Continued adverse trends in coronary heart disease mortality among blacks, 1980-91.

An abrupt downturn in mortality rates from coronary heart disease occurred in the United States in the mid-1960s, and for the next decade all four major sex-race groups experienced virtually identical rates of decline. Beginning around the mid-1970s, however, trends for blacks and whites began to diverge, with a deceleration in the annual fall in rates for blacks. The recent release of mortality data extending through 1991, with correction of the denominator estimates in the 1980s using the 1990 census, demonstrate a striking linearity of this trend over the entire decade. In 1989, for the first time since the category of coronary heart disease has been recorded in vital statistics, the age-adjusted death rate for it among black men exceeded that of whites. As a result of the divergent trends among men, an excess of 4,000 deaths of blacks were recorded in 1991 alone. Among women, coronary heart disease mortality was higher among blacks at the beginning of this period, and the average annual percent decline was only two-thirds that of whites. As a result, the absolute mortality gap between blacks and whites steadily increased from 19 to 33 percent (1980 to 1991). This study indicates that the factors that have led to the decline in coronary heart disease have not influenced all demographic groups equally over the last decade.     

Mortality from cardiovascular diseases in three Brazilian states from 1980 through 2002]

OBJECTIVE: To evaluate and compare adult mortality from diseases of the circulatory system (CDs), especially ischemic heart disease (IHD) and cerebrovascular disease (CVD), from 1980 through 2002 in the Brazilian states of Rio de Janeiro, Rio Grande do Sul, and S?o Paulo and their capital cities (respectively Rio de Janeiro, Porto Alegre, and S?o Paulo), taking into account the impact of deaths due to ill-defined causes on mortality rates. METHOD: We estimated mortality rates (crude and adjusted by age and sex) from CDs overall and from IHD and CVD among individuals aged 20 years or older. These rates were weighted with a portion of the deaths from ill-defined or unknown causes, in the same proportion as deaths from CDs, IHD, and CVD in relation to deaths overall, excluding deaths from ill-defined causes. Using linear regression models, we also estimated the mean values of and annual differences in the weighted adjusted mortality rates. The reference population was that of the state of Rio de Janeiro in 2000. RESULTS: The annual decline in the weighted adjusted mortality rates from CDs ranged from -13.1 per 100,000 individuals in the state of Rio de Janeiro to -8.7 per 100,000 in the city of S?o Paulo. For IHD, the annual declines were greatest in the city of Rio de Janeiro (-5.0 per 100,000) and the state of Rio de Janeiro (-4.5 per 100,000), and smallest in the state of Rio Grande do Sul (-2.8 per 100,000) and the city of S?o Paulo (-2.7 per 100,000). With CVD, the range that was found extended from -6.5 per 100,000 in the state of Rio de Janeiro to -2.9 per 100,000 in the city of Porto Alegre. CONCLUSION: The decreases in weighted adjusted mortality rates from CDs, IHD, and CVD occurred after 1980, so it is unlikely that the declines resulted from controlling risk factors or from the practice of myocardial revascularization. The decreases might be related to a period of strong economic development preceding the declines, which translated into improved living conditions and reduced exposure to infections in the perinatal period and childhood.     

Trends in cardiovascular diseases mortality in the Philippines

Cardiovascular disease mortality in the Philippines was studied from the existing vital statistics for 1963-76. Death rates from rheumatic fever and rheumatic heart disease remained unchanged, those for cerebrovascular diseases decreased, whereas mortality rates of ischaemic heart disease (IHD) and hypertensive disease (HPN) increased enormously both in men and women. This increase in IHD and HPN mortality was seen in all age groups. The age-standardized IHD mortality rate in men rose from 33.3 in 1964 to 78.0 in 1976, and that of women from 15.4 to 34.5. The age-standardized HPN mortality rate in men rose from 21.0 in 1964 to 45.6 in 1976, and that of women from 15.6 to 25.5. The male to female ratios in the age-standardized death rates for IHD, HPN and also for all causes increased during this 12-year period. Age-standardized all causes mortality increased clearly in the male population but decreased in the female population of the Philippines. This excess mortality in males is mostly due to the increased cardiovascular disease death rate. This is a clear example of how chronic non-communicable diseases are becoming major health problems in countries where they previously have not been prevalent. Immediate preventive measures are needed in order to control cardiovascular diseases in these countries where disease rates are rapidly increasing.     

How does breast cancer mortality compare with that of other cancers and selected cardiovascular diseases at different ages in U.S. women?

