA
| | - Rebecca Molsberry
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA
| | - Jamal S Rana
- Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Stephen Sidney
- Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Simon Capewell
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | | | - Mercedes Carnethon
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N St Clair Street, Suite 600, Chicago, IL, USA
| | - Sadiya S Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL 60611, USA
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N St Clair Street, Suite 600, Chicago, IL, USA
| |
Collapse
|
23
|
Lloyd-Williams F, Hyseni L, Guzman-Castillo M, Kypridemos C, Collins B, Capewell S, Schwaller E, O'Flaherty M. Evaluating stakeholder involvement in building a decision support tool for NHS health checks: co-producing the WorkHORSE study. BMC Med Inform Decis Mak 2020; 20:182. [PMID: 32778087 PMCID: PMC7418313 DOI: 10.1186/s12911-020-01205-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 07/29/2020] [Indexed: 11/16/2022] Open
Abstract
Background Stakeholder engagement is being increasingly recognised as an important way to achieving impact in public health. The WorkHORSE (Working Health Outcomes Research Simulation Environment) project was designed to continuously engage with stakeholders to inform the development of an open access modelling tool to enable commissioners to quantify the potential cost-effectiveness and equity of the NHS Health Check Programme. An objective of the project was to evaluate the involvement of stakeholders in co-producing the WorkHORSE computer modelling tool and examine how they perceived their involvement in the model building process and ultimately contributed to the strengthening and relevance of the modelling tool. Methods We identified stakeholders using our extensive networks and snowballing techniques. Iterative development of the decision support modelling tool was informed through engaging with stakeholders during four workshops. We used detailed scripts facilitating open discussion and opportunities for stakeholders to provide additional feedback subsequently. At the end of each workshop, stakeholders and the research team completed questionnaires to explore their views and experiences throughout the process. Results 30 stakeholders participated, of which 15 attended two or more workshops. They spanned local (NHS commissioners, GPs, local authorities and academics), third sector and national organisations including Public Health England. Stakeholders felt valued, and commended the involvement of practitioners in the iterative process. Major reasons for attending included: being able to influence development, and having insight and understanding of what the tool could include, and how it would work in practice. Researchers saw the process as an opportunity for developing a common language and trust in the end product, and ensuring the support tool was transparent. The workshops acted as a reality check ensuring model scenarios and outputs were relevant and fit for purpose. Conclusions Computational modellers rarely consult with end users when developing tools to inform decision-making. The added value of co-production (continuing collaboration and iteration with stakeholders) enabled modellers to produce a “real-world” operational tool. Likewise, stakeholders had increased confidence in the decision support tool’s development and applicability in practice.
Collapse
Affiliation(s)
- Ffion Lloyd-Williams
- Department of Public Health and Policy. Institute of Population Health Science, University of Liverpool, The Quadrangle, University of Liverpool, Liverpool, L69 3GB, UK
| | - Lirije Hyseni
- Department of Public Health and Policy. Institute of Population Health Science, University of Liverpool, The Quadrangle, University of Liverpool, Liverpool, L69 3GB, UK
| | - Maria Guzman-Castillo
- Department of Public Health and Policy. Institute of Population Health Science, University of Liverpool, The Quadrangle, University of Liverpool, Liverpool, L69 3GB, UK.,Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Chris Kypridemos
- Department of Public Health and Policy. Institute of Population Health Science, University of Liverpool, The Quadrangle, University of Liverpool, Liverpool, L69 3GB, UK
| | - Brendan Collins
- Department of Public Health and Policy. Institute of Population Health Science, University of Liverpool, The Quadrangle, University of Liverpool, Liverpool, L69 3GB, UK
| | - Simon Capewell
- Department of Public Health and Policy. Institute of Population Health Science, University of Liverpool, The Quadrangle, University of Liverpool, Liverpool, L69 3GB, UK
| | - Ellen Schwaller
- Department of Public Health and Policy. Institute of Population Health Science, University of Liverpool, The Quadrangle, University of Liverpool, Liverpool, L69 3GB, UK
| | - Martin O'Flaherty
- Department of Public Health and Policy. Institute of Population Health Science, University of Liverpool, The Quadrangle, University of Liverpool, Liverpool, L69 3GB, UK.
| |
Collapse
|
24
|
Marasigan V, Perry I, Bennett K, Balanda K, Capewell S, O' Flaherty M, Kabir Z. Explaining the fall in Coronary Heart Disease mortality in the Republic of Ireland between 2000 and 2015 - IMPACT modelling study. Int J Cardiol 2020; 310:159-161. [DOI: 10.1016/j.ijcard.2020.03.067] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 02/28/2020] [Accepted: 03/27/2020] [Indexed: 10/24/2022]
|
25
|
Vogel C, Crozier S, Dhuria P, Shand C, Lawrence W, Cade J, Moon G, Lord J, Ball K, Cooper C, Baird J. Protocol of a natural experiment to evaluate a supermarket intervention to improve food purchasing and dietary behaviours of women (WRAPPED study) in England: a prospective matched controlled cluster design. BMJ Open 2020; 10:e036758. [PMID: 32047023 PMCID: PMC7044911 DOI: 10.1136/bmjopen-2020-036758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Poor diet is a leading risk factor for non-communicable diseases and costs the National Health Service £5.8 billion annually. Product placement strategies used extensively in food outlets, like supermarkets, can influence customers' preferences. Policy-makers, including the UK Government, are considering legislation to ensure placement strategies promote healthier food purchasing and dietary habits. High-quality scientific evidence is needed to inform future policy action. This study will assess whether healthier placement strategies in supermarkets improve household purchasing patterns and the diets of more than one household member. METHODS AND ANALYSES This natural experiment, with a prospective matched controlled cluster design, is set in discount supermarkets across England. The primary objective is to investigate whether enhanced placement of fresh fruit and vegetables improves household-level purchasing of these products after 6 months. Secondary objectives will examine: (1) differences in intervention effects on purchasing by level of educational attainment, (2) intervention effects on the dietary quality of women and their young children, (3) intervention effects on store-level sales of fruit and vegetables and (4) cost-effectiveness of the intervention from individual, retailer and societal perspectives. Up to 810 intervention and 810 control participants will be recruited from 18 intervention and 18 matched control stores. Eligible participants will be women aged 18-45 years, who hold a loyalty card and shop in a study store. Each control store will be matched to an intervention store on: (1) sales profile, (2) neighbourhood deprivation and (3) customer profile. A detailed process evaluation will assess intervention implementation, mechanisms of impact and, social and environmental contexts. ETHICS AND DISSEMINATION Ethical approval was obtained from the University of Southampton, Faculty of Medicine Ethics Committee (ID 20986.A5). Primary, secondary and process evaluation results will be submitted for publication in peer-reviewed scientific journals and shared with policy-makers. TRIAL REGISTRATION NUMBER NCT03573973; Pre-results.
