The Impact of Clinical and Population Strategies on Coronary Heart Disease Mortality: An Assessment of Rose’s Big Idea

Peer reviewed: 
Yes, item is peer reviewed.
Scholarly level: 
Undergraduate student
Final version published as: 

Ahmadi, M., & Lanphear, B. (2022). The impact of clinical and population strategies on coronary heart disease mortality: An assessment of Rose’s big idea. BMC Public Health, 22(1), 14.

Date created: 
DOI: 10.1186/s12889-021-12421-0

Background: Coronary heart disease (CHD), the leading cause of death worldwide, has declined in many afuent countries but it continues to rise in industrializing countries.

Objective: To quantify the relative contribution of the clinical and population strategies to the decline in CHD mortality in afuent countries.

Design: Meta-analysis of cross-sectional and prospective studies.

Data sources: PubMed and Web of Science from January 1, 1970 to December 31, 2019.

Method: We combined and analyzed data from 22 cross-sectional and prospective studies, representing 500 million people, to quantify the relative decline in CHD mortality attributable to the clinical strategy and population strategy.

Result: The population strategy accounted for 48% (range=19 to 73%) of the decline in CHD deaths and the clinical strategy accounted for 42% (range=25 to 56%), with moderate inconsistency of results across studies.

Conclusion: Since 1970, a larger fraction of the decline in CHD deaths in industrialized countries was attributable to reduction in CHD risk factors than medical care. Population strategies, which are more cost-efective than clinical strategies, are under-utilized.

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