Sustained, community-wide programs targeting cardiovascular disease (CVD) risk factors and behavior changes were associated with reductions in hospitalization and death rates over a 40 year period (1970-2010) in a rural Maine county, compared with the rest of the state. Substantial improvements were noted for hypertension and cholesterol control and smoking cessation, according to researchers at Franklin Memorial Hospital, Farmington, Maine.
Researchers studied health outcomes associated with a comprehensive cardiovascular risk reduction program in Franklin County, Maine, which is a low-income rural community. CVD prevention was identified as a priority by local community groups in Franklin County in the late 1960s. A new Community Action Agency (CAA), Rural Health Associates (RHA), and later the community's hospital initiated and coordinated their efforts. With sponsorship of hospital medical staff, RHA established the community-wide Franklin Cardiovascular Health Program (FCHP) in 1974 with programs targeting hypertension, cholesterol, and smoking, as well as diet and physical activity.
For the current analysis, residents of Franklin County (population, 22,444 in 1970) were included, and the preceding decade was used as a baseline to compare Franklin County with other Maine counties and state averages.
The hospitalizations per capita in Franklin County were less than expected between 1994 and 2006. This lower overall hospitalization rates was associated with $5,450,362 reductions in total in- and out-of-area hospital charges for Franklin County residents per year. The mortality rates also declined.
The authors wrote, "The experience in Franklin County suggests that community health improvement programs may be both feasible and effective. This may be especially true in socio-economically disadvantaged communities where the needs are the greatest, as the increasing association of lower household income with higher mortality in Maine suggests. Further studies are needed to assess the generalizability of such programs to other U.S. county populations, especially rural ones, and to other parts of the world."
The study is published in JAMA.