在 COVID-19 大流行之前和期间，贫困社区初级保健中的心血管相关疾病和危险因素：英格兰北部的一项观察性研究。

Cardiovascular-related conditions and risk factors in primary care for deprived communities before and during the COVID-19 pandemic: an observational study in Northern England.

机构信息

Population Health Sciences Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK

NIHR Applied Research Collaboration North East North Cumbria, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.

出版信息

BMJ Open. 2022 Nov 22;12(11):e066868. doi: 10.1136/bmjopen-2022-066868.

DOI:10.1136/bmjopen-2022-066868

PMID:36414311

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9684275/

Abstract

OBJECTIVES

The North East of England, ranked as having the highest poverty levels and the lowest health outcomes, has the highest cardiovascular disease (CVD) premature mortality. This study aimed to compare CVD-related conditions and risk factors for deprived practice populations with other general practice (GP) populations in Northern England to England overall, before and during COVID-19 to identify changes in recorded CVD-related risk factors and conditions and evidence-based lipid prescribing behaviour.

DESIGN

A population-based observational study of aggregated practice-level data obtained from publicly accessible data sets.

SETTING

34 practices that fall into the 15% most deprived practice populations in England were identified as the most deprived communities in the North East and North Cumbria (Deep End).

PARTICIPANTS

Patients aged ≥16 registered with GP and diagnosed with any form of CVD.

PRIMARY AND SECONDARY OUTCOME MEASURES

CVD-related conditions and risk factors, statin prescribing.

RESULTS

Deep End (n=263 830) had a smaller, younger and more deprived population with lower levels of employment and full-time education and higher smoking prevalence. They had some higher recorded CVD-related conditions than England but lower than the non-Deep End. Atrial fibrillation (-0.9, -0.5), hypertension (-3.7, -1.3) and stroke and transient ischaemic attack rates (-0.5, -0.1) appeared to be lower in the Deep End than in the non-Deep End but the optimal statin prescribing rate was higher (3.1, 8.2) than in England.

CONCLUSION

Recorded CVD-related risk factors and conditions remained comparable before and during COVID-19. These are higher in the Deep End than in England and similar or lower than the non-Deep End, with a higher optimal statin prescribing rate. However, it was not possible to control for age and sex. More work is needed to estimate the consequences of the pandemic on disadvantaged communities and to compare whether the findings are replicated in other areas of deprivation.

摘要

目的

英格兰东北部的贫困水平最高，健康状况最差，心血管疾病（CVD）的过早死亡率也最高。本研究旨在比较英格兰东北部和北部坎布里亚（Deep End）的贫困社区与英格兰其他地区的一般实践（GP）人群的 CVD 相关疾病和风险因素，以确定 COVID-19 前后记录的 CVD 相关风险因素和疾病的变化以及基于证据的降脂药物处方行为。

设计

一项基于人群的观察性研究，使用从公开可获得的数据集获得的汇总实践水平数据。

设置

从英格兰 15%最贫困的实践人群中确定的 34 个实践被认为是英格兰东北部和北部坎布里亚（Deep End）的最贫困社区。

参与者

年龄≥16 岁并患有任何形式 CVD 的登记在 GP 并诊断出患有任何形式 CVD 的患者。

主要和次要结果

CVD 相关疾病和风险因素、他汀类药物的处方。

结果

Deep End（n=263830）的人口规模较小，年龄较小，人口更贫困，就业率和全日制教育水平较低，吸烟率较高。与英格兰相比，他们记录的一些 CVD 相关疾病较高，但低于非 Deep End。与非 Deep End 相比，心房颤动（-0.9，-0.5）、高血压（-3.7，-1.3）和中风和短暂性脑缺血发作率（-0.5，-0.1）似乎较低，但最佳他汀类药物处方率较高（3.1，8.2）高于英格兰。

结论

在 COVID-19 之前和期间，记录的 CVD 相关风险因素和疾病仍然相似。与英格兰相比，Deep End 的这些疾病更高，但与非 Deep End 相比，相似或更低，且最佳他汀类药物处方率更高。然而，无法控制年龄和性别。需要做更多的工作来估计大流行对贫困社区的影响，并比较这些发现是否在其他贫困地区得到复制。