title: Innovations in medical care and mortality trends from four circulatory diseases between 1970 and 2005.
abstract: BACKGROUND
  Governments have identified innovation in pharmaceuticals and medical technology as a priority for health policy. Although the contribution of medical care to health has been studied extensively in clinical settings, much less is known about its contribution to population health. We examine how innovations in the management of four circulatory disorders have influenced trends in cause-specific mortality at the population level.
  
  
  METHODS
  Based on literature reviews, we selected six medical innovations with proven effectiveness against hypertension, ischaemic heart disease, heart failure and cerebrovascular disease. We combined data on the timing of these innovations and cause-specific mortality trends (1970-2005) from seven European countries. We sought to identify associations between the introduction of innovations and favourable changes in mortality, using Joinpoint-models based on linear spline regression.
  
  
  RESULTS
  For both ischaemic heart disease and cerebrovascular disease, the timing of medical innovations was associated with improved mortality in four out of five countries and five out of seven countries, respectively, depending on the innovation. This suggests that innovation has impacted positively on mortality at the population level. For hypertension and heart failure, such associations could not be identified.
  
  
  CONCLUSIONS
  Although improvements in cause-specific mortality coincide with the introduction of some innovations, this is not invariably true. This is likely to reflect the incremental effects of many interventions, the time taken for them to be adopted fully and the presence of contemporaneous changes in disease incidence. Research on the impact of medical innovations on population health is limited by unreliable data on their introduction.
authors.affiliation: 1 Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Hoffmann
authors.forename: Iris
authors.initials: I
authors.lastname: Plug
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
authors.forename: Bernadette
authors.initials: B
authors.lastname: Khoshaba
authors.forename: Ragnar
authors.initials: R
authors.lastname: Westerling
authors.forename: Caspar
authors.initials: C
authors.lastname: Looman
authors.forename: Gregoire
authors.initials: G
authors.lastname: Rey
authors.forename: Eric
authors.initials: E
authors.lastname: Jougla
authors.forename: Jose
authors.initials: J
authors.lastname: Luis Alfonso
authors.forename: Katrin
authors.initials: K
authors.lastname: Lang
authors.forename: Kersti
authors.initials: K
authors.lastname: Pärna
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
mesh_terms: D002423:Cause of Death / Q000639:trends; D002561:Cerebrovascular Disorders / Q000401:mortality* / Q000628:therapy; D004957:Estonia / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005602:France / Q000453:epidemiology; D005858:Germany / Q000453:epidemiology; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000401:mortality* / Q000628:therapy; D009026:Mortality / Q000639:trends*; D017202:Myocardial Ischemia / Q000401:mortality* / Q000628:therapy; D009426:Netherlands / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D035703:Therapies, Investigational; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology