Long-term cardiovascular risks and the impact of statin treatment on socioeconomic inequalities: a microsimulation model.
Markov microsimulation model
cardiovascular disease
individual patient characteristics
inequality
quality-adjusted life years
socioeconomic status
Journal
The British journal of general practice : the journal of the Royal College of General Practitioners
ISSN: 1478-5242
Titre abrégé: Br J Gen Pract
Pays: England
ID NLM: 9005323
Informations de publication
Date de publication:
19 Feb 2024
19 Feb 2024
Historique:
received:
22
04
2023
accepted:
19
09
2023
medline:
20
2
2024
pubmed:
20
2
2024
entrez:
19
2
2024
Statut:
aheadofprint
Résumé
UK cardiovascular disease (CVD) incidence and mortality have declined in recent decades but socioeconomic inequalities persist. To present a new CVD model, and project health outcomes and the impact of guideline-recommended statin treatment across quintiles of socioeconomic deprivation in the UK. A lifetime microsimulation model was developed using 117 896 participants in 16 statin trials, 501 854 UK Biobank (UKB) participants, and quality-of-life data from national health surveys. A CVD microsimulation model was developed using risk equations for myocardial infarction, stroke, coronary revascularisation, cancer, and vascular and non-vascular death, estimated using trial data. The authors calibrated and further developed this model in the UKB cohort, including further characteristics and a diabetes risk equation, and validated the model in UKB and Whitehall II cohorts. The model was used to predict CVD incidence, life expectancy, quality-adjusted life years (QALYs), and the impact of UK guideline-recommended statin treatment across socioeconomic deprivation quintiles. Age, sex, socioeconomic deprivation, smoking, hypertension, diabetes, and cardiovascular events were key CVD risk determinants. Model-predicted event rates corresponded well to observed rates across participant categories. The model projected strong gradients in remaining life expectancy, with 4-5-year (5-8 QALYs) gaps between the least and most socioeconomically deprived quintiles. Guideline-recommended statin treatment was projected to increase QALYs, with larger gains in quintiles of higher deprivation. The study demonstrated the potential of guideline-recommended statin treatment to reduce socioeconomic inequalities. This CVD model is a novel resource for individualised long-term projections of health outcomes of CVD treatments.
Sections du résumé
BACKGROUND
BACKGROUND
UK cardiovascular disease (CVD) incidence and mortality have declined in recent decades but socioeconomic inequalities persist.
AIM
OBJECTIVE
To present a new CVD model, and project health outcomes and the impact of guideline-recommended statin treatment across quintiles of socioeconomic deprivation in the UK.
DESIGN AND SETTING
METHODS
A lifetime microsimulation model was developed using 117 896 participants in 16 statin trials, 501 854 UK Biobank (UKB) participants, and quality-of-life data from national health surveys.
METHOD
METHODS
A CVD microsimulation model was developed using risk equations for myocardial infarction, stroke, coronary revascularisation, cancer, and vascular and non-vascular death, estimated using trial data. The authors calibrated and further developed this model in the UKB cohort, including further characteristics and a diabetes risk equation, and validated the model in UKB and Whitehall II cohorts. The model was used to predict CVD incidence, life expectancy, quality-adjusted life years (QALYs), and the impact of UK guideline-recommended statin treatment across socioeconomic deprivation quintiles.
RESULTS
RESULTS
Age, sex, socioeconomic deprivation, smoking, hypertension, diabetes, and cardiovascular events were key CVD risk determinants. Model-predicted event rates corresponded well to observed rates across participant categories. The model projected strong gradients in remaining life expectancy, with 4-5-year (5-8 QALYs) gaps between the least and most socioeconomically deprived quintiles. Guideline-recommended statin treatment was projected to increase QALYs, with larger gains in quintiles of higher deprivation.
CONCLUSION
CONCLUSIONS
The study demonstrated the potential of guideline-recommended statin treatment to reduce socioeconomic inequalities. This CVD model is a novel resource for individualised long-term projections of health outcomes of CVD treatments.
Identifiants
pubmed: 38373851
pii: BJGP.2023.0198
doi: 10.3399/BJGP.2023.0198
pmc: PMC10904120
mid: EMS188946
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Department of Health
ID : 17/140/02
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/R024227/1
Pays : United Kingdom
Informations de copyright
© The Authors.
Références
Am J Cardiol. 1995 Jun 1;75(16):1130-4
pubmed: 7762499
Front Pharmacol. 2016 Mar 24;7:66
pubmed: 27047381
JAMA. 2015 Jul 14;314(2):142-50
pubmed: 26172894
Eur Heart J. 2021 Jul 1;42(25):2439-2454
pubmed: 34120177
BMJ. 2017 May 23;357:j2099
pubmed: 28536104
Sci Rep. 2020 May 18;10(1):8140
pubmed: 32424214
Eur J Health Econ. 2015 Mar;16(2):141-51
pubmed: 24408476
Diabet Med. 2014 Jun;31(6):640-6
pubmed: 24533646
Heart. 2015 Feb;101(3):201-8
pubmed: 25324535
Am J Epidemiol. 2017 Nov 1;186(9):1026-1034
pubmed: 28641372
Med Decis Making. 2006 Mar-Apr;26(2):134-44
pubmed: 16525167
Pharmacoeconomics. 2023 Feb;41(2):199-207
pubmed: 36449173
BMJ. 2006 Dec 2;333(7579):1145
pubmed: 17098764
Heart. 2016 Dec 15;102(24):1945-1952
pubmed: 27550425
Hypertension. 2021 Feb;77(2):682-691
pubmed: 33342242
Qual Life Res. 2016 Dec;25(12):3009-3016
pubmed: 27307010
Eur Heart J. 2019 Feb 14;40(7):621-631
pubmed: 30476079
BMJ Open. 2021 Dec 30;11(12):e052884
pubmed: 35536740
Soc Sci Med. 2019 Jun;230:147-157
pubmed: 31009881
Heart. 2016 May 15;102(10):755-62
pubmed: 26864674
PLoS Med. 2015 Mar 31;12(3):e1001779
pubmed: 25826379
Heart. 2023 Feb 14;109(5):388-395
pubmed: 36192149
BMJ. 2020 Feb 24;368:m693
pubmed: 32094110
Int J Epidemiol. 2012 Dec;41(6):1737-49; discussion 1750-2
pubmed: 23129720
Am J Public Health. 2003 Jul;93(7):1137-43
pubmed: 12835199
Diabetes Obes Metab. 2022 Mar;24(3):530-538
pubmed: 34866309
Med Care. 1997 Nov;35(11):1095-108
pubmed: 9366889
BMJ Open. 2017 Jan 24;7(1):e013791
pubmed: 28119387
J Epidemiol Community Health. 2005 Feb;59(2):115-20
pubmed: 15650142