Collapse
Affiliation(s)
- Christina Vogel
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Crozier
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Preeti Dhuria
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Calum Shand
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Wendy Lawrence
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Janet Cade
- School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | - Graham Moon
- Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Joanne Lord
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | - Kylie Ball
- Institute for Physical Activity and Nutrition Research, Deakin University, Burwood, Victoria, Australia
| | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Janis Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
26
|
Feigin VL, Brainin M, Norrving B, Gorelick PB, Dichgans M, Wang W, Pandian JD, Martins SCO, Owolabi MO, Wood DA, Hankey GJ. What Is the Best Mix of Population-Wide and High-Risk Targeted Strategies of Primary Stroke and Cardiovascular Disease Prevention? J Am Heart Assoc 2020; 9:e014494. [PMID: 31983323 PMCID: PMC7033901 DOI: 10.1161/jaha.119.014494] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/05/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Valery L. Feigin
- National Institute for Stroke and Applied NeurosciencesSchool of Public Health and Psychosocial StudiesFaculty of Health and Environmental SciencesAUT UniversityAucklandNew Zealand
| | - Michael Brainin
- Department of Neuroscience and Preventive MedicinePresident of the World Stroke OrganizationDanube University KremsAustria
| | - Bo Norrving
- Department of Clinical SciencesDepartment of NeurologySkåne University HospitalLund UniversityLundSweden
| | - Philip B. Gorelick
- Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoIL
- Population Health Research InstituteMcMaster University of Health Sciences and Hamilton UniversityHamiltonOntarioCanada
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD)University HospitalLudwig‐Maximilians‐Universität LMUMunichGermany
- Munich Cluster of Systems Neurology (SyNergy)MunichGermany
| | - Wenzhi Wang
- Beijing Neurosurgical InstituteCapital Medical UniversityBeijingPeople's Republic of China
- National Office for CVD Prevention and ControlNational Health CommissionBeijingChina
| | | | | | - Mayowa O. Owolabi
- Center for Genomic and Precision MedicineUniversity of IbadanIbadanOyoNigeria
- University College HospitalIbadanOyoNigeria
- Blossom Center for NeurorehabilitationIbadanNigeria
| | - David A. Wood
- National Heart and Lung InstituteImperial College LondonLondonUnited Kingdom
- National Institute for Prevention and Cardiovascular HealthNational University of IrelandGalwayIreland
| | | |
Collapse
|
27
|
Taylor-Robinson D, Kee F. Precision public health-the Emperor's new clothes. Int J Epidemiol 2020; 48:1-6. [PMID: 30212875 PMCID: PMC6380317 DOI: 10.1093/ije/dyy184] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2018] [Indexed: 01/08/2023] Open
Affiliation(s)
- David Taylor-Robinson
- Institute of Psychology, Health and Society, The Farr Institute@HeRC, University of Liverpool, Liverpool, UK
| | - Frank Kee
- UKCRC Centre of Excellence for Public Health Research, Centre for Public Health, Queens University of Belfast, Belfast, UK
| |
Collapse
|
28
|
Collins B, Kypridemos C, Cookson R, Parvulescu P, McHale P, Guzman-Castillo M, Bandosz P, Bromley H, Capewell S, O'Flaherty M. Universal or targeted cardiovascular screening? Modelling study using a sector-specific distributional cost effectiveness analysis. Prev Med 2020; 130:105879. [PMID: 31678586 DOI: 10.1016/j.ypmed.2019.105879] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/16/2019] [Accepted: 10/23/2019] [Indexed: 11/29/2022]
Abstract
Distributional cost effectiveness analysis is a new method that can help to redesign prevention programmes by explicitly modelling the distribution of health opportunity costs as well as the distribution of health benefits. Previously we modelled cardiovascular disease (CVD) screening audit data from Liverpool, UK to see if the city could redesign its cardiovascular screening programme to enhance its cost effectiveness and equity. Building on this previous analysis, we explicitly examined the distribution of health opportunity costs and we looked at new redesign options co-designed with stakeholders. We simulated four plausible scenarios: a) no CVD screening, b) 'current' basic universal CVD screening as currently implemented, c) enhanced universal CVD screening with 'increased' population-wide delivery, and d) 'universal plus targeted' with top-up delivery to the most deprived fifth. We also compared assumptions around whether displaced health spend would come from programmes that might benefit the poor more and how much health these programmes would generate. The main outcomes were net health benefit and change in the slope index of inequality (SII) in QALYs per 100,000 person years. 'Universal plus targeted' dominated 'increased' and 'current' and also reduced health inequality by -0.65 QALYs per 100,000 person years. Results are highly sensitive to assumptions about opportunity costs and, in particular, whether funding comes from health care or local government budgets. By analysing who loses as well as who gains from expenditure decisions, distributional cost effectiveness analysis can help decision makers to redesign prevention programmes in ways that improve health and reduce health inequality.
