Department of Health Sciences, University of Leicester, 22-28 Princess Rd W, Leicester LE1 6TP, England.
JAMA. 2010 Nov 10;304(18):2028-34. doi: 10.1001/jama.2010.1636.
The goal of US health care reform is to extend access. In England, with a universal access health system, coronary heart disease (CHD) mortality rates have decreased by more than two-fifths in the last decade, but variations in rates between local populations persist.
To identify which features of populations and primary health care explain variations in CHD mortality rates between the 152 primary care trust populations in England.
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study in England of all 152 primary care trusts (total registered population, 54.3 million in 2008) using a hierarchical regression model with age-standardized CHD mortality rate as the dependent variable, and population characteristics (index of multiple deprivation, smoking, ethnicity, and registers of individuals with diabetes) and service characteristics (level of provision of primary care services, levels of detected hypertension, pay for performance data) as candidate explanatory variables.
Age-standardized CHD mortality rates in 2006, 2007, and 2008.
The mean age-standardized CHD mortality rates per 100,000 European Standard Population were 97.9 (95% confidence interval [CI], 94.9-100.9) in 2006, 93.5 (95% CI, 90.4-96.5) in 2007, and 88.4 (95% CI, 85.7-91.1) in 2008. In all 3 years, 4 population characteristics were significantly positively associated with CHD mortality (index of multiple deprivation, smoking, white ethnicity, and registers of individuals with diabetes), and 1 service characteristic (levels of detected hypertension) was significantly negatively associated with CHD mortality (adjusted r(2) = 0.66 in 2006, adjusted r(2) = 0.68 in 2007, and adjusted r(2) = 0.67 in 2008). Other service characteristics did not contribute significantly to the model.
In England, variations in CHD mortality are predominantly explained by population characteristics; however, greater detection of hypertension is associated with lower CHD mortality.
美国医疗改革的目标是扩大医疗服务的可及性。在英国，全民医保体系（universal access health system）建立后，过去十年间，冠心病死亡率下降了超过五分之二，但当地人群之间的死亡率差异依然存在。
确定英国 152 个基层医疗信托机构（primary care trust）的人群特征和初级医疗保健服务特征，哪些因素可以解释冠心病死亡率的差异。
设计、地点和参与者：本研究为英格兰 152 个基层医疗信托机构的横断面研究（总注册人口为 2008 年的 5430 万），使用分层回归模型，以年龄标准化冠心病死亡率为因变量，人口特征（多重剥夺指数、吸烟、种族和糖尿病患者登记）和服务特征（初级保健服务水平、检出高血压水平、绩效付费数据）为候选解释变量。
2006、2007 和 2008 年的年龄标准化冠心病死亡率。
2006 年、2007 年和 2008 年每 10 万欧洲标准人口的平均年龄标准化冠心病死亡率分别为 97.9（95%置信区间，94.9-100.9）、93.5（95%置信区间，90.4-96.5）和 88.4（95%置信区间，85.7-91.1）。在所有 3 年中，有 4 个人口特征与冠心病死亡率呈显著正相关（多重剥夺指数、吸烟、白种人、糖尿病患者登记），1 项服务特征（检出高血压水平）与冠心病死亡率呈显著负相关（2006 年调整 r²=0.66，2007 年调整 r²=0.68，2008 年调整 r²=0.67）。其他服务特征对模型的贡献不显著。
在英国，冠心病死亡率的差异主要由人口特征决定；然而，高血压检出率的提高与冠心病死亡率的降低有关。
