OP09 Coronary mortality reductions attributable to primary prevention medications versus dietary changes in Scotland 2000–2010: modelling study using routine linked data
Why this work is in the frame
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Bibliographic record
Abstract
<h3>Background</h3> Between 2000 and 2010, coronary heart disease (CHD) mortality rates in Scotland fell by over one third. Important contributions came from reductions in blood pressure and serum cholesterol (primary prevention). However, the relative contributions from preventive medications (anti-hypertensives and statins) in individuals and from population-wide dietary changes remain unclear. We therefore examined the impact of differential effects on health inequalities. <h3>Methods</h3> We used the previously validated IMPACTsec model to estimate the contributions of population-level risk factor changes and treatment changes to the CHD mortality decline in Scotland between 2000 and 2010 for adults aged over 25. Data were stratified using the Scottish Index of Multiple Deprivation (SIMD), a small area measure of deprivation. Model outputs were quantified as deaths prevented or postponed (DPPs) by each intervention. Sensitivity analyses were conducted using Ersatz-based Monte Carlo simulations. <h3>Results</h3> Between 2000 and 2010, 5770 fewer CHD deaths than expected occurred in Scotland; an estimated 3570 (62%) were attributable to reductions in blood pressure and serum cholesterol. Declines in blood pressure were responsible for approximately 2285 DPPs (minimum estimate 1630, maximum estimate 2915). The vast majority (2130 DPPs) came from population-wide blood pressure falls, with bigger absolute mortality decreases in the most deprived quintile compared with the least deprived (460 vs. 340 DPPs respectively); relative contributions were similar (37.2% and 37.5%). Anti-hypertension medications resulted in only 155 fewer deaths, with similar DPPs in the most (35) and least (30) deprived quintiles. Reductions in serum cholesterol resulted in 1280 fewer deaths; approximately 515 of these were attributable to population-wide changes in diet with more deaths prevented in the most deprived quintile compared with the least deprived (170 vs. 45 DPPs; relative contribution 13.8% and 4.7%). Conversely, approximately 770 fewer deaths were attributable to statin use, with very similar absolute numbers of deaths prevented in most (140) and least (140) deprived quintiles, but relatively greater contributions in the least deprived (15.4% vs 11.2%). Statin uptake was higher in the most deprived areas (17% vs 13.2%). <h3>Conclusion</h3> Population-wide falls in blood pressure helped to reduce CHD mortality; however the benefit from hypertension treatment was small. Improved diet and statins for high-risk individuals both made important contributions to the fall in population cholesterol. Population-wide falls in blood pressure and reductions due to medical treatments for hypertension were equitable between socio-economic groups. Higher socio-economic groups appeared to benefit more from statins, probably due to better compliance; this may perpetuate inequalities.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it