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Impact of the NHS Health Check on inequalities in cardiovascular disease risk: a difference-in-differences matching analysis

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Title: Impact of the NHS Health Check on inequalities in cardiovascular disease risk: a difference-in-differences matching analysis
Authors: Chang, C
Vamos, E
Palladino, R
Majeed, A
Lee, T
Millett, C
Item Type: Journal Article
Abstract: Background We assessed impacts of a large, nationwide cardiovascular disease (CVD) risk assessment and management programme on sociodemographic group inequalities in (1) early identification of hypertension, type 2 diabetes (T2D) and chronic kidney disease (CKD); and (2) management of global CVD risk among high-risk individuals. Methods We obtained retrospective electronic medical records from the Clinical Practice Research Datalink for a randomly selected sample of 138 788 patients aged 40–74 years without known CVD or diabetes, who were registered with 462 practices between 2009 and 2013. We estimated programme impact using a difference-in-differences matching analysis that compared changes in outcome over time between attendees and non-attendees. Results National Health Service Health Check attendance was 21.4% (29 672/138 788). A significantly greater number of hypertension and T2D incident cases were identified in men than women (eg, an additional 4.02%, 95% CI 3.65% to 4.39%, and 2.08%, 1.81% to 2.35% cases of hypertension in men and women, respectively). A significantly greater number of T2D incident cases were identified among attendees living in the most deprived areas, but no differences were found for hypertension and CKD across socioeconomic groups. No major differences in CVD risk management were observed between sociodemographic subgroups (eg, programme impact on 10-year CVD risk score was −1.13%, −1.48% to −0.78% in male and −1.53%, −2.36% to −0.71% in female attendees). Conclusion During 2009–2013, the programme had low attendance and small overall impacts on early identification of disease and risk management. The age, sex and socioeconomic subgroups appeared to have derived similar level of benefits, leaving existing inequalities unchanged. These findings highlight the importance of population-wide interventions to address inequalities in CVD outcomes.
Issue Date: 3-Oct-2018
Date of Acceptance: 31-Aug-2018
URI: http://hdl.handle.net/10044/1/63997
DOI: https://dx.doi.org/10.1136/jech-2018-210961
ISSN: 0143-005X
Publisher: BMJ Publishing Group
Start Page: 11
End Page: 18
Journal / Book Title: Journal of Epidemiology and Community Health
Volume: 73
Copyright Statement: © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Sponsor/Funder: Department of Health
Funder's Grant Number: 009/0051
Keywords: cardiovascular disease
health inequalities
health services
prevention
screening
1117 Public Health And Health Services
1604 Human Geography
Epidemiology
Publication Status: Submitted
Online Publication Date: 2018-10-03
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care



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