Cardiovascular disease (CVD) includes coronary heart disease (CHD) and cerebrovascular disease or stroke. CVD prevention programmes have been implemented in England and Scotland with the aim of reducing the burden of CVD and other diseases such as diabetes, and reducing related health inequalities, but there is a lack of strong evidence that such programmes are effective. The two programmes have a number of similarities and differences in their aims, organisation, duration, the age range they target, and what they include. This research study aims to use CPRD data, which covers both countries, to demonstrate the similarities and the differences between the NHS Health Check CVD prevention programme in England and the Keep Well programme in Scotland. We will compare the programmes in terms of their attendance rate and the proportion of the population covered. We will also report the differences and changes in the population level of risk of developing CVD in future, and also the levels of individual risk factors for CVD (high blood pressure, high body weight, high cholesterol and smoking), and prescribing of statin drugs to people found to be at high risk.
The main objective is to compare the English NHS Health Check programme and the Scottish Keep Well programme in terms of their coverage in the eligible population, global CVD risk and risk factor prevalence, and statin prescribing. We will quantify the population eligible for a health check from individuals aged 40-74 between 1 April 2009 and 31 March 2013 for the English programme, and from individuals aged 45-64 years between 1 April 2006 and 31 March 2013 for the Scottish population.
We will calculate and assess equities in coverage using a multilevel logistic regression model and compare them between the two countries using chi-square tests, or by including an interaction term into the regression model (aim 1). Level of population global CVD risk and individual risk factors will be summarized in means or proportions, and compared between the English and Scottish populations using t-tests or chi-square tests (aim 2). Level of statins prescribing will be assessed and compared between two populations using chi-square tests. Statistical analyses will be carried out using StataSE 13 software.
Health Outcomes to be Measured:
NHS Health Check/Keep Well coverage
Patient global CVD risk score
Individual CVD risk factors
Post check statin prescribing
HES Admitted;Patient IMD;Patient Townsend;Practice IMD (Standard)