Collapse
Affiliation(s)
- Brendan Collins
- University of Liverpool, Department of Public Health and Policy, United Kingdom.
| | - Chris Kypridemos
- University of Liverpool, Department of Public Health and Policy, United Kingdom
| | - Richard Cookson
- Centre for Health Economics, University of York, United Kingdom
| | | | - Philip McHale
- University of Liverpool, Department of Public Health and Policy, United Kingdom
| | | | - Piotr Bandosz
- University of Liverpool, Department of Public Health and Policy, United Kingdom; Medical University of Gdansk, Poland
| | - Helen Bromley
- University of Liverpool, Department of Public Health and Policy, United Kingdom
| | - Simon Capewell
- University of Liverpool, Department of Public Health and Policy, United Kingdom
| | - Martin O'Flaherty
- University of Liverpool, Department of Public Health and Policy, United Kingdom
| |
Collapse
|
29
|
Symonds P, Hutchinson E, Ibbetson A, Taylor J, Milner J, Chalabi Z, Davies M, Wilkinson P. MicroEnv: A microsimulation model for quantifying the impacts of environmental policies on population health and health inequalities. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 697:134105. [PMID: 32380606 PMCID: PMC7212697 DOI: 10.1016/j.scitotenv.2019.134105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/30/2019] [Accepted: 08/24/2019] [Indexed: 05/07/2023]
Abstract
The Sustainable Development Goals (SDGs) recognise the critical need to improve population health and environmental sustainability. This paper describes the development of a microsimulation model, MicroEnv, aimed at quantifying the impact of environmental exposures on health as an aid to selecting policies likely to have greatest benefit. Its methods allow the integration of morbidity and mortality outcomes and the generation of results at high spatial resolution. We illustrate its application to the assessment of the impact of air pollution on health in London. Simulations are performed at Lower Layer Super Output Area (LSOA), the smallest geographic unit (population of around 1500 inhabitants) for which detailed socio-demographic data are routinely available in the UK. The health of each individual in these LSOAs is simulated year-by-year using a health-state-transition model, where transition probabilities from one state to another are based on published statistics modified by relative risks that reflect the effect of environmental exposures. This is done through linkage of the simulated population in each LSOA with 1 × 1 km annual average PM2.5 concentrations and area-based deprivation indices. Air pollution is a leading cause of mortality and morbidity globally, and improving air quality is critical to the SDGs for Health (Goal 3) and Cities (Goal 11). The evidence of MicroEnv is aimed at providing better understanding of the benefits for population health and health inequalities of policy actions that affect exposure such as air quality, and thus to help shape policy decisions. Future work will extend the model to integrate other environmental determinants of health.
Collapse
Affiliation(s)
- Phil Symonds
- Institute of Environmental Design and Engineering, UCL, London, UK.
| | | | | | - Jonathon Taylor
- Institute of Environmental Design and Engineering, UCL, London, UK.
| | - James Milner
- London School of Hygiene and Tropical Medicine, London, UK.
| | - Zaid Chalabi
- Institute of Environmental Design and Engineering, UCL, London, UK; London School of Hygiene and Tropical Medicine, London, UK.
| | - Michael Davies
- Institute of Environmental Design and Engineering, UCL, London, UK.
| | - Paul Wilkinson
- Institute of Environmental Design and Engineering, UCL, London, UK.
| |
Collapse
|
30
|
Saidi O, Zoghlami N, Bennett KE, Mosquera PA, Malouche D, Capewell S, Romdhane HB, O’Flaherty M. Explaining income-related inequalities in cardiovascular risk factors in Tunisian adults during the last decade: comparison of sensitivity analysis of logistic regression and Wagstaff decomposition analysis. Int J Equity Health 2019; 18:177. [PMID: 31730469 PMCID: PMC6858762 DOI: 10.1186/s12939-019-1047-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 09/03/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND It is important to quantify inequality, explain the contribution of underlying social determinants and to provide evidence to guide health policy. The aim of the study is to explain the income-related inequalities in cardiovascular risk factors in the last decade among Tunisian adults aged between 35 and 70 years old. METHODS We performed the analysis by applying two approaches and compared the results provided by the two methods. The methods were global sensitivity analysis (GSA) using logistic regression models and the Wagstaff decomposition analysis. RESULTS Results provided by the two methods found a higher risk of cardiovascular diseases and diabetes in those with high socio-economic status in 2005. Similar results were observed in 2016. In 2016, the GSA showed that education level occupied the first place on the explanatory list of factors explaining 36.1% of the adult social inequality in high cardiovascular risk, followed by the area of residence (26.2%) and income (15.1%). Based on the Wagstaff decomposition analysis, the area of residence occupied the first place and explained 40.3% followed by income and education level explaining 19.2 and 14.0% respectively. Thus, both methods found similar factors explaining inequalities (income, educational level and regional conditions) but with different rankings of importance. CONCLUSIONS The present study showed substantial income-related inequalities in cardiovascular risk factors and diabetes in Tunisia and provided explanations for this. Results based on two different methods similarly showed that structural disparities on income, educational level and regional conditions should be addressed in order to reduce inequalities.
