Explaining trends in Scottish coronary heart disease mortality between 2000 and 2010 using IMPACTSEC model:...

Area of Science:

• Cardiovascular epidemiology
• Public health policy
• Health economics

Background:

• Coronary heart disease (CHD) remains a leading cause of mortality globally.
• Understanding the drivers of CHD mortality trends is crucial for effective public health interventions.
• Scotland has experienced significant declines in CHD mortality in recent decades.

Purpose of the Study:

• To quantify the respective contributions of medical treatments and risk factor modifications to the decline in CHD mortality in Scotland.
• To assess the equity of these contributions across different socioeconomic groups.

Main Methods:

• Retrospective analysis utilizing the validated IMPACTSEC policy model.
• Apportionment of CHD mortality decline to changes in cardiovascular risk factors and over 40 medical treatments.
• Analysis stratified by sex, age group, and socioeconomic status (Scottish Index of Multiple Deprivation).

Main Results:

• CHD mortality in Scotland fell by 43% between 2000 and 2010, preventing 5770 deaths.
• Improved medical treatments accounted for approximately 43% of this decline, distributed equitably across socioeconomic groups.
• Risk factor improvements contributed 39%, with significant reductions in systolic blood pressure, total cholesterol, and smoking; however, increases in obesity and diabetes partially offset these gains, particularly in deprived areas.

Conclusions:

• Medical advancements and treatments were major drivers of reduced CHD mortality in Scotland, delivered equitably.
• Population-wide risk factor improvements, especially blood pressure reduction, were substantial but undermined by rising obesity and diabetes.
• Urgent, population-wide interventions are required to address future CHD mortality and health inequalities.