Key result
Simulated population secondary prevention cuts hypertension prevalence ~64%, outperforming high-risk primary prevention strategies.
Why the study?
Limited work has empirically explored the consequences of different population health intervention strategies on disease burden and on within- and between-group differences in disease.
How do simulated population and high-risk primary and secondary smoking reduction interventions influence systolic blood pressure, hypertension prevalence, and income-related health inequalities?
How do simulated population and high-risk primary and secondary smoking reduction interventions influence systolic blood pressure, hypertension prevalence, and income-related health inequalities?
In simulated models of smoking reduction, population secondary prevention maximizes overall blood pressure reduction, whereas high-risk prevention strategies are superior for reducing income-related health disparities in hypertension.
Population secondary prevention may maximize modeled hypertension reductions; leaves open real-world validation and equity effects before guiding practice.
Maximizing both efficiency and equity are core considerations for population health. These considerations can result in tension in population health science as we seek to improve overall population health while achieving equitable health distributions within populations. Limited work has explored empirically the consequences of different population health intervention strategies on the burden of disease and on within- and between-group differences in disease. To address this gap, we compared the impact of four simulated interventions using data from the National Health and Nutrition Examination Survey. In particular, we focus on assessing how population and high-risk primary prevention and population and high-risk secondary interventions efforts to reduce smoking behavior influence systolic blood pressure (SBP) and hypertension, and how such strategies influence inequalities in SBP by income. The greatest reductions in SBP mean and standard deviation resulted from the population secondary prevention. High-risk primary and secondary prevention and population secondary prevention programs all yielded substantial reductions in hypertension prevalence. The effect of population primary prevention did little to decrease population SBP mean and standard deviation, as well as hypertension prevalence. Both high-risk strategies had a larger impact in the low-income population, leading to the greatest narrowing the income-related gap in disease. The population prevention strategies had a larger impact in the high-income population. Population health approaches must consider the potential impact on both the whole population and also on those with different levels of risk for disease within a population, including those in under-represented or under-served groups.
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Keyes et al. (2016) studied Hypertension (n=3,393). Simulated population secondary prevention (8% SBP reduction among hypertensives) vs. Baseline general population and high-risk/population primary prevention strategies was evaluated on Prevalence of hypertension (SBP > 130 mmHg). Simulated population secondary prevention (8% SBP reduction) decreased hypertension prevalence by 64.2% (to 7.6%), whereas high-risk primary prevention reduced prevalence by 23.6%.
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