Collapse
Affiliation(s)
- Olfa Saidi
- Cardiovascular Epidemiology and Prevention Research Laboratory –Faculty of medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- National Institute of Health, Tunis, Tunisia
| | - Nada Zoghlami
- Cardiovascular Epidemiology and Prevention Research Laboratory –Faculty of medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- National Institute of Health, Tunis, Tunisia
| | - Kathleen E. Bennett
- Population and Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Dhafer Malouche
- Cardiovascular Epidemiology and Prevention Research Laboratory –Faculty of medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- National Institute of Statistics and Data Analysis Tunis, Tunis, Tunisia
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Habiba Ben Romdhane
- Cardiovascular Epidemiology and Prevention Research Laboratory –Faculty of medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Martin O’Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| |
Collapse
|
31
|
Good Pharmacovigilance Practice in Paediatrics: An Overview of the Updated European Medicines Agency Guidelines. Paediatr Drugs 2019; 21:317-321. [PMID: 31378846 DOI: 10.1007/s40272-019-00350-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
32
|
Olstad DL, McIntyre L. Reconceptualising precision public health. BMJ Open 2019; 9:e030279. [PMID: 31519678 PMCID: PMC6747655 DOI: 10.1136/bmjopen-2019-030279] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/22/2019] [Accepted: 07/30/2019] [Indexed: 01/11/2023] Open
Abstract
As currently conceived, precision public health is at risk of becoming precision medicine at a population level. This paper outlines a framework for precision public health that, in contrast to its current operationalisation, is consistent with public health principles because it integrates factors at all levels, while illuminating social position as a fundamental determinant of health and health inequities. We review conceptual foundations of public health, outline a proposed framework for precision public health and describe its operationalisation within research and practice. Social position shapes individuals' unequal experiences of the social determinants of health. Thus, in our formulation, precision public health investigates how multiple dimensions of social position interact to confer health risk differently for precisely defined population subgroups according to the social contexts in which they are embedded, while considering relevant biological and behavioural factors. It leverages this information to uncover the precise and intersecting social structures that pattern health outcomes, and to identify actionable interventions within the social contexts of affected groups. We contend that studies informed by this framework offer greater potential to improve health than current conceptualisations of precision public health that do not address root causes. Moreover, expanding beyond master categories of social position and operationalising these categories in more precise ways across time and place can enrich public health research through greater attention to the heterogeneity of social positions, their causes and health effects, leading to the identification of points of intervention that are specific enough to be useful in reducing health inequities. Failure to attend to this level of particularity may mask the true nature of health risk, the causal mechanisms at play and appropriate interventions. Conceptualised thus, precision public health is a research endeavour with much to offer by way of understanding and intervening on the causes of poor health and health inequities.As currently conceived, precision public health is at risk of becoming precision medicine at a population level. This paper outlines a framework for precision public health that, in contrast to its current operationalization, is consistent with public health principles because it integrates factors at all levels, while illuminating social position as a fundamental determinant of health and health inequities. We review conceptual foundations of public health, outline a proposed framework for precision public health and describe its operationalization within research and practice. Social position shapes individuals' unequal experiences of the social determinants of health. Thus, in our formulation, precision public health investigates how multiple dimensions of social position interact to confer health risk differently for precisely defined population subgroups according to the social contexts in which they are embedded, while considering relevant biological and behavioural factors. It leverages this information to uncover the precise and intersecting social structures that pattern health outcomes, and to identify actionable interventions within the social contexts of affected groups. We contend that studies informed by this framework offer greater potential to improve health than current conceptualizations of precision public health that do not address root causes. Moreover, expanding beyond master categories of social position and operationalizing these categories in more precise ways across time and place can enrich public health research through greater attention to the heterogeneity of social positions, their causes and health effects, leading to identification of points of intervention that are specific enough to be useful in reducing health inequities. Failure to attend to this level of particularity may mask the true nature of health risk, the causal mechanisms at play and appropriate interventions. Conceptualized thus, precision public health is a research endeavour with much to offer by way of understanding and intervening on the causes of poor health and health inequities.
Collapse
Affiliation(s)
- Dana Lee Olstad
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lynn McIntyre
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
33
|
Ogata S, Nishimura K, Guzman-Castillo M, Sumita Y, Nakai M, Nakao YM, Nishi N, Noguchi T, Sekikawa A, Saito Y, Watanabe T, Kobayashi Y, Okamura T, Ogawa H, Yasuda S, Miyamoto Y, Capewell S, O'Flaherty M. Explaining the decline in coronary heart disease mortality rates in Japan: Contributions of changes in risk factors and evidence-based treatments between 1980 and 2012. Int J Cardiol 2019; 291:183-188. [DOI: 10.1016/j.ijcard.2019.02.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 12/14/2018] [Accepted: 02/12/2019] [Indexed: 11/16/2022]
|
34
|
Kunz SM, Holzmann D, Soyka MB. Association of epistaxis with atherosclerotic cardiovascular disease. Laryngoscope 2018; 129:783-787. [PMID: 30549051 DOI: 10.1002/lary.27604] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the association between epistaxis and atherosclerotic cardiovascular disease. STUDY DESIGN Case-control cohort study. METHODS This study included patients from the tertiary-care ear, nose, and throat department at the University Hospital of Zurich between December 1, 2016 and June 1, 2017. We assessed the cardiovascular risk profiles in a group of 41 patients presenting with epistaxis, and a group of 41 matched controls, focusing on a surrogate parameter for atherosclerosis: the carotid intima-media thickness (CIMT). RESULTS With a mean of 1.06 mm (standard deviation [SD] = 0.17), CIMT values were on average 26% higher in epistaxis patients than in their controls, with a mean of 0.84 mm (SD = 0.14; P < .001). Occurrence of severe epistaxis was also associated with lower ankle-brachial index values at 0.96 (SD = 0.12) versus 1.05 (SD = 0.17) (P < .001) and significantly higher QRISK2 relative risks (an algorithm for predicting cardiovascular risk) than found in the control group (1.81, SD = 0.97 vs. 1.35, SD = 0.28; P = .028). A binary logistic regression model, adjusted for possible confounders, showed an odds ratio of 2.5 for the occurrence of epistaxis per increase in CIMT of 0.1 mm in the study population (95% confidence interval: 1.56-4.11; P < .001). CONCLUSIONS The occurrence of severe epistaxis was shown to be closely associated with the prevalence of atherosclerotic cardiovascular disease. Accordingly, patients affected by epistaxis should be regarded as at an elevated cardiovascular risk, which indicates the need for appropriate further medical assessment and preventive measures. LEVEL OF EVIDENCE 3b TRIAL REGISTRATION: Clinical trials NCT03092973 Laryngoscope, 129:783-787, 2019.
Collapse
Affiliation(s)
- Seraina M Kunz
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - David Holzmann
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Michael B Soyka
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
35
|
Chang KCM, Vamos EP, Palladino R, Majeed A, Lee JT, Millett C. Impact of the NHS Health Check on inequalities in cardiovascular disease risk: a difference-in-differences matching analysis. J Epidemiol Community Health 2018; 73:11-18. [PMID: 30282645 DOI: 10.1136/jech-2018-210961] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 07/27/2018] [Accepted: 08/31/2018] [Indexed: 11/04/2022]
Abstract
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.
