Long-Term Effects of Integrated Strategies of Community Health Promotion on Diabetes Mellitus Mortality: a Natural Policy Experiment Based on Aggregated Longitudinal Secondary Data

Abstract

Integrated strategies of community health promotion (ISCHP) are based on intersectoral collaborations using the Health in All Policies approach to address determinants of health. While effects on health determinants have been shown, evidence on the effectiveness of ISCHP on health outcomes is scarce. The aim of this study is to assess the long-term effects of ISCHP on diabetes mellitus mortality (DMM) in German communities. A nonrandomized evaluation based on secondary county-level official data (1998–2016) was performed. In April 2019, 149 communities in Germany with ISCHP out of 401 were identified. Communities with < 5 measurements of DMM, starting before 1999 or after 2015, were excluded. Analyses included 65 communities with ISCHP (IG) and 124 without ISCHP (CG). ISCHP ran for a mean of 5.6 years. Fixed effects (FE) models were used to estimate effects of ISCHP and duration on DMM taking into account the time-varying average age. The FE estimator for DMM is b = − 2.48 (95% CI − 3.45 to − 1.51) for IG vs. CG and b = − 0.30 (95% CI − 0.46 to − 0.14) for ISCHP duration (0–16 years). In the first year of an ISCHP, a reduction of the annual DMM of 0.3 per 100,000 population (1%), and in the 16th year of 4.8 (14%) was achieved. This study provides preliminary evidence of the effectiveness of ISCHP in Germany. Limitations include inaccuracies to classify IG and CG and possible selection bias. Longitudinal county-level data may be an efficient data source to evaluate complex interventions, thereby contributing to further strengthen evidence-based integrated health promotion.

Evaluation of the science-based community prevention system Communities That Care: study design and baseline equivalence of intermediate outcomes

“…Es besteht mittlerweile auch in der deutschen Präventions-Wissenschafts-Community Einigkeit darüber, dass Wirkweisen und Effektivität dieser hochkomplexen Interventionen mit randomisiert kontrollierten, quasiexperimentellen und weiteren Designs summativ evaluiert werden können [5,9]. Seit Kurzem werden solche Studien auch in Deutschland durchgeführt [10,11].…”

Needs to Create Healthy Living Environments—A Two-Stage Delphi Survey in Europe to Identify Facilitating Factors and Barriers in Municipal Health Promotion

“…They represent a valuable opportunity to influence the health of an aging population. Röding, Walter, and Dreier investigated the long-term effects of integrated municipal health promotion strategies on mortality associated with diabetes mellitus and were able to present initial evidence of the effectiveness of integrated municipal health promotion strategies in Germany [21]. Coordinated linking of different sectors within the municipality is required in order to support a multimorbid, aging population, and to improve their participation and quality of life.…”