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Cardiovascular screening to reduce the burden from cardiovascular disease: microsimulation study to quantify policy options

Objectives To estimate the potential impact of universal screening for primary prevention of cardiovascular disease (National Health Service Health Checks) on disease burden and socioeconomic inequalities in health in England, and to compare universal screening with alternative feasible strategies....

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Autores principales: Kypridemos, Chris, Allen, Kirk, Hickey, Graeme L, Guzman-Castillo, Maria, Bandosz, Piotr, Buchan, Iain, Capewell, Simon, O’Flaherty, Martin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group Ltd. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898640/
https://www.ncbi.nlm.nih.gov/pubmed/27279346
http://dx.doi.org/10.1136/bmj.i2793
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author Kypridemos, Chris
Allen, Kirk
Hickey, Graeme L
Guzman-Castillo, Maria
Bandosz, Piotr
Buchan, Iain
Capewell, Simon
O’Flaherty, Martin
author_facet Kypridemos, Chris
Allen, Kirk
Hickey, Graeme L
Guzman-Castillo, Maria
Bandosz, Piotr
Buchan, Iain
Capewell, Simon
O’Flaherty, Martin
author_sort Kypridemos, Chris
collection PubMed
description Objectives To estimate the potential impact of universal screening for primary prevention of cardiovascular disease (National Health Service Health Checks) on disease burden and socioeconomic inequalities in health in England, and to compare universal screening with alternative feasible strategies. Design Microsimulation study of a close-to-reality synthetic population. Five scenarios were considered: baseline scenario, assuming that current trends in risk factors will continue in the future; universal screening; screening concentrated only in the most deprived areas; structural population-wide intervention; and combination of population-wide intervention and concentrated screening. Setting Synthetic population with similar characteristics to the community dwelling population of England. Participants Synthetic people with traits informed by the health survey for England. Main outcome measure Cardiovascular disease cases and deaths prevented or postponed by 2030, stratified by fifths of socioeconomic status using the index of multiple deprivation. Results Compared with the baseline scenario, universal screening may prevent or postpone approximately 19 000 cases (interquartile range 11 000-28 000) and 3000 deaths (−1000-6000); concentrated screening 17 000 cases (9000-26 000) and 2000 deaths (−1000-5000); population-wide intervention 67 000 cases (57 000-77 000) and 8000 deaths (4000-11 000); and the combination of the population-wide intervention and concentrated screening 82 000 cases (73 000-93 000) and 9000 deaths (6000-13 000). The most equitable strategy would be the combination of the population-wide intervention and concentrated screening, followed by concentrated screening alone and the population-wide intervention. Universal screening had the least apparent impact on socioeconomic inequalities in health. Conclusions When primary prevention strategies for reducing cardiovascular disease burden and inequalities are compared, universal screening seems less effective than alternative strategies, which incorporate population-wide approaches. Further research is needed to identify the best mix of population-wide and risk targeted CVD strategies to maximise cost effectiveness and minimise inequalities.
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spelling pubmed-48986402016-06-15 Cardiovascular screening to reduce the burden from cardiovascular disease: microsimulation study to quantify policy options Kypridemos, Chris Allen, Kirk Hickey, Graeme L Guzman-Castillo, Maria Bandosz, Piotr Buchan, Iain Capewell, Simon O’Flaherty, Martin BMJ Research Objectives To estimate the potential impact of universal screening for primary prevention of cardiovascular disease (National Health Service Health Checks) on disease burden and socioeconomic inequalities in health in England, and to compare universal screening with alternative feasible strategies. Design Microsimulation study of a close-to-reality synthetic population. Five scenarios were considered: baseline scenario, assuming that current trends in risk factors will continue in the future; universal screening; screening concentrated only in the most deprived areas; structural population-wide intervention; and combination of population-wide intervention and concentrated screening. Setting Synthetic population with similar characteristics to the community dwelling population of England. Participants Synthetic people with traits informed by the health survey for England. Main outcome measure Cardiovascular disease cases and deaths prevented or postponed by 2030, stratified by fifths of socioeconomic status using the index of multiple deprivation. Results Compared with the baseline scenario, universal screening may prevent or postpone approximately 19 000 cases (interquartile range 11 000-28 000) and 3000 deaths (−1000-6000); concentrated screening 17 000 cases (9000-26 000) and 2000 deaths (−1000-5000); population-wide intervention 67 000 cases (57 000-77 000) and 8000 deaths (4000-11 000); and the combination of the population-wide intervention and concentrated screening 82 000 cases (73 000-93 000) and 9000 deaths (6000-13 000). The most equitable strategy would be the combination of the population-wide intervention and concentrated screening, followed by concentrated screening alone and the population-wide intervention. Universal screening had the least apparent impact on socioeconomic inequalities in health. Conclusions When primary prevention strategies for reducing cardiovascular disease burden and inequalities are compared, universal screening seems less effective than alternative strategies, which incorporate population-wide approaches. Further research is needed to identify the best mix of population-wide and risk targeted CVD strategies to maximise cost effectiveness and minimise inequalities. BMJ Publishing Group Ltd. 2016-06-08 /pmc/articles/PMC4898640/ /pubmed/27279346 http://dx.doi.org/10.1136/bmj.i2793 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 3.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/3.0/.
spellingShingle Research
Kypridemos, Chris
Allen, Kirk
Hickey, Graeme L
Guzman-Castillo, Maria
Bandosz, Piotr
Buchan, Iain
Capewell, Simon
O’Flaherty, Martin
Cardiovascular screening to reduce the burden from cardiovascular disease: microsimulation study to quantify policy options
title Cardiovascular screening to reduce the burden from cardiovascular disease: microsimulation study to quantify policy options
title_full Cardiovascular screening to reduce the burden from cardiovascular disease: microsimulation study to quantify policy options
title_fullStr Cardiovascular screening to reduce the burden from cardiovascular disease: microsimulation study to quantify policy options
title_full_unstemmed Cardiovascular screening to reduce the burden from cardiovascular disease: microsimulation study to quantify policy options
title_short Cardiovascular screening to reduce the burden from cardiovascular disease: microsimulation study to quantify policy options
title_sort cardiovascular screening to reduce the burden from cardiovascular disease: microsimulation study to quantify policy options
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898640/
https://www.ncbi.nlm.nih.gov/pubmed/27279346
http://dx.doi.org/10.1136/bmj.i2793
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