Collapse
Affiliation(s)
- Kiara C-M Chang
- Public Health Policy Evaluation Unit, Imperial College London, London, UK.,Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Eszter P Vamos
- Public Health Policy Evaluation Unit, Imperial College London, London, UK.,Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Raffaele Palladino
- Public Health Policy Evaluation Unit, Imperial College London, London, UK.,Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - John Tayu Lee
- Public Health Policy Evaluation Unit, Imperial College London, London, UK.,Department of Primary Care and Public Health, Imperial College London, London, UK.,Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher Millett
- Public Health Policy Evaluation Unit, Imperial College London, London, UK.,Department of Primary Care and Public Health, Imperial College London, London, UK
| |
Collapse
|
36
|
Martin A, Saunders CL, Harte E, Griffin SJ, MacLure C, Mant J, Meads C, Walter FM, Usher-Smith JA. Delivery and impact of the NHS Health Check in the first 8 years: a systematic review. Br J Gen Pract 2018; 68:e449-e459. [PMID: 29914882 PMCID: PMC6014431 DOI: 10.3399/bjgp18x697649] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/14/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Since 2009, all eligible persons in England have been entitled to an NHS Health Check. Uncertainty remains about who attends, and the health-related impacts. AIM To review quantitative evidence on coverage (the proportion of eligible individuals who attend), uptake (proportion of invitees who attend), and impact of NHS Health Checks. DESIGN AND SETTING A systematic review and quantitative data synthesis. Included were studies or data reporting coverage or uptake and studies reporting any health-related impact that used an appropriate comparison group or before- and-after study design. METHOD Eleven databases and additional internet sources were searched to November 2016. RESULTS Twenty-six observational studies and one additional dataset were included. Since 2013, 45.6% of eligible individuals have received a health check. Coverage is higher among older people, those with a family history of coronary heart disease, those living in the most deprived areas, and some ethnic minority groups. Just under half (48.2%) of those invited have taken up the invitation. Data on uptake and impact (especially regarding health-related behaviours) are limited. Uptake is higher in older people and females, but lower in those living in the most deprived areas. Attendance is associated with small increases in disease detection, decreases in modelled cardiovascular disease risk, and increased statin and antihypertensive prescribing. CONCLUSION Published attendance, uptake, and prescribing rates are all lower than originally anticipated, and data on impact are limited, with very few studies reporting the effect of attendance on health-related behaviours. High-quality studies comparing matched attendees and non-attendees and health economic analyses are required.
Collapse
Affiliation(s)
- Adam Martin
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, and RAND Europe, Cambridge
| | - Catherine L Saunders
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, and RAND Europe, Cambridge
| | | | - Simon J Griffin
- Primary Care Unit, Department of Public Health and Primary Care, and Medical Research Council (MRC) Epidemiology Unit, Institute of Metabolic Science, University of Cambridge, Cambridge
| | | | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge
| | - Catherine Meads
- RAND Europe, and Faculty of Health, Social Care and Education, Anglia Ruskin University, Cambridge
| | - Fiona M Walter
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge
| | - Juliet A Usher-Smith
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge
| |
Collapse
|
37
|
Kim D. Projected impacts of federal tax policy proposals on mortality burden in the United States: A microsimulation analysis. Prev Med 2018; 111:272-279. [PMID: 29066374 PMCID: PMC5911242 DOI: 10.1016/j.ypmed.2017.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 10/09/2017] [Accepted: 10/18/2017] [Indexed: 11/22/2022]
Abstract
The public health consequences of federal income tax policies that influence income inequality are not well understood. I aimed to project the impacts on mortality of modifying federal income tax structures based on proposals by two recent United States (U.S.) Presidential candidates: Donald Trump and Senator Bernie Sanders. I performed a microsimulation analysis using the latest U.S. Internal Revenue Service public-use tax file with state identifiers (2008 tax year), containing nationally-representative data from 139,651 tax returns. I considered five tax plan scenarios: 1) actual 2008 tax structures; proposals in 2016 by then-candidates 2) Trump and 3) Sanders; 4) a modified Sanders plan with higher top tax rates (75%); and 5) a modified Sanders plan with higher top rates plus revenue redistribution to lower-income households (<$40,000/year). I combined projected changes in income inequality with vital statistics data and past estimates of linkages between income inequality, income, and mortality. 29,689 (95% CI: 10,865-48,920) more deaths/year and 31,302 (95% CI: 11,455-51,577) fewer deaths/year from all causes are anticipated under the Trump and Sanders plans, respectively. Under the modified Sanders plan including higher top rates, 68,919 (95% CI: 25,221-113,561) fewer deaths/year are projected. Under the modified Sanders plan with redistribution, 333,504 (95% CI: 192,897-473,787) fewer deaths/year are expected. Policies that both raise federal income tax rates and redistribute tax revenue could confer large reductions in the total number of annual deaths among Americans. In this era of high income inequality and growing public support to address the rich-poor gap, policymakers should consider joint federal tax and redistributive policies as levers to reduce the burden of mortality in the United States.
Collapse
Affiliation(s)
- Daniel Kim
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, United States; EHESP School of Public Health, Sorbonne Paris Cité, Paris Descartes University, Paris, France.
