Public Health Policy Evaluation Unit, Imperial College London, London, UK.
Department of Primary Care and Public Health, Imperial College London, London, UK.
J Epidemiol Community Health. 2019 Jan;73(1):11-18. doi: 10.1136/jech-2018-210961. Epub 2018 Oct 3.
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.
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.
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).
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.
我们评估了一项大型的全国心血管疾病（CVD）风险评估和管理计划对（1）高血压、2 型糖尿病（T2D）和慢性肾脏病（CKD）的早期发现以及（2）高危人群的整体 CVD 风险管理方面的社会人口学群体不平等的影响。
我们从临床实践研究数据链中获取了 2009 年至 2013 年间年龄在 40-74 岁之间、无已知 CVD 或糖尿病的 138788 例随机抽样患者的回顾性电子病历，这些患者在 462 个实践中注册。我们使用差异-差异匹配分析来估计计划的影响，该分析比较了参与者和非参与者在不同时间点的结果变化。
NHS 健康检查的出勤率为 21.4%（29672/138788）。与女性相比，男性中高血压和 T2D 的新发病例数明显更多（例如，男性高血压和 T2D 的新发病例数分别增加了 4.02%、95%置信区间为 3.65%至 4.39%和 2.08%、1.81%至 2.35%）。在最贫困地区居住的参与者中，T2D 的新发病例数明显更多，但在社会经济群体中，高血压和 CKD 没有差异。在社会人口亚组中，没有观察到 CVD 风险管理的重大差异（例如，10 年 CVD 风险评分的计划影响在男性参与者中为-1.13%、-1.48%至-0.78%，在女性参与者中为-1.53%、-2.36%至-0.71%）。
在 2009-2013 年期间，该计划的出勤率较低，对疾病的早期发现和风险管理的总体影响较小。年龄、性别和社会经济亚组似乎获得了相似水平的收益，使现有不平等状况保持不变。这些发现强调了开展全民干预措施以解决 CVD 结局不平等问题的重要性。
