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Original Articles

Would Achieving Healthy People 2010’s Targets Reduce Both Population Levels and Social Disparities in Heart Disease?

Beatriz E. Alvarado, MD, PhD; Sam Harper, PhD; Robert W. Platt, PhD; George Davey Smith, MD, DSc and John Lynch, PhD

From the Department of Epidemiology, Biostatistics, and Occupational Health (B.E.A., S.H., R.W.P., J.L.), McGill University, Montreal, Quebec, Canada; the Department of Social Medicine (G.D.S., J.L.), University of Bristol, Bristol, United Kingdom; and the School of Health Sciences (J.L.), University of South Australia, Adelaide, Australia. Dr Alvarado’s current affiliation is Community Health and Epidemiology Department, Queen’s University, Kingston, Ontario, Canada.

Correspondence to Beatriz E. Alvarado, MD, PhD, McGill University, Department of Epidemiology, Biostatistics, and Occupational Health, Purvis Hall, 1020 Pine Ave W, Montreal, Quebec, H3A 1A2 Canada. E-mail beatriz.alvarado-llano{at}queensu.ca

Received October 15, 2008; accepted July 9, 2009.

Background— The US Healthy People 2010 (HP2010) agenda set targets for major risk factors for coronary heart disease (CHD). However, the potential impact of achieving those risk factor reductions on both population levels and social disparities in CHD has not been quantified.

Methods and Results— Data on 10-year risk of CHD (from the First National Health and Nutrition Examination Epidemiological Follow-Up study 1971 to 1982), prevalence of major CHD risk factors (from the National Health and Nutrition Examination Survey 2003 to 2004), and HP2010 targets for CHD risk factors (reduction of smoking rate to 12%, hypertension to 14%, high cholesterol levels to 17%, diabetes to 2.5%, and obesity to 15%) were used to estimate effects of different scenarios on population levels and social disparities in CHD. Over a 10-year period, the largest relative reductions in population levels of CHD (20.0% in men; 23.9% in women) would be achieved if all social groups met the HP2010 targets. CHD disparities would be most reduced if the less educated (absolute disparities reduced by 66.1% in men; 56.3% in women) and the low income group (absolute disparities reduced by 93.7% in men; 94.3% in women) achieved the targets before the most advantaged. These reductions are larger than those expected if targets were achieved overall for the population but relative social group differences in risk factors remained, or under leveling-up approaches in which the least advantaged achieved the current levels of risk factors of the most advantaged.

Conclusions— Interventions to reduce CHD risk factors to HP2010 targets that focus on all social groups would produce the best overall scenario for both population levels and disparities in CHD.

Key Words: coronary disease • socioeconomic factors • risk factors • Healthy People programs

The online-only Data Supplement is available at http://circoutcomes.ahajournals.org/cgi/content/full/CIRCOUTCOMES.109.884601/DC1.