| |
Collapse
|
38
|
Rasella D, Basu S, Hone T, Paes-Sousa R, Ocké-Reis CO, Millett C. Child morbidity and mortality associated with alternative policy responses to the economic crisis in Brazil: A nationwide microsimulation study. PLoS Med 2018; 15:e1002570. [PMID: 29787574 PMCID: PMC5963760 DOI: 10.1371/journal.pmed.1002570] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 04/20/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Since 2015, a major economic crisis in Brazil has led to increasing poverty and the implementation of long-term fiscal austerity measures that will substantially reduce expenditure on social welfare programmes as a percentage of the country's GDP over the next 20 years. The Bolsa Família Programme (BFP)-one of the largest conditional cash transfer programmes in the world-and the nationwide primary healthcare strategy (Estratégia Saúde da Família [ESF]) are affected by fiscal austerity, despite being among the policy interventions with the strongest estimated impact on child mortality in the country. We investigated how reduced coverage of the BFP and ESF-compared to an alternative scenario where the level of social protection under these programmes is maintained-may affect the under-five mortality rate (U5MR) and socioeconomic inequalities in child health in the country until 2030, the end date of the Sustainable Development Goals. METHODS AND FINDINGS We developed and validated a microsimulation model, creating a synthetic cohort of all 5,507 Brazilian municipalities for the period 2017-2030. This model was based on the longitudinal dataset and effect estimates from a previously published study that evaluated the effects of poverty, the BFP, and the ESF on child health. We forecast the economic crisis and the effect of reductions in BFP and ESF coverage due to current fiscal austerity on the U5MR, and compared this scenario with a scenario where these programmes maintain the levels of social protection by increasing or decreasing with the size of Brazil's vulnerable populations (policy response scenarios). We used fixed effects multivariate regression models including BFP and ESF coverage and accounting for secular trends, demographic and socioeconomic changes, and programme duration effects. With the maintenance of the levels of social protection provided by the BFP and ESF, in the most likely economic crisis scenario the U5MR is expected to be 8.57% (95% CI: 6.88%-10.24%) lower in 2030 than under fiscal austerity-a cumulative 19,732 (95% CI: 10,207-29,285) averted under-five deaths between 2017 and 2030. U5MRs from diarrhoea, malnutrition, and lower respiratory tract infections are projected to be 39.3% (95% CI: 36.9%-41.8%), 35.8% (95% CI: 31.5%-39.9%), and 8.5% (95% CI: 4.1%-12.0%) lower, respectively, in 2030 under the maintenance of BFP and ESF coverage, with 123,549 fewer under-five hospitalisations from all causes over the study period. Reduced coverage of the BFP and ESF will also disproportionately affect U5MR in the most vulnerable areas, with the U5MR in the poorest quintile of municipalities expected to be 11.0% (95% CI: 8.0%-13.8%) lower in 2030 under the maintenance of BFP and ESF levels of social protection than under fiscal austerity, compared to no difference in the richest quintile. Declines in health inequalities over the last decade will also stop under a fiscal austerity scenario: the U5MR concentration index is expected to remain stable over the period 2017-2030, compared to a 13.3% (95% CI: 5.6%-21.8%) reduction under the maintenance of BFP and ESF levels of protection. Limitations of our analysis are the ecological nature of the study, uncertainty around future macroeconomic scenarios, and potential changes in other factors affecting child health. A wide range of sensitivity analyses were conducted to minimise these limitations. CONCLUSIONS The implementation of fiscal austerity measures in Brazil can be responsible for substantively higher childhood morbidity and mortality than expected under maintenance of social protection-threatening attainment of Sustainable Development Goals for child health and reducing inequality.
Collapse
Affiliation(s)
- Davide Rasella
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
- * E-mail:
| | - Sanjay Basu
- Center for Population Health Sciences, School of Medicine, Stanford University, Stanford, California, United States of America
- Center for Primary Care and Outcomes Research, School of Medicine, Stanford University, Stanford, California, United States of America
- Department of Health Research and Policy, School of Medicine, Stanford University, Stanford, California, United States of America
- Center for Primary Care, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Thomas Hone
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Romulo Paes-Sousa
- René Rachou Institute, Fiocruz Minas, Belo Horizonte, Minas Gerais, Brasil
| | | | - Christopher Millett
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
- Center for Epidemiological Studies in Health and Nutrition, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
39
|
Future cost-effectiveness and equity of the NHS Health Check cardiovascular disease prevention programme: Microsimulation modelling using data from Liverpool, UK. PLoS Med 2018; 15:e1002573. [PMID: 29813056 PMCID: PMC5973555 DOI: 10.1371/journal.pmed.1002573] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/26/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Aiming to contribute to prevention of cardiovascular disease (CVD), the National Health Service (NHS) Health Check programme has been implemented across England since 2009. The programme involves cardiovascular risk stratification-at 5-year intervals-of all adults between the ages of 40 and 74 years, excluding any with preexisting vascular conditions (including CVD, diabetes mellitus, and hypertension, among others), and offers treatment to those at high risk. However, the cost-effectiveness and equity of population CVD screening is contested. This study aimed to determine whether the NHS Health Check programme is cost-effective and equitable in a city with high levels of deprivation and CVD. METHODS AND FINDINGS IMPACTNCD is a dynamic stochastic microsimulation policy model, calibrated to Liverpool demographics, risk factor exposure, and CVD epidemiology. Using local and national data, as well as drawing on health and social care disease costs and health-state utilities, we modelled 5 scenarios from 2017 to 2040: Scenario (A): continuing current implementation of NHS Health Check;Scenario (B): implementation 'targeted' toward areas in the most deprived quintile with increased coverage and uptake;Scenario (C): 'optimal' implementation assuming optimal coverage, uptake, treatment, and lifestyle change;Scenario (D): scenario A combined with structural population-wide interventions targeting unhealthy diet and smoking;Scenario (E): scenario B combined with the structural interventions as above. We compared all scenarios with a counterfactual of no-NHS Health Check. Compared with no-NHS Health Check, the model estimated cumulative incremental cost-effectiveness ratio (ICER) (discounted £/quality-adjusted life year [QALY]) to be 11,000 (95% uncertainty interval [UI] -270,000 to 320,000) for scenario A, 1,500 (-91,000 to 100,000) for scenario B, -2,400 (-6,500 to 5,700) for scenario C, -5,100 (-7,400 to -3,200) for scenario D, and -5,000 (-7,400 to -3,100) for scenario E. Overall, scenario A is unlikely to become cost-effective or equitable, and scenario B is likely to become cost-effective by 2040 and equitable by 2039. Scenario C is likely to become cost-effective by 2030 and cost-saving by 2040. Scenarios D and E are likely to be cost-saving by 2021 and 2023, respectively, and equitable by 2025. The main limitation of the analysis is that we explicitly modelled CVD and diabetes mellitus only. CONCLUSIONS According to our analysis of the situation in Liverpool, current NHS Health Check implementation appears neither equitable nor cost-effective. Optimal implementation is likely to be cost-saving but not equitable, while targeted implementation is likely to be both. Adding structural policies targeting cardiovascular risk factors could substantially improve equity and generate cost savings.
