Health inequalities

Wilfrid Treasure

doi:10.3399/bjgp11X561348

I was struck by some statements in two of the leaders in the December Journal so I looked up the references.

One leader1 reported that ‘practices in deprived localities improved performance to the level of their peers in the least deprived areas over a period of only 3 years’ and referenced three papers. The first of these papers2 didn't seem to me to compare deprived areas with other areas. The second3 was a review article that supported its comments about deprivation by referencing a leader rather than a research paper — I didn't pursue that line of enquiry. And the third4 was a cross-sectional study that didn't seem to report change over time.

The other leader reported that ‘The DASH diet … is associated with a lower incidence of heart failure, all-cause mortality, and stroke’5 and referenced two papers. The first6 demonstrated a reduction in Framingham 10-year coronary heart disease risk score rather than in outcomes; and the second7 was a review article, the abstract of which (I couldn't access the full article) referred to evidence of risk factor reduction rather than event reduction.

My interpretation of these papers doesn't seem the same as the leader writers' and I'd welcome some clarification.

REFERENCES

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1. Hull S
(2010) Health inequalities affect the health of all. Br J Gen Pract 60(581):877–878.
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(2009) Effects of pay for performance on the quality of primary care in England. N Eng J Med 361(4):368–378.
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(2010) Quality and Outcomes Framework: time to take stock. Br J Gen Pract 60(578):637–638.
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(2010) The association between quality of primary care, deprivation and cardiovascular outcomes: a cross-sectional study using data from the UK Quality and Outcomes Framework. J Epidemiol Community Health 64(10):927–934.
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(2010) Hypertension and lifestyle modification: how useful are the guidelines? Br J Gen Pract 60(581):879–880.
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1. Chen ST,
2. Maruthur NM,
3. Appel LJ
(2010) The effect of dietary patterns on estimated coronary heart disease risk: results from the Dietary Approaches to Stop Hypertension (DASH) trial. Circ Cardiovasc Qual Outcomes 3(5):484–489.
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(2003) The DASH diet and blood pressure. Curr Atheroscler Rep 5(6):484–491.
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