Population characteristics explain regional CHD mortality rate variation
MedWire News: Marked regional variations in coronary heart disease (CHD) mortality rates currently exist across England and are primarily due to differences in population characteristics, UK researchers report.
More specifically, areas with high proportions of White individuals and smokers, and high levels of diabetes and socioeconomic deprivation appear to associate with high levels of CHD mortality at Primary Care Trust (PCT) level, explain the team of researchers in JAMA.
"10% of the variation was also explained by how successful primary care services are at detecting people who have high blood pressure (BP)," commented lead researcher Steve Levene from the University of Leicester.
Levene and colleagues assessed age-standardized CHD mortality rates in all 152 PCTs in England in 2006, 2007, and 2008, in order to analyze the contribution of primary health care services and population characteristics to regional CHD mortality variations.
Over these 3 years, the team noted a decline in the mean overall CHD mortality rate, from 97.9 to 88.4 CHD-related deaths per 100,000 European Standard Population.
"This represents a decrease of approximately 5 per 100,000 population per year over the 3 years," say Levene and co-authors.
They also observed wide variations in CHD mortality rates across the different PCTS, with the highest rates (more than 3 standard deviations [SDs] higher than the mean) found in Blackburn and Tameside PCTs in 2007 and 2008, respectively, and lowest rates (less than 3 SDs lower than the mean) in Kensington and Chelsea PCT throughout the 3 years.
Primary care provision, determined by numbers of staff per 100,000 population, and clinical performance, determined by quality and outcomes framework indicator scores, did not associate with CHD mortality rates of each PCT.
However, an inverse and significant association was identified between the numbers of adults recorded in hypertension registers of practices in each PCT and CHD mortality rates.
And there was a strong positive association between CHD mortality rate and levels of socioeconomic deprivation, diabetes, White ethnicity, and smoking.
Levene and colleagues conclude: "A population orientation may be important in promoting further declines in CHD mortality rates.
"The extent to which primary health care services can affect these population factors is not certain."
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By Lauretta Ihonor