Collapse
|
40
|
The current and potential health benefits of the National Health Service Health Check cardiovascular disease prevention programme in England: A microsimulation study. PLoS Med 2018; 15:e1002517. [PMID: 29509767 PMCID: PMC5839536 DOI: 10.1371/journal.pmed.1002517] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 01/25/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The National Health Service (NHS) Health Check programme was introduced in 2009 in England to systematically assess all adults in midlife for cardiovascular disease risk factors. However, its current benefit and impact on health inequalities are unknown. It is also unclear whether feasible changes in how it is delivered could result in increased benefits. It is one of the first such programmes in the world. We sought to estimate the health benefits and effect on inequalities of the current NHS Health Check programme and the impact of making feasible changes to its implementation. METHODS AND FINDINGS We developed a microsimulation model to estimate the health benefits (incident ischaemic heart disease, stroke, dementia, and lung cancer) of the NHS Health Check programme in England. We simulated a population of adults in England aged 40-45 years and followed until age 100 years, using data from the Health Survey of England (2009-2012) and the English Longitudinal Study of Aging (1998-2012), to simulate changes in risk factors for simulated individuals over time. We used recent programme data to describe uptake of NHS Health Checks and of 4 associated interventions (statin medication, antihypertensive medication, smoking cessation, and weight management). Estimates of treatment efficacy and adherence were based on trial data. We estimated the benefits of the current NHS Health Check programme compared to a healthcare system without systematic health checks. This counterfactual scenario models the detection and treatment of risk factors that occur within 'routine' primary care. We also explored the impact of making feasible changes to implementation of the programme concerning eligibility, uptake of NHS Health Checks, and uptake of treatments offered through the programme. We estimate that the NHS Health Check programme prevents 390 (95% credible interval 290 to 500) premature deaths before 80 years of age and results in an additional 1,370 (95% credible interval 1,100 to 1,690) people being free of disease (ischaemic heart disease, stroke, dementia, and lung cancer) at age 80 years per million people aged 40-45 years at baseline. Over the life of the cohort (i.e., followed from 40-45 years to 100 years), the changes result in an additional 10,000 (95% credible interval 8,200 to 13,000) quality-adjusted life years (QALYs) and an additional 9,000 (6,900 to 11,300) years of life. This equates to approximately 300 fewer premature deaths and 1,000 more people living free of these diseases each year in England. We estimate that the current programme is increasing QALYs by 3.8 days (95% credible interval 3.0-4.7) per head of population and increasing survival by 3.3 days (2.5-4.1) per head of population over the 60 years of follow-up. The current programme has a greater absolute impact on health for those living in the most deprived areas compared to those living in the least deprived areas (4.4 [2.7-6.5] days of additional quality-adjusted life per head of population versus 2.8 [1.7-4.0] days; 5.1 [3.4-7.1] additional days lived per head of population versus 3.3 [2.1-4.5] days). Making feasible changes to the delivery of the existing programme could result in a sizable increase in the benefit. For example, a strategy that combines extending eligibility to those with preexisting hypertension, extending the upper age of eligibility to 79 years, increasing uptake of health checks by 30%, and increasing treatment rates 2.5-fold amongst eligible patients (i.e., 'maximum potential' scenario) results in at least a 3-fold increase in benefits compared to the current programme (1,360 premature deaths versus 390; 5,100 people free of 1 of the 4 diseases versus 1,370; 37,000 additional QALYs versus 10,000; 33,000 additional years of life versus 9,000). Ensuring those who are assessed and eligible for statins receive statins is a particularly important strategy to increase benefits. Estimates of overall benefit are based on current incidence and management, and future declines in disease incidence or improvements in treatment could alter the actual benefits observed in the long run. We have focused on the cardiovascular element of the NHS Health Check programme. Some important noncardiovascular health outcomes (e.g., chronic obstructive pulmonary disease [COPD] prevention from smoking cessation and cancer prevention from weight loss) and other parts of the programme (e.g., brief interventions to reduce harmful alcohol consumption) have not been modelled. CONCLUSIONS Our model indicates that the current NHS Health Check programme is contributing to improvements in health and reducing health inequalities. Feasible changes in the organisation of the programme could result in more than a 3-fold increase in health benefits.
Collapse
|
41
|
Lopez-Rodriguez JA, Rubio Valladolid G. Web-Based Alcohol, Smoking, and Substance Involvement Screening Test Results for the General Spanish Population: Cross-Sectional Study. J Med Internet Res 2018; 20:e57. [PMID: 29453188 PMCID: PMC5834753 DOI: 10.2196/jmir.7121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 07/07/2017] [Accepted: 07/27/2017] [Indexed: 11/13/2022] Open
Abstract
Background Information technology in health sciences could be a screening tool of great potential and has been shown to be effective in identifying single-drug users at risk. Although there are many published tests for single-drug screening, there is a gap for concomitant drug use screening in general population. The ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) website was launched on February 2015 in Madrid, Spain, as a tool to identify those at risk. Objective The aim of this study was to describe the use of a tool and to analyze profiles of drug users, their consumption patterns, and associated factors. Methods Government- and press-released launching of a Spanish-validated ASSIST test from the World Health Organization (WHO) was used for voluntary Web-based screening of people with drug-related problems. The tests completed in the first 6 months were analyzed . Results A total of 1657 visitors of the 15,867 visits (1657/15,867, 10.44%) completed the whole Web-based screening over a 6-month period. The users had an average age of 37.4 years, and 78.87% (1307/1657) screened positive for at least one of the 9 drugs tested. The drugs with higher prevalence were tobacco (840/1657, 50.69%), alcohol (437/1657, 26.37%), cannabis (361/1657, 21.79%), and sedatives or hypnotics (192/1657, 11.59%). Polyconsumption or concomitant drug use was stated by 31.80% (527/1657) of the users. Male respondents had a higher risk of having alcohol problems (odds ratio, OR 1.55, 95% CI 1.18-2.04; P=.002) and double the risk for cannabis problems (OR 2.07, 95% CI 1.46-2.92; P<.001). Growing age increased by 3 times the risk of developing alcohol problems for people aged between 45 and 65 years (OR 3.01, 95% CI 1.89-4.79; P<.001). Conclusions A Web-based screening test could be useful to detect people at risk. The drug-related problem rates detected by the study are consistent with the current literature. This tool could be useful for users, who use information technology on a daily basis, not seeking medical attention.
