title: Community-wide cardiovascular disease prevention programs and health outcomes in a rural county, 1970-2010.
abstract: OBJECTIVE
  Few comprehensive cardiovascular risk reduction programs, particularly those in rural, low-income communities, have sustained community-wide interventions for more than 10 years and demonstrated the effect of risk factor improvements on reductions in morbidity and mortality.
  
  
  OBJECTIVE
  To document health outcomes associated with an integrated, comprehensive cardiovascular risk reduction program in Franklin County, Maine, a low-income rural community.
  
  
  METHODS
  Forty-year observational study involving residents of Franklin County, Maine, a rural, low-income population of 22,444 in 1970, that used the preceding decade as a baseline and compared Franklin County with other Maine counties and state averages.
  
  
  METHODS
  Community-wide programs targeting hypertension, cholesterol, and smoking, as well as diet and physical activity, sponsored by multiple community organizations, including the local hospital and clinicians.
  
  
  METHODS
  Resident participation; hypertension and hyperlipidemia detection, treatment, and control; smoking quit rates; hospitalization rates from 1994 through 2006, adjusted for median household income; and mortality rates from 1970 through 2010, adjusted for household income and age.
  
  
  RESULTS
  More than 150,000 individual county resident contacts occurred over 40 years. Over time, as cardiovascular risk factor programs were added, relevant health indicators improved. Hypertension control had an absolute increase of 24.7% (95% CI, 21.6%-27.7%) from 18.3% to 43.0%, from 1975 to 1978; later, elevated cholesterol control had an absolute increase of 28.5% (95% CI, 25.3%-31.6%) from 0.4% to 28.9%, from 1986 to 2010. Smoking quit rates improved from 48.5% to 69.5%, better than state averages (observed - expected [O - E], 11.3%; 95% CI, 5.5%-17.7%; P < .001), 1996-2000; these differences later disappeared when Maine's overall quit rate increased. Franklin County hospitalizations per capita were less than expected for the measured period, 1994-2006 (O - E, -17 discharges/1000 residents; 95% CI -20.1 to -13.9; P < .001). Franklin was the only Maine county with consistently lower adjusted mortality than predicted over the time periods 1970-1989 and 1990-2010 (O - E, -60.4 deaths/100,000; 95% CI, -97.9 to -22.8; P < .001, and -41.6/100,000; 95% CI, -77.3 to -5.8; P = .005, respectively).
  
  
  CONCLUSIONS
  Sustained, community-wide programs targeting cardiovascular risk factors and behavior changes to improve a Maine county's population health were associated with reductions in hospitalization and mortality rates over 40 years, compared with the rest of the state. Further studies are needed to assess the generalizability of such programs to other US county populations, especially rural ones, and to other parts of the world.
authors.affiliation: Franklin Memorial Hospital, Farmington, Maine.
authors.forename: N Burgess
authors.initials: NB
authors.lastname: Record
authors.affiliation: Maine-Dartmouth Family Medicine Residency, Augusta3Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Onion
authors.affiliation: Franklin Memorial Hospital, Farmington, Maine.
authors.forename: Roderick E
authors.initials: RE
authors.lastname: Prior
authors.affiliation: Franklin Memorial Hospital, Farmington, Maine.
authors.forename: David C
authors.initials: DC
authors.lastname: Dixon
authors.affiliation: Franklin Memorial Hospital, Farmington, Maine.
authors.forename: Sandra S
authors.initials: SS
authors.lastname: Record
authors.affiliation: Western Maine Community Action, Wilton.
authors.forename: Fenwick L
authors.initials: FL
authors.lastname: Fowler
authors.affiliation: Franklin Memorial Hospital, Farmington, Maine.
authors.forename: Gerald R
authors.initials: GR
authors.lastname: Cayer
authors.affiliation: Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Amos
authors.affiliation: University of Florida Health Science Center, Gainesville.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Pearson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control*; D003153:Community Health Services; D005260:Female; D015438:Health Behavior; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications / Q000628:therapy; D006973:Hypertension / Q000150:complications / Q000628:therapy; D007182:Income; D008281:Maine / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011322:Primary Prevention / Q000379:methods*; D012307:Risk Factors; D012424:Rural Population; D016540:Smoking Cessation