Poor people living in a poor population do not necessarily have to have poor health, according to a Franklin County research project on cardiovascular disease that has garnered attention from a national medical publication.

Research published Tuesday in the Journal of the American Medical Association found that cardiovascular health in Franklin County was improved significantly, and mortality rates decreased in connection to a 40-year preventive health effort that an editorial in the journal said has the potential to be a model for other counties in the country.

“Low-income counties may not be doomed to poor health outcomes,” said Dr. Daniel Onion, a MaineGeneral physician and project co-author, at a news conference Tuesday on the study.

Dr. Roderick Prior, physician and one of five co-authors with Franklin Community Health Network, said the health data they collected on the county stands out because it shows the cardiovascular health of Franklin County often on par over the years with more affluent communities such as Cumberland County and Sagadahoc County despite its lower socio-economic standing, which traditionally means poorer health.

In a sustained effort defined by volunteer outreach, preventive health care and overlapping intervention efforts, the study showed these efforts were associated with reductions in hospitalization and death rates from 1970 to 2010 compared to the rest of the state.

Franklin County hospitalizations per capita were fewer than expected for the period 1994-2006. The lower overall hospitalization rates were associated with $5,450,362 in reductions in total in- and out-of-area hospital charges for Franklin County residents per year.

Researchers said the county’s success grew from being one of the early adopters of preventive disease management, which now is being promoted by the Affordable Care Act.

Onion said the project was heavily powered by volunteers who went out into the community to work on efforts such as quit-smoking campaigns and other preventive health care programs. He said the Affordable Care Act has provisions attempting to foster similar population health care efforts.

Substantial improvements were seen in hypertension and cholesterol control and smoking cessation, according to their study published Tuesday in the Journal of the American Medical Association.

The journal is a peer-reviewed medical publication, and in an editorial on the article, the reviewers said the research showed that a concerted effort can improve population health.

“The Franklin County, Maine, program demonstrates significant accomplishments in one northern U.S. rural community that have made a difference in cardiovascular outcomes,” the editorial authors wrote. “The experience deserves consideration as a model for other communities to emulate, adapt, and implement.”

Authors of the study include N. Burgess Record, Roderick Prior, David Dixon, Sandra Record and Gerald Cayer, of Franklin Memorial Hospital; Daniel Onion, of MaineGeneral; Fenwick Fowler, of Western Maine Community Action; Thomas Pearson, of the University of Florida Health Science Center; and Christopher Amos, of Geisel School of Medicine at Dartmouth College.

The effort started in the late 1960s, when local community groups in Franklin County identified cardiovascular disease prevention as a priority. A new Community Action Agency, a new nonprofit medical group practice Rural Health Associates, and later the community’s hospital came together to work on this effort. The communitywide Franklin Cardiovascular Health Program was started in 1974 with programs that targeted hypertension, cholesterol, smoking, diet and physical activity.

After being at or above overall Maine mortality rates in the 1960s, Franklin County’s overall mortality rates as well as cardiovascular-specific mortality rates decreased below Maine rates for almost the entire period 1970-2010. The greatest differences coincided with periods of peak preventive health care efforts, according to the study.

From 1975 to 1978, those studied with hypertension who were in control of their blood pressure increased from 18.3 percent to 43 percent. From 1986 to 2010, those studied who were in control of cholesterol increased from 0.4 percent to 28.9 percent. After starting different community smoking-cessation projects, communitywide smoking quit rates improved from 48.5 percent to 69.5 percent and became significantly higher than that of the rest of Maine. The study stated that those differences later disappeared when Maine’s overall quit rate increased.

U.S. Sen. Angus King, who attended the meeting by teleconference, congratulated the researchers and noted that in an age of trying to find a solution to the higher cost of health care, the cheapest treatment “is the one that never occurs” because proactive efforts made treatment unnecessary. King said he had been following the progression of the research over the years, and he commended their efforts for lowering the mortality rate.

Cayer, executive vice president of Franklin Community Health Network, said replicating these efforts in the age of the Affordable Care Act will mean health care workers will need to know how to navigate new regulations that did not exist when they first rolled out their initiatives.

He said “regulations are there for a reason,” but they can be complicated. Replicating their initiative, he said, will take people who can make changing regulations work to their advantage and not hinder their efforts.

Kaitlin Schroeder — 861-9252

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