[Development of a tool for assessment of local government health policy]

A tool was developed for assessment of health status in communities to help formulate health policy of local governments and allow estimates of magnitude of changes in mortality with modification of selected risk variables.

A total of 25,201 men and 51,776 women aged 40-69 years who underwent health checkups in Ibaraki-ken, Japan, in 1993 were followed through 2002. Risk ratios for all cause, cardiovascular disease, cerebrovascular disease, ischemic heart disease, all cancer, and lung cancer deaths were calculated according to smoking, heavy alcohol consumption, obesity, hypertension, hypercholesterolemia, low high-density lipoprotein cholesterol, and diabetes using a Cox proportional hazards model. Regression coefficients for body mass index, systolic blood pressure, serum total cholesterol, serum high-density lipoprotein cholesterol, and plasma glucose were also calculated by the model with quadratic terms. On the basis of the results, we developed a tool using Microsoft EXCEL, allowing estimation of the magnitude of changes in death rates according to variation in mean and standard deviation values for risk factors by impact fraction.

The developed tool facilitates estimation of magnitude of changes in death rates with alteration in exposure rates and means/standard deviations of risk variables with intervention. The best magnitude of decline for all cause mortality with a 50% reduction of exposure to smoking was 10% in men. The magnitudes of decline in cardiovascular disease mortality with a 50% reduction in hypertension were 12% in men and 11% in women. Furthermore, the magnitude of decline in cardiovascular disease mortality if a 10% lowering of mean systolic blood pressure were achieved would be 22% in men and 18% in women.

Our developed tool may be useful to assess health status in communities with cooperation between municipal and prefectural governments.