Effect of the national integrated demonstration area for the prevention and control of noncommunicable diseases programme on behavioural risk factors in China: a synthetic difference-in-differences study

IF 7.6 1区 医学 Q1 HEALTH CARE SCIENCES & SERVICES The Lancet Regional Health: Western Pacific Pub Date : 2024-08-09 DOI:10.1016/j.lanwpc.2024.101167
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Abstract

Background

The government-led community-based Chinese National Integrated Demonstration Areas for the Prevention and Control of Noncommunicable Diseases programme was launched in 2011, but no rigorous impact evaluation has been conducted to date. We aimed to evaluate the causal effects of this programme on behavioural risk factors.

Methods

We used data from the latest five waves of the China Chronic Disease and Risk Factor Surveillance. The primary outcome is a behavioural risk score combining current smoking, passive smoking, drinking in last month, regular exercise, body mass index, and waist circumference. We applied the synthetic difference-in-differences method and constructed synthetic controls from the non-demonstration areas with the outcome. The average treatment effects on the treated were estimated for overall effect and by short- (1–2), medium- (3–4), and long-term (6–7 years) effects.

Findings

We identified 26 demonstration areas (N = 72,193) and 100 non-demonstration areas (N = 275,397). Participants in the demonstration areas had higher education and income levels and different pre-implementation trends than non-demonstration areas. Using synthetic controls instead of non-demonstration areas reduced these pre-implementation differences. Compared to the synthetic controls, declines were observed in current smoking (−1.78% [−4.51%, 0.96%]), passive smoking (−8.09% [−14.27%, −1.90%]), and drinking in last month (−4.04% [−8.75%, 0.67%]) but not in the other factors. Behavioural risk score declined by 1.05 short-term (95% CI: −1.84, −0.26), 1.15 medium-term (95% CI: −2.08, −0.22), 2.82 long-term (95% CI: −4.79, −0.85), and 1.54 overall (95% CI: −2.51, −0.56).

Interpretation

The programme improved behavioural risk scores, primarily through reductions in the prevalence of smoking and drinking, and the effect was long-lasting. Our findings provided empirical evidence for utilizing an integrated prevention and control strategy to fight against NCD in China and other countries facing similar challenges.

Funding

The China National Key Research and Development Program (2018YFC1315304 and 2017YFC1310902); National Natural Science Foundation of China (81872721).

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国家级非传染性疾病综合防控示范区项目对中国行为风险因素的影响:差异合成研究
背景由政府主导、以社区为基础的中国国家非传染性疾病综合防控示范区项目于 2011 年启动,但迄今为止尚未进行过严格的影响评估。我们的目的是评估该项目对行为风险因素的因果影响。方法我们使用了最近五次中国慢性病及危险因素监测的数据。主要结果是结合当前吸烟、被动吸烟、上月饮酒、经常锻炼、体重指数和腰围的行为风险评分。我们采用了合成差分法,并在非示范区建立了具有该结果的合成对照。我们估算了总体效果以及短期(1-2 年)、中期(3-4 年)和长期(6-7 年)效果对被治疗者的平均治疗效果。与非示范区相比,示范区参与者的教育和收入水平更高,实施前的趋势也不同。使用合成对照组代替非示范区缩小了这些实施前的差异。与合成对照组相比,当前吸烟率(-1.78% [-4.51%, 0.96%])、被动吸烟率(-8.09% [-14.27%, -1.90%] )和上月饮酒率(-4.04% [-8.75%, 0.67%])均有所下降,但其他因素没有下降。行为风险得分短期下降了 1.05(95% CI:-1.84,-0.26),中期下降了 1.15(95% CI:-2.08,-0.22),长期下降了 2.82(95% CI:-4.79,-0.85),总体下降了 1.54(95% CI:-2.51,-0.56)。我们的研究结果为中国及其他面临类似挑战的国家利用综合防控策略防治非传染性疾病提供了经验证据。
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来源期刊
The Lancet Regional Health: Western Pacific
The Lancet Regional Health: Western Pacific Medicine-Pediatrics, Perinatology and Child Health
CiteScore
8.80
自引率
2.80%
发文量
305
审稿时长
11 weeks
期刊介绍: The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.
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