Did it fall or was it pushed? The contribution of trends in established risk factors to the decline in premature coronary heart disease mortality in New Zealand

被引:30
作者
Tobias, Martin [1 ]
Taylor, Richard [2 ]
Yeh, Li-Chia [1 ]
Huang, Ken [1 ]
Mann, Stewart [3 ]
Sharpe, Norman [4 ]
机构
[1] Minist Hlth, Publ Hlth Intelligence, Wellington, New Zealand
[2] Univ Queensland, Dept Publ Hlth, St Lucia, Qld 4067, Australia
[3] Univ Otago, Wellington Sch Med & Hlth Sci, Christchurch, New Zealand
[4] Natl Heart Fdn New Zealand, Christchurch, New Zealand
关键词
risk factor; coronary heart disease; New Zealand;
D O I
10.1111/j.1753-6405.2008.00186.x
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 [公共卫生与预防医学]; 120402 [社会医学与卫生事业管理];
摘要
Objective: To estimate the contribution of trends in three risk factors - systolic blood pressure (SBP), total blood cholesterol (TBC) and cigarette smoking - to the decline in premature coronary heart disease (CHD) mortality in New Zealand from 1980-2004. Method: Risk factor prevalence data by 10-year age group (35-64 years) and sex was sourced from six national or Auckland regional health surveys and three population censuses (the latter only for smoking). The data were smoothed using two-point moving averages, then further smoothed by fitting quadratic regression equations (SBP and TBC) or splines (smoking). Risk factor/CHD mortality hazard ratios estimated by expert working groups for the World Health Organization Global Burden of Disease Study 2001 were used to translate average annual changes in risk factor prevalences to the corresponding percentage changes in premature CHD mortality. The expected trends in CHD mortality were then compared with the observed trend to estimate the contribution of each risk factor to the decline. Findings: Approximately 80% (73% for males, 87% for females) of the decline in premature CHD mortality from 1980 to 2004 is estimated to have resulted from the joint trends in population SBP and TBC distributions and smoking prevalence. Overall, approximately 42%, 36% and 22% of the joint risk factor effect was contributed by trends in SBP, TBC and smoking respectively. Conclusion: Our estimate for the joint risk factor contribution to the CHD mortality decline of 80% exceeds those of two earlier New Zealand studies, but agrees closely with a similar Australian study. This provides an indicator of the scope that still remains for further reduction in CHD mortality through primary and secondary prevention.
引用
收藏
页码:117 / 125
页数:9
相关论文
共 39 条
[1]
[Anonymous], 2004, COMP QUANTIFICATION
[2]
[Anonymous], 1999, TAK PULS 1996 97 NZ
[3]
[Anonymous], FOOD NUTR MON REP 20
[4]
*AS PAC COH STUD C, 2003, INT J EPIDEMIOL, V21, P707
[5]
Health consequences of smoking 1-4 cigarettes per day [J].
Bjartveit, K ;
Tverdal, A .
TOBACCO CONTROL, 2005, 14 (05) :315-320
[6]
Contribution of modern cardiovascular treatment and risk factor changes to the decline in coronary heart disease mortality in Scotland between 1975 and 1994 [J].
Capewell, S ;
Morrison, CE ;
McMurray, JJ .
HEART, 1999, 81 (04) :380-386
[7]
Explanation for the decline in coronary heart disease mortality rates in Auckland, New Zealand, between 1982 and 1993 [J].
Capewell, S ;
Beaglehole, R ;
Seddon, M ;
McMurray, J .
CIRCULATION, 2000, 102 (13) :1511-1516
[8]
2005 presidential address: Diabetes: Past, present, and future [J].
Cherrington, Alan D. .
DIABETES CARE, 2006, 29 (09) :2158-2164
[9]
Substantial potential for reductions in coronary heart disease mortality in the UK through changes in risk factor levels [J].
Critchley, JA ;
Capewell, S .
JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, 2003, 57 (04) :243-247
[10]
Changing patterns of coronary heart disease in the hunter region of New South Wales, Australia [J].
Dobson, AJ ;
McElduff, P ;
Heller, R ;
Alexander, H ;
Colley, P ;
D'Este, K .
JOURNAL OF CLINICAL EPIDEMIOLOGY, 1999, 52 (08) :761-771