Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal; Department of Epidemiology of the Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal.
Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal; Department of Epidemiology of the Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisboa, Portugal; Centro de Investigação em Saúde Pública - ENSP-UNL, Lisboa, Portugal.
Rev Port Cardiol (Engl Ed). 2020 Jan;39(1):27-34. doi: 10.1016/j.repc.2019.05.010. Epub 2020 Mar 3.
Every year cardiovascular disease (CVD) causes 3.9 million deaths in Europe. Portugal has implemented a set of public health policies to tackle CVD mortality: a smoking ban in 2008, a salt reduction regulation in 2010 and the coronary fast-track system (FTS) for acute coronary syndrome (ACS) in 2007. Our goal in this study was to analyze the impact of these three public health policies in reducing case-fatality rates from ACS between 2000 and 2016.
The impact of these policies on monthly ACS case-fatalities was assessed by creating individual models for each of the initiatives and implementing multiple linear regression analysis, using standard methods for interrupted time series. We also implemented segmented regression analysis to test which year showed a significant difference in the case-fatality slopes.
Separate modeling showed that the smoking ban (beta=-0.861, p=0.050) and the FTS (beta=-1.27, p=0.003) had an immediate impact after implementation, but did not have a significant impact on ACS trends. The salt reduction regulation did not have a significant impact. For the segmented model, we found significant differences between case-fatality trends before and after 2009, with rates before 2009 showing a steeper decrease.
The smoking ban and the FTS led to an immediate decrease in case-fatality rates; however, after 2009 no major decrease in case-fatality trends was found. Coronary heart disease constitutes an immense public health problem and it remains essential for decision-makers, public health authorities and the cardiology community to keep working to reduce ACS mortality rates.
每年，心血管疾病（CVD）在欧洲导致 390 万人死亡。葡萄牙已经实施了一系列公共卫生政策来解决 CVD 死亡率问题：2008 年禁烟，2010 年减盐法规以及 2007 年急性冠状动脉综合征（ACS）的冠状动脉快速通道系统（FTS）。我们在这项研究中的目标是分析这三项公共卫生政策在降低 2000 年至 2016 年 ACS 病死率方面的影响。
通过为每项举措创建单独的模型，并使用中断时间序列的标准方法实施多元线性回归分析，评估这些政策对每月 ACS 病死率的影响。我们还实施了分段回归分析，以测试哪一年的病死率斜率有显著差异。
单独建模表明，禁烟（β=-0.861，p=0.050）和 FTS（β=-1.27，p=0.003）在实施后立即产生影响，但对 ACS 趋势没有显著影响。减盐法规没有产生显著影响。对于分段模型，我们发现病死率趋势在 2009 年前后存在显著差异，2009 年之前的病死率呈更陡峭下降趋势。
禁烟和 FTS 导致病死率立即下降；然而，2009 年之后，病死率趋势没有发现明显下降。冠心病构成了巨大的公共卫生问题，决策者、公共卫生当局和心脏病学社区仍然必须努力降低 ACS 死亡率。
