Abstract
BackgroundCardiovascular disease (CVD) is the main cause of morbidity and mortality in Sweden. This study aims to assess the impact of a CVD intervention implemented in 1993 in northern Sweden on the reduction of premature ischemic heart disease (IHD) morbidity and mortality in women and men during the period 1987–2013.MethodsAn ecological controlled interrupted time series design, with pre-intervention period defined as 1987–1993 and post-intervention period 1994–2013 was carried out. For each year, IHD events, stratified by sex, were retrieved from national registers.ResultsImpressive reductions on IHD premature morbidity and mortality were observed to a similar degree in both the intervention county and the other comparison counties across the last 27 years. Significant differences in the pre-post intervention trends indicating the intervention group had smaller reductions than expected from its pre-intervention trend and the trend of control counties were found among men for both IHD morbidity and mortality. A similar pattern was observed among women but without significant differences.ConclusionsTaken together, the data do not support that the intervention has contributed to an additional reduction on IHD morbidity and mortality, above and beyond that which is already seen in neighbouring counties without similar programs.
Highlights
Cardiovascular disease (CVD) is the main cause of morbidity and mortality in Sweden
ischemic heart disease (IHD) morbidity and mortality rates reduction A considerable reduction of IHD morbidity across the study period was observed in both the intervention (Västerbotten) and control (Norrbotten, Västernorrland and Jämtland) counties
During the pre-intervention period from 1987 to 1993, a numerically larger decrease in morbidity was observed in the intervention county compared to the control counties in both men (− 27.8% vs − 19.5%) and women (− 23.6% vs − 15.9%)
Summary
This study aims to assess the impact of a CVD intervention implemented in 1993 in northern Sweden on the reduction of premature ischemic heart disease (IHD) morbidity and mortality in women and men during the period 1987–2013. Community-based CVD prevention programs are based on the idea that if the population as a whole is targeted, even a modest risk factor and lifestyle change would potentially have a substantial public health impact [5]. Such programs have a long tradition in high income countries, and have been implemented to promote risk-reducing lifestyle changes in different populations since the 1970s [6, 7]. A review has highlighted that whereas community programs for prevention of CVDs seem to achieve favorable changes in overall CVD
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