Ahmadi M, Lanphear B. The impact of clinical and population strategies on coronary heart disease mortality: an assessment of Rose's big idea.
BMC Public Health 2022;
22:14. [PMID:
34991551 PMCID:
PMC8734316 DOI:
10.1186/s12889-021-12421-0]
[Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/09/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND
Coronary heart disease (CHD), the leading cause of death worldwide, has declined in many affluent countries but it continues to rise in industrializing countries.
OBJECTIVE
To quantify the relative contribution of the clinical and population strategies to the decline in CHD mortality in affluent countries.
DESIGN
Meta-analysis of cross-sectional and prospective studies.
DATA SOURCES
PubMed and Web of Science from January 1, 1970 to December 31, 2019.
METHOD
We combined and analyzed data from 22 cross-sectional and prospective studies, representing 500 million people, to quantify the relative decline in CHD mortality attributable to the clinical strategy and population strategy.
RESULT
The population strategy accounted for 48% (range = 19 to 73%) of the decline in CHD deaths and the clinical strategy accounted for 42% (range = 25 to 56%), with moderate inconsistency of results across studies.
CONCLUSION
Since 1970, a larger fraction of the decline in CHD deaths in industrialized countries was attributable to reduction in CHD risk factors than medical care. Population strategies, which are more cost-effective than clinical strategies, are under-utilized.
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