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Background An estimated 25% of GP patients within the UK have multimorbidity, a large proportion of which is attributable to non-communicable diseases, many of them preventable. The heterogeneity of existing study methodologies limits comparisons to assess temporal trends. This study aims to use a large population-representative dataset to describe changes over time in multimorbidity incidence and prevalence. Methods We used two measures of multimorbidity a) basic: two or more chronic conditions; b) complex: at least three chronic conditions affecting at least three body systems. Chronic conditions for inclusion were discussed by a multidisciplinary team. A 1m random sample of patients registered between 2004 and 2019 at GP practices in England were drawn from the UK Clinical Practice Research Datalink. We calculated crude and age-sex standardised annual multimorbidity prevalence and incidence using standard formulae. Analyses were conducted using R v3.6.3. Participants will be linked to the 2015 Index of Multiple Deprivation to describe equity trends over time. Results Preliminary results show that age-sex standardised annual prevalence increased from 32.9% (95% CI: 32.7% - 33.1%) with basic multimorbidity and 14.9% (95% CI: 14.7%-15.0%) with complex multimorbidity in 2004 to 51.0% (95% CI: 50.8% - 51.3%) and 29.9% (95% CI: 29.7% - 30.1%) in 2019. Basic multimorbidity incidence per 10,000 person-years showed little change, however there was an increase in the incidence of complex multimorbidity from 322 (95% CI: 315- 330) to 418 (95% CI: 407 - 430). Conclusions The burden of multimorbidity has increased substantially over the last 15 years. Complex multimorbidity incidence and prevalence have increased more rapidly than for basic multimorbidity. This highlights the need for improved population-level prevention strategies to postpone and prevent the onset of long-term conditions. Next, we will assess whether there are socioeconomic differences in these temporal trends. Key messages The burden of multimorbidity increased between 2004 and 2019. The increase in incidence and prevalence of complex multimorbidity was greater than for basic multimorbidity.

Background The post-Brexit agricultural regime represents an opportunity to positively influence food systems and improve public health. Health-improving measures could include expanding the UK production of fruits and vegetables (F&V), thus increasing F&V availability. Currently, only 1.4% of total agricultural land in England is allocated to F&V. This study aims to estimate the potential impacts of allocating additional land to F&V production on cardiovascular disease (CVD) and inequalities in England between 2021 and 2030. Methods We used the previously validated IMPACT Food Policy model to translate changes in land allocated to F&V into changes in F&V intake and associated CVD mortality, expressed in number of deaths prevented or postponed (DPPs) by age, sex, and Index of Multiple Deprivation (IMD) quintile. We modelled two scenarios that assumed a linear increase in agricultural land allocated to F&V until it covers a) 10% and b) 20% of all land suitable for production of horticultural crops in England. We assumed that F&V prices would drop to a new equilibrium. We used Monte Carlo simulations to produce uncertainty intervals. Results Our model suggested that by 2030, F&V intake might increase by approximately 4% (95% Uncertainty Interval: 2%-7%) and 8% (4%-13%) respectively, under the first scenario. Under the second scenario, F&V intake could increase by approximately 17% (10%-29%) and 37% (26%-51%) respectively. These increases in F&V intake were associated with 3360 (1760-5920) CVD DPPs under the first scenario and 15700 (9000-24310) under the second scenario in 2021-2030. Our modelled scenarios could also reduce inequalities, with some 16% of DPPs occurring in the least deprived group compared with 22% in the most deprived. Conclusions Policymakers should consider the public health impacts of the post-Brexit agricultural regime in England. Increasing the land allocated to F&V production could substantially reduce the burden of CVD and associated inequalities. Key messages The post-Brexit agricultural policy can be an opportunity to improve diet and public health in the UK. Increasing the agricultural land allocated to fruit and vegetable production in England could reduce the burden of cardiovascular disease and associated inequalities.

