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Modelling coronary heart disease mortality in Northern Ireland between 1987 and 2007: broader lessons for prevention
John Hughes1, Frank Kee, Martin O'Flaherty
1Queen's University, Belfast, UK. john.hughes@qub.ac.uk
Insights
Cardiovascular risk factor changes accounted for 60% of the coronary heart disease mortality decline in Northern Ireland, while treatments contributed 35%. Rising diabetes and obesity rates are a concern.
Area of Science:
- Cardiovascular epidemiology
- Public health research
- Health services research
Background:
- Coronary heart disease (CHD) mortality has seen significant declines in many developed nations.
- Understanding the drivers of these declines is crucial for public health policy and intervention strategies.
- Northern Ireland experienced a notable reduction in CHD mortality between 1987 and 2007.
Purpose of the Study:
- To determine the proportion of CHD mortality decline attributable to medical/surgical treatments.
- To quantify the impact of changes in population cardiovascular risk factors on CHD mortality.
- To analyze trends in risk factors and their contribution to mortality reduction in Northern Ireland.
Main Methods:
- Utilized the IMPACT mortality model to integrate data from various sources.
- Incorporated data on treatment uptake, effectiveness, and population risk factor trends (1987-2007).
- Data sources included mortality statistics, hospital records, primary care data, surveys, and published literature.
Main Results:
- CHD mortality decreased by 52% in men and 60% in women (aged 25-84) between 1987 and 2007.
- This decline represented 3180 fewer deaths in 2007 compared to 1987 rates.
- Risk factor changes explained approximately 60% of the decline, with treatments accounting for 35%.
Conclusions:
- Major cardiovascular risk factor changes were the primary driver of CHD mortality reduction.
- Medical and surgical treatments played a significant, but secondary, role in the observed decline.
- Adverse trends in diabetes, obesity, and physical inactivity pose a significant future concern for cardiovascular health.
Aims:
To quantify how much of the coronary heart disease (CHD) mortality decline in Northern Ireland between 1987 and 2007 could be attributed to medical and surgical treatments and how much to changes in population cardiovascular risk factors.
Methods And Results:
The IMPACT mortality model was used to integrate data on uptake and effectiveness of cardiological treatments and risk factor trends in the Northern Ireland population between 1987 and 2007. The main data sources were official population and mortality statistics, hospital administration systems, primary care datasets, published trials and meta-analyses, clinical audits, and national surveys. Between 1987 and 2007, CHD mortality rates in Northern Ireland decreased by 52% in men and 60% in women aged 25-84 years. This resulted in 3180 fewer deaths in 2007 than expected if 1987 mortality rates had persisted. Approximately 35% of this decrease was attributed to increased uptake of treatments in individuals and 60% to population risk factor reductions (principally blood pressure, total cholesterol, and smoking); however, these reductions were partially offset by adverse trends in diabetes, physical inactivity, and obesity.
Conclusion:
Approximately 60% of the substantial CHD mortality decline in Northern Ireland between 1987 and 2007 was attributable to major cardiovascular risk factor changes and approximately 35% was attributable to treatments. However, adverse trends in diabetes, obesity, and physical inactivity are of major concern.
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