Causal analysis of the National Chronic Disease Management Program on intracerebral hemorrhage mortality

Intracerebral hemorrhage (ICH) significantly contributes to mortality and long-term disability, particularly in low- and middle-income countries (LMICs) like Vietnam. ICH prevalence is higher in individuals with chronic diseases, particularly with poor treatment adherence. This study aims to evaluate the impact of the outpatient treatment strategy with the National Chronic Disease Management Program (NCDMP), implemented in Vietnam, on the intracerebral hemorrhage mortality rate per 100,000 individuals (IHMR100k) from 2010 to 2019. National IHMR100k data were analyzed over the period, employing the 'CausalImpact' method to assess the causal effect of the NCDMP intervention, with data from the end of 2016 serving as the baseline for comparison. Analysis of the national mortality data over the period (2010-2019) revealed significant changes in mortality rates due to ICH, with the IHMR100k showing a gradual decline over time, reaching a low of 0.44 in 2019, although it remained among the top 10 causes of death. The implementation of the NCDMP strategy contributed to a decline in IHMR100k from 0.88 in 2010 to 0.44 in 2019. The Causal Impact analysis indicated that the actual average mortality rate was 0.54, lower than the predicted mean of 0.75. The absolute effect of the intervention was -0.21 (95% CI: -0.34 to -0.08), signifying a substantial reduction in mortality rates associated with ICH. The findings indicate that the NCDMP effectively reduced ICH mortality rates in Vietnam. This underscores the importance of sustainable outpatient care strategies for managing chronic diseases, enhancing medication access, and improving health outcomes in LMICs.