Introduction High participation rates in screening programmes targeting non-communicable diseases are instrumental in achieving full screening benefits; however, screening programmes remain underused, especially among vulnerable populations. We conducted an umbrella review to assess the type of approaches screening programmes use to maximise uptake, the effectiveness of the approaches and the impact on equity. Methods Electronic databases were searched (1999-2019) for systematic reviews on approaches aimed at improving uptake of screening programmes for adults in middle- and high-income countries, with participation rate as the primary outcome. A narrative synthesis was undertaken to present the results by strategy, screening programme and strength of evidence. This study was registered in PROSPERO [CRD42019132087]. Results In total, 3,059 records were identified, and 82 systematic reviews were included. Preliminary findings suggest contradictory evidence, and effectiveness appears to depend on the disease screened for and specific program implementation. Invitation methods including letters and direct reminders seem to work universally. However, combined approaches using access-enhancing, individual- and system-directed strategies seem to be more effective than single approaches such as invitation methods alone. Few studies evaluated the impact on equity. Conclusions Strategies to improve uptake of screening programmes have the potential to be effective. However, there are many components within the system, either at individual, health care professional or health care system level that can influence uptake of screening programmes. Within each screening programme, it is likely that a range of interventions is needed to improve the uptake as opposed to a single intervention. Key messages Improving uptake of screening programmes is a complex issue with many factors influencing the process. A range of interventions is favoured over single interventions.

Background: Finland, Ireland and the United Kingdom have the highest rates of coronary heart disease (CHD) mortality among EU-15 countries. This study examines the pace of change in CHD mortality in these countries from 1985–2006. Methods: The percentage change in 5-year average all age, under 65 and 65 years and over age standardized mortality rates from 1985–89 to 2002–06 was calculated for each country. Joinpoint regression analysis was used to analyse age standardized mortality rates to identify points (years) where the slope of the linear trend changed significantly. The pace of change in the CHD mortality rate was measured using annual percentage change (APC). Results: The percentage change in 5-year age standardized (under 65) CHD mortality rates was similar in Finland and the UK for both genders whereas in Ireland the rate of change was greater, especially for females. The percentage change in ≥65 year and all age rates was between 8.2% and 12.4% lower for Finnish males, and between 11.6% and 13% lower for Finnish females compared to their Irish and UK counterparts. There were different turning points in the downward trend in CHD mortality across the three countries varying from 1991–2003. The APC in CHD mortality after the turning point was greatest for Irish males (all age = −7.3%, under 65 = −8.2% and 65 and over = −7.1%), and Irish females (under 65 = −7.2%). Conclusion: We have identified differing pace of decline in three countries with similar burden of disease and successful national strategies to control CHD.

Problem The lack of any international consensus on how best to promote the consumption of healthy nutrition. Description of the problem Public health can celebrate two centuries of successfully overcoming barriers to implement effective policies for safe drinking water, clear air, safe motorcars, seatbelts, immunisations, smoke-free …

Background Stroke and Cardiovascular Diseases (CVD) are the main cause of premature deaths globally. Over a third of stroke deaths occur in developing countries including Turkey. Stroke deaths are substantially preventable; however, the most effective interventions and policy options are not known in Turkey. We therefore aimed to model the potential impact of treatments and health promotion interventions on future stroke and CVD deaths during the next 10 years. Methods We developed …

Introduction Between 2000 and 2010, coronary heart disease (CHD) mortality rates in Scotland fell by over one third. Previous work suggests that important contributions came from primary prevention reductions in blood pressure. However, the relative contributions from preventive medications such as anti-hypertensives in individuals and from population-wide blood pressure reduction remain unclear. We examined the impact of differential effects on health inequalities. Methods The IMPACTsec model …

Background EuroHeart 2 is a European research programme led by the European Heart Network and European Society of Cardiology. One aspect of the project aimed to identify the most effective public health nutrition policies, in order to inform future evidence-based strategies to promote cardiovascular health. Methods We mapped national nutrition policies across 30 European countries. We identified contacted and recruited potential participants in 14 diverse countries. Policy-makers, thought-leaders and others active in the field of public health …

Background Road Traffic accidents (RTAs) cause 91% of global road traffic deaths in low income countries and Africa is most affected (WHO, 2013). RTAs are the eighth leading cause of death globally and leading cause of death in 15 to 29 year olds (WHO, 2013). They are projected to be the 5th leading cause of death by 2030 (WHO, 2013) Despite this only 7% of the …

Background Population-wide policy actions to promote a healthy diet offer potentially large benefits in terms of reducing the non-communicable disease burden. In order to make sense of the wide range of policy options, we conducted a rapid scoping review using a conceptual framework based on the marketing ‘4Ps' approach (Price, Product, Place and Promotion). Methods We searched for evaluations of food policies in six electronic databases. Reference lists were screened. Key …