Effects of a community-wide health education program on cardiovascular disease morbidity and mortality - The Stanford Five-City Project

The authors examined changes in morbidity and mortality from 1979 through 1 992 during the Stanford Five-City Project, a comprehensive community health education study conducted in northern California. The intervention (1980-1 986), a multiple risk factor strategy delivered through multiple educationa l methods, targeted all residents in two treatment communities. Potentially fatal and nonfatal myocardial infarction and stroke events were identified from death certificates and hospital records. Clinical information was abs tracted from hospital charts and coroner records; for fatal events, it was collected from attending physicians and next of kin. Standard diagnostic cr iteria were used to classify all events, without knowledge of the city of o rigin. All first definite events were analyzed; denominators were estimated from 1980 and 1990 US Census figures. Mixed model regression analyses were used in statistical comparisons. Over the full 14 years of the study, the combined-event rate declined about 3% per year in all five cities. However, during the first 7-year period (1979-1985), no significant trends were fou nd in any of the cities; during the late period (1986-1992), significant do wnward trends were found in all except one city. The change in trends betwe en periods was slightly but not significantly greater in the treatment citi es. it is most likely that some influence affecting all cities, not the int ervention, accounted for the observed change.