Collapse
Affiliation(s)
- Juan A Lopez-Rodriguez
- Primary Care Research Unit, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain.,General Ricardos Primary Health Care Centre, Madrid, Spain.,School of Health Sciences, King Juan Carlos University, Alcorcón, Madrid, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, Madrid, Spain
| | - Gabriel Rubio Valladolid
- School of Medicine, Complutense University of Madrid, Madrid, Spain.,Department of Psychiatry, 12 Octubre University Hospital, Madrid, Spain.,Area 8, Neurociencias y Salud Mental, Madrid, Spain.,Red de Trastornos Adictivos (RTA), Carlos III Health Institute, Madrid, Spain
| |
Collapse
|
42
|
Knight J, Wells S, Marshall R, Exeter D, Jackson R. Developing a synthetic national population to investigate the impact of different cardiovascular disease risk management strategies: A derivation and validation study. PLoS One 2017; 12:e0173170. [PMID: 28384217 PMCID: PMC5383032 DOI: 10.1371/journal.pone.0173170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 02/16/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Many national cardiovascular disease (CVD) risk factor management guidelines now recommend that drug treatment decisions should be informed primarily by patients' multi-variable predicted risk of CVD, rather than on the basis of single risk factor thresholds. To investigate the potential impact of treatment guidelines based on CVD risk thresholds at a national level requires individual level data representing the multi-variable CVD risk factor profiles for a country's total adult population. As these data are seldom, if ever, available, we aimed to create a synthetic population, representing the joint CVD risk factor distributions of the adult New Zealand population. METHODS AND RESULTS A synthetic population of 2,451,278 individuals, representing the actual age, gender, ethnicity and social deprivation composition of people aged 30-84 years who completed the 2013 New Zealand census was generated using Monte Carlo sampling. Each 'synthetic' person was then probabilistically assigned values of the remaining cardiovascular disease (CVD) risk factors required for predicting their CVD risk, based on data from the national census national hospitalisation and drug dispensing databases and a large regional cohort study, using Monte Carlo sampling and multiple imputation. Where possible, the synthetic population CVD risk distributions for each non-demographic risk factor were validated against independent New Zealand data sources. CONCLUSIONS We were able to develop a synthetic national population with realistic multi-variable CVD risk characteristics. The construction of this population is the first step in the development of a micro-simulation model intended to investigate the likely impact of a range of national CVD risk management strategies that will inform CVD risk management guideline updates in New Zealand and elsewhere.
Collapse
Affiliation(s)
- Josh Knight
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, Australia
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Susan Wells
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Roger Marshall
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Daniel Exeter
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rod Jackson
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
43
|
Cookson R, Mirelman AJ, Griffin S, Asaria M, Dawkins B, Norheim OF, Verguet S, J Culyer A. Using Cost-Effectiveness Analysis to Address Health Equity Concerns. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:206-212. [PMID: 28237196 PMCID: PMC5340318 DOI: 10.1016/j.jval.2016.11.027] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/09/2016] [Accepted: 11/28/2016] [Indexed: 05/22/2023]
Abstract
This articles serves as a guide to using cost-effectiveness analysis (CEA) to address health equity concerns. We first introduce the "equity impact plane," a tool for considering trade-offs between improving total health-the objective underpinning conventional CEA-and equity objectives, such as reducing social inequality in health or prioritizing the severely ill. Improving total health may clash with reducing social inequality in health, for example, when effective delivery of services to disadvantaged communities requires additional costs. Who gains and who loses from a cost-increasing health program depends on differences among people in terms of health risks, uptake, quality, adherence, capacity to benefit, and-crucially-who bears the opportunity costs of diverting scarce resources from other uses. We describe two main ways of using CEA to address health equity concerns: 1) equity impact analysis, which quantifies the distribution of costs and effects by equity-relevant variables, such as socioeconomic status, location, ethnicity, sex, and severity of illness; and 2) equity trade-off analysis, which quantifies trade-offs between improving total health and other equity objectives. One way to analyze equity trade-offs is to count the cost of fairer but less cost-effective options in terms of health forgone. Another method is to explore how much concern for equity is required to choose fairer but less cost-effective options using equity weights or parameters. We hope this article will help the health technology assessment community navigate the practical options now available for conducting equity-informative CEA that gives policymakers a better understanding of equity impacts and trade-offs.
Collapse
Affiliation(s)
| | | | - Susan Griffin
- Centre for Health Economics, University of York, York, UK
| | - Miqdad Asaria
- Centre for Health Economics, University of York, York, UK
| | - Bryony Dawkins
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ole Frithjof Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard University, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | |
Collapse
|
44
|
Crossan C, Lord J, Ryan R, Nherera L, Marshall T. Cost effectiveness of case-finding strategies for primary prevention of cardiovascular disease: a modelling study. Br J Gen Pract 2017; 67:e67-e77. [PMID: 27821671 PMCID: PMC5198616 DOI: 10.3399/bjgp16x687973] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 08/09/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Policies of active case finding for cardiovascular disease (CVD) prevention in healthy adults are common, but economic evaluation has not investigated targeting such strategies at those who are most likely to benefit. AIM To assess the cost effectiveness of targeted case finding for CVD prevention. DESIGN AND SETTING Cost-effectiveness modelling in an English primary care population. METHOD A cohort of 10 000 individuals aged 30-74 years and without existing CVD or diabetes was sampled from The Health Improvement Network database, a large primary care database. A discrete-event simulation was used to model the process of inviting people for assessment, assessing cardiovascular risk, and initiation and persistence with drug treatment. Risk factors and drug cessation rates were obtained from primary care data. Published sources provided estimates of uptake of assessment, treatment initiation, and treatment effects. The researchers determined the lifetime costs and quality-adjusted life years (QALYs) with opportunistic case finding, and strategies prioritising and targeting patients by age or prior estimate of cardiovascular risk. This study reports on the optimum strategy if a QALY is valued at £20 000. RESULTS Compared with no case finding, inviting all adults aged 30-74 years in a population of 10 000 yields 30.32 QALYs at a total cost of £705 732. The optimum strategy is to rank patients by prior risk estimate and invite 8% of those who are assessed as being at highest risk (those at ≥12.76% predicted 10-year CVD risk), yielding 17.53 QALYs at a cost of £162 280. There is an 89.4% probability that the optimum strategy is to invite <35% of patients for assessment. CONCLUSION Across all age ranges, targeted case finding using a prior estimate of CVD risk is more efficient than universal case finding in healthy adults.
Collapse
Affiliation(s)
- Catriona Crossan
- Health Economics Research Group, Brunel University London, Uxbridge
| | - Joanne Lord
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton
| | - Ronan Ryan
- Primary Care Clinical Sciences, School of Health and Population Sciences, University of Birmingham, Birmingham
| | | | - Tom Marshall
- School of Health and Population Sciences, University of Birmingham, Birmingham
| |
Collapse
|