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Effect of cardiovascular prevention strategies on incident coronary disease hospitalisation rates in Spain; an ecological time series analysis.

Medrano MJ, Alcalde-Cabero E, Ortíz C, Galán I - BMJ Open (2014)

Bottom Line: Hospitalisation rates increased from 1982 to 1996, with an inflection point in 1997 and a subsequent 52% decrease until 2009.Prevalences of smoking, obesity, overweight and use of vascular risk drug therapy were significantly associated with hospitalisation rates (p<0.001): incidence rates ratios (95% CI) for the fourth versus the first quartile were 1.46 (1.42 to 1.50), 1.80 (1.78 to 1.83), 1.58 (1.55 to 1.60) and 0.57 (0.51 to 0.63), respectively.After decades of continuous rises, hospitalisation due to incident ischaemic heart disease has been cut by half, an achievement associated with the decline in smoking and the increase in vascular risk drug therapy.

View Article: PubMed Central - PubMed

Affiliation: National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain.

ABSTRACT

Objective: To assess the overall population impact of primary prevention strategies (promotion of healthy lifestyles, prevention of smoking and use of vascular risk drug therapy) of coronary disease in Spain.

Design: Ecological time series analysis, 1982-2009.

Setting: All public and private hospitals in Spain.

Participants: General population.

Outcome: Incident coronary disease hospitalisation as derived from official hospital discharge data.

Methods: Annual hospitalisation rates were modelled according to nationwide use of statins, antihypertensive, antidiabetic and antiplatelet drugs, and prevalences of smoking, obesity and overweight. Additive generalised models and mixed Poisson regression models were used for the purpose, taking year as the random-effect variable and adjusting for age, sex, prevalence of vascular risk factors and the number of hospital beds in intensive and coronary care units.

Results: Across 28 years and 671.5 million person-years of observation, there were 2 986 834 hospitalisations due to coronary disease; of these, 1 441 980 (48.28%) were classified as incident. Hospitalisation rates increased from 1982 to 1996, with an inflection point in 1997 and a subsequent 52% decrease until 2009. Prevalences of smoking, obesity, overweight and use of vascular risk drug therapy were significantly associated with hospitalisation rates (p<0.001): incidence rates ratios (95% CI) for the fourth versus the first quartile were 1.46 (1.42 to 1.50), 1.80 (1.78 to 1.83), 1.58 (1.55 to 1.60) and 0.57 (0.51 to 0.63), respectively. These variables accounted for 92% of interannual variability.

Conclusions: After decades of continuous rises, hospitalisation due to incident ischaemic heart disease has been cut by half, an achievement associated with the decline in smoking and the increase in vascular risk drug therapy. These results indicate that these two primary prevention strategies have been effective at a population level, thanks to an appropriate balance between financial and health goals, something that should be left intact despite the current economic crisis. Future strategies ought to lay special stress on excessive body weight prevention.

No MeSH data available.


Related in: MedlinePlus

Annual trends in explanatory variables and incident ischaemic heart disease hospitalisation rates.
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BMJOPEN2013004257F1: Annual trends in explanatory variables and incident ischaemic heart disease hospitalisation rates.

Mentions: The annual age-adjusted incident IHD hospitalisation rates per 100 000, which are depicted graphically in figure 1, show a rise from 1982 to 1996, a sharp inflection in 1997 and a subsequent cumulative decrease of 52% until 2009 (53.5% and 49.6% in men and women, respectively). The decline was constant throughout the period, with a slight increase in 2000, coinciding with the change in the definition of IHD. The distribution by sex of the incidence rates changed across the study period, with a decrease in the male/female ratio from 3.3 to 2.4.


Effect of cardiovascular prevention strategies on incident coronary disease hospitalisation rates in Spain; an ecological time series analysis.

Medrano MJ, Alcalde-Cabero E, Ortíz C, Galán I - BMJ Open (2014)

Annual trends in explanatory variables and incident ischaemic heart disease hospitalisation rates.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927998&req=5

BMJOPEN2013004257F1: Annual trends in explanatory variables and incident ischaemic heart disease hospitalisation rates.
Mentions: The annual age-adjusted incident IHD hospitalisation rates per 100 000, which are depicted graphically in figure 1, show a rise from 1982 to 1996, a sharp inflection in 1997 and a subsequent cumulative decrease of 52% until 2009 (53.5% and 49.6% in men and women, respectively). The decline was constant throughout the period, with a slight increase in 2000, coinciding with the change in the definition of IHD. The distribution by sex of the incidence rates changed across the study period, with a decrease in the male/female ratio from 3.3 to 2.4.

Bottom Line: Hospitalisation rates increased from 1982 to 1996, with an inflection point in 1997 and a subsequent 52% decrease until 2009.Prevalences of smoking, obesity, overweight and use of vascular risk drug therapy were significantly associated with hospitalisation rates (p<0.001): incidence rates ratios (95% CI) for the fourth versus the first quartile were 1.46 (1.42 to 1.50), 1.80 (1.78 to 1.83), 1.58 (1.55 to 1.60) and 0.57 (0.51 to 0.63), respectively.After decades of continuous rises, hospitalisation due to incident ischaemic heart disease has been cut by half, an achievement associated with the decline in smoking and the increase in vascular risk drug therapy.

View Article: PubMed Central - PubMed

Affiliation: National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain.

ABSTRACT

Objective: To assess the overall population impact of primary prevention strategies (promotion of healthy lifestyles, prevention of smoking and use of vascular risk drug therapy) of coronary disease in Spain.

Design: Ecological time series analysis, 1982-2009.

Setting: All public and private hospitals in Spain.

Participants: General population.

Outcome: Incident coronary disease hospitalisation as derived from official hospital discharge data.

Methods: Annual hospitalisation rates were modelled according to nationwide use of statins, antihypertensive, antidiabetic and antiplatelet drugs, and prevalences of smoking, obesity and overweight. Additive generalised models and mixed Poisson regression models were used for the purpose, taking year as the random-effect variable and adjusting for age, sex, prevalence of vascular risk factors and the number of hospital beds in intensive and coronary care units.

Results: Across 28 years and 671.5 million person-years of observation, there were 2 986 834 hospitalisations due to coronary disease; of these, 1 441 980 (48.28%) were classified as incident. Hospitalisation rates increased from 1982 to 1996, with an inflection point in 1997 and a subsequent 52% decrease until 2009. Prevalences of smoking, obesity, overweight and use of vascular risk drug therapy were significantly associated with hospitalisation rates (p<0.001): incidence rates ratios (95% CI) for the fourth versus the first quartile were 1.46 (1.42 to 1.50), 1.80 (1.78 to 1.83), 1.58 (1.55 to 1.60) and 0.57 (0.51 to 0.63), respectively. These variables accounted for 92% of interannual variability.

Conclusions: After decades of continuous rises, hospitalisation due to incident ischaemic heart disease has been cut by half, an achievement associated with the decline in smoking and the increase in vascular risk drug therapy. These results indicate that these two primary prevention strategies have been effective at a population level, thanks to an appropriate balance between financial and health goals, something that should be left intact despite the current economic crisis. Future strategies ought to lay special stress on excessive body weight prevention.

No MeSH data available.


Related in: MedlinePlus