Effect of cardiovascular prevention strategies on incident coronary disease hospitalisation rates in Spain; an ecological time series analysis

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dc.contributor.author Medrano, María José
dc.contributor.author Alcalde-Cabero, Enrique
dc.contributor.author Ortíz, Cristina
dc.contributor.author Galán, Iñaki
dc.contributor.other UAM.Departamento de Medicina Preventiva y Salud Pública y Microbiología es_ES
dc.date.accessioned 2015-01-09T09:25:19Z
dc.date.available 2015-01-09T09:25:19Z
dc.date.issued 2014-03-04
dc.identifier.citation BMJ Open 4.2 (2014): e004257 en_US
dc.identifier.issn 2044-6055 es_ES
dc.identifier.uri http://hdl.handle.net/10486/663015
dc.description.abstract Objective: To assess the overall population impact of primary prevention strategies (promotion of healthy lifestyles, prevention of smoking and use of vascular risk drug therapy) of coronary disease in Spain. Design: Ecological time series analysis, 1982–2009. Setting: All public and private hospitals in Spain. Participants: General population. Outcome: Incident coronary disease hospitalisation as derived from official hospital discharge data. Methods: Annual hospitalisation rates were modelled according to nationwide use of statins, antihypertensive, antidiabetic and antiplatelet drugs, and prevalences of smoking, obesity and overweight. Additive generalised models and mixed Poisson regression models were used for the purpose, taking year as the random-effect variable and adjusting for age, sex, prevalence of vascular risk factors and the number of hospital beds in intensive and coronary care units. Results: Across 28 years and 671.5 million personyears of observation, there were 2 986 834 hospitalisations due to coronary disease; of these, 1 441 980 (48.28%) were classified as incident. Hospitalisation rates increased from 1982 to 1996, with an inflection point in 1997 and a subsequent 52% decrease until 2009. Prevalences of smoking, obesity, overweight and use of vascular risk drug therapy were significantly associated with hospitalisation rates (p<0.001): incidence rates ratios (95% CI) for the fourth versus the first quartile were 1.46 (1.42 to 1.50), 1.80 (1.78 to 1.83), 1.58 (1.55 to 1.60) and 0.57 (0.51 to 0.63), respectively. These variables accounted for 92% of interannual variability. Conclusions: After decades of continuous rises, hospitalisation due to incident ischaemic heart disease has been cut by half, an achievement associated with the decline in smoking and the increase in vascular risk drug therapy. These results indicate that these two primary prevention strategies have been effective at a population level, thanks to an appropriate balance between financial and health goals, something that should be left intact despite the current economic crisis. Future strategies ought to lay special stress on excessive body weight prevention en_US
dc.description.sponsorship This study was supported by Independent Clinical Research grant EC11-282 from the Ministry of Health, Social Services & Equality en_US
dc.format.extent 10 pag. en
dc.format.mimetype application/pdf en
dc.language.iso eng en
dc.publisher BMJ Publishing Group en_US
dc.relation.ispartof BMJ Open en_US
dc.subject.other Cardiovascular prevention strategies en_US
dc.subject.other Coronary disease hospitalisation en_US
dc.subject.other Epidemiology en_US
dc.subject.other Public Health en_US
dc.title Effect of cardiovascular prevention strategies on incident coronary disease hospitalisation rates in Spain; an ecological time series analysis en_US
dc.type article en
dc.subject.eciencia Medicina es_ES
dc.relation.publisherversion http://dx.doi.org/:10.1136/bmjopen-2013-004257 es_ES
dc.identifier.doi 10.1136/bmjopen-2013-004257 es_ES
dc.identifier.publicationfirstpage e004257 es_ES
dc.identifier.publicationissue 2 es_ES
dc.identifier.publicationlastpage e004257 es_ES
dc.identifier.publicationvolume 4 es_ES
dc.type.version info:eu-repo/semantics/publishedVersion en
dc.rights.cc Reconocimiento – NoComercial es_ES
dc.rights.accessRights openAccess en
dc.authorUAM Galán Labaca, Ignacio (262111)

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