A better understanding of recent coronary heart disease mortality trends and determinants

摘要: Introduction Coronary heart disease (CHD) is one of the leading global causes morbidity and mortality. The underlying biological mechanisms are well understood, a host causal risk factors for have been identified, mainly related to diet, smoking physical activity. Evidence-based treatments also available, reducing mortality improving quality life. The decline in CHD rates observed most developed countries since 1960s represents remarkable epidemiological phenomenon. However, this not universal, may now be jeopardy. Thus, has recently plateaued young adults United States. Furthermore, absolute burden set increase because an increasingly ageing population, will represent heavy high, middle low income alike. incidence rise future recent adverse trends major factors, namely worldwide increases obesity diabetes prevalence 1980s. Moreover, new technology improved decreasing case fatality patients, increasing life expectancy thus expanding pool patients surviving with clinically apparent disease. Finally, crucially, important socioeconomic inequalities persist, perhaps reflecting determinants. complex interplay these potential changes over time together suggest that epidemic still evolving. Further attention therefore essential. The analysis specific can potentially help us understand population dynamic diseases such as CHD, warn about key offer some novel insights better prevention control. previous analyses focused on age-adjusted might conceal differences by age or status, which provide further understanding trend drivers. Aims objectives: My aim study coronary different countries, order current state epidemic. I analyze relative importance drivers trends. consider Public Health implications my findings. My objectives are: 1. To summarize our Coronary Heart Disease causation 2. To describe focusing gender identifying periods similar rate change diverse populations (England & Wales, Netherlands, Poland Australia). 3. To Socio-Economic Status England Scotland. 4. To quantify role evidence-based trends, first using modelling approach Poland, then while considering factors. 5. To public health policy mortality. Methods CHD were analysed joinpoint regression approach. Widely used cancer epidemiology, but rarely method explores data find points (“joinpoints”) define segments where constant pace change. strength technique objectivity- (it avoids detection biased patterns when described intervals defined subjectively researcher). Joinpoint bias essentially removing observer from selection process, instead formal objective exploration time-series data. My rates, rates. Scotland considered socio-economic status (using area-based measures material deprivation). contributions CHJD studied IMPACT model, comprehensive, population-based model epidemiology. goal deaths Polish between 1991 2005 explained factor treatments. incorporating all usual failure plus cardiovascular including smoking, blood pressure, cholesterol, diabetes, Similar exploring conducted England, modified (IMPACTsec). That was estimate contribution evidence based 2000 2007, each quintile index multiple deprivation. Results Age-adjusted Scotland, Australia Netherlands patterns. In show continuing declines; however, among period slowing down observed. very dynamic, surprisingly quickly. sustained minimal followed decline. offers strikingly example dynamism. After increase, showed sudden, sharp within few years. This occurred groups, continues. probably attributable more rather than medical For example, phase epidemic, approximately 55% fall attributed only third therapies. Because social patterning levels, contributors obtained studying levels stratified circumstances. particular opportunities detailed studies high status. resulting picture complex. flattening confined deprived groups uniform England. A marked deterioration care implausible, meaning likely explanation must factors. produced intriguing results. As expected, contributed amongst groups. Social less clear SEC suggested half treatment uptake, benefits occurring equitably across Scottish urgently needed gain Conclusions The seen many experiencing overall strongly suggests favourable reverse. rapid reversal entire recovery occur These cannot easily dismissed artefact. There strong attribute affluent appears implausible. interpretation consistent reductions randomised drug diet trials. several experienced “natural experiments” events producing beneficial effects rapidly dramatic challenge aspects causation. Specifically temporal relationship fatal outcomes operating much shorter timescales previously assumed, years decades. The findings clear: large achieved quickly, dietary other Population level interventions both powerful rapid.