Women tend to fear breast cancer and thus overestimate their risk of developing it, have less concern about developing heart disease, and do not know that lung cancer is the major cause of cancer death. Death certificate data, consolidated into a national database by the National Center for Health Statistics, were used to compare age-specific mortality due to selected cardiovascular diseases and cancers among women who died in 1997 in the United States. The outcomes examined included underlying cause of death categorized as all circulatory system disease, cerebrovascular disease, and heart disease, including coronary and noncoronary disease, and as all cancers combined plus cancer of the lung, breast, and colon/rectum. In 1997, 500,703 women in the United States died from diseases of the circulatory system, including 370,357 deaths from heart disease. Most deaths from heart disease were due to coronary heart disease, which exceeded mortality from cerebrovascular disease at all ages except under age 40. In 1997, 258,463 women in the United States died from cancer, and before age 55, breast cancer death rates exceeded lung and colorectal cancer death rates. Mortality due to total heart disease exceeded breast and lung cancer mortality among women at all ages, but before age 55, when absolute death rates are low, breast cancer death rates exceeded those for coronary heart disease. In conclusion, aside from mortality due to all cancers combined and circulatory system disease, only accidents, which were not included in this study, and total heart disease caused more deaths than breast cancer before age 55.     

Competing risks analysis using Markov chains: impact of cerebrovascular and ischaemic heart disease in cancer mortality

BACKGROUND: A decrease in cerebrovascular disease (CVD) and ischaemic heart disease (IHD) mortality can produce an increase in mortality from other causes, even cancer. This problem is called the competing risks problem. METHODS: A Markov chain is used to analyse the interrelation between CVD, IHD and cancer mortalities in Spanish women in 1981 and 1994. We compare the results using two models: discarding CVD and IHD mortality (the elimination model) and substituting CVD and IHD 1981 mortality rates in 1994 figures (the constant model). RESULTS: Removing mortality from CVD and IHD increases cancer mortality rates in women aged > or = 70, and the probability of death from cancer rises from 10.7% to 13.3%. In the second model, the use of CVD and IHD 1981 mortality rates in 1994 data yields slightly lower mortality rates and so the impact of CVD and IHD mortality changes in the period 1981 to 1994 is negligible except in elderly women. CONCLUSIONS: Although IHD and CVD mortality have decreased in all age groups of Spanish women from 1981 to 1994, this has not had a great impact on cancer mortality.     

Changing patterns of ischaemic heart disease mortality in New Jersey 1968-1982, and the relationship with urbanization

Geographical variations in the declining rates of ischaemic heart disease (IHD) mortality may provide clues about various environmental risk factors responsible as a mass influence on the population IHD rate. The rate of IHD decline in 18 of 21 NJ counties was 2 to 45% less than the USA national rate of decline. The overall decline of IHD mortality in New Jersey (NJ) counties lagged significantly (p less than 0.05 to p less than 0.0003) behind the national trend. Age-adjusted mortality rate (AAMR) for IHD in NJ's 21 counties were 4% to 56% higher than the US rates. The IHD mortality rate of 14 of 21 NJ, counties and the entire state were significantly (p less than 0.005 to p less than 0.000001) above the US rate. Highly urbanized, industrialized, and densely populated NJ counties had the highest IHD rates. In these highly urbanized, industrialized and overcrowded NJ counties the AAMR for IHD was significantly higher and the IHD decline was significantly lower than that in the US. There was a significant (p less than 0.02 to p less than 0.00001) inverse association between annual per capita income and IHD rates. These data suggest that a high degree of urbanization, extensive industrialization, high population density and low socioeconomic status were acting as mass influences on the NJ population IHD rate.     

Cohort-specific trends in stroke mortality in seven European countries were related to infant mortality rates

OBJECTIVES: To assess, in a population-based study, whether secular trends in cardiovascular disease mortality in seven European countries were correlated with past trends in infant mortality rate (IMR) in these countries. STUDY DESIGN AND SETTING: Data on ischemic heart disease (IHD) and stroke mortality in 1950-1999 in the Netherlands, England & Wales, France, and four Nordic countries were analyzed. We used Poisson regression to describe trends in mortality according to birth cohort, for the cohorts born between 1860 and 1939. Pearson correlation coefficients were calculated to determine associations between IMR and IHD, or stroke mortality. RESULTS: IHD mortality increased for successive cohorts up to 1900, and then started to decline. Stroke mortality levels were virtually stable among birth cohorts up to 1880, but declined rapidly among later cohorts. A strong positive association was found between cohort-specific IMR levels and stroke mortality rates. There were no strong cohort-wise associations between IMR and IHD mortality. CONCLUSION: These results support other studies in suggesting that living conditions in early childhood may influence population levels of stroke mortality. Future studies should determine the contribution of specific early life factors to the mortality decline in IHD and especially stroke.     

Cultural and economic determinants of geographical mortality patterns in The Netherlands.

STUDY OBJECTIVE--The geographical pattern of mortality in The Netherlands is dominated by an area of relatively high mortality in the southern part of the country. The aim was to analyse the background of this geographical mortality pattern in the early 1980s, and its evolution over time since the early 1950s. DESIGN--Mortality data by district (n = 39), cause of death (13 large causes, "symptoms and ill defined conditions", all other causes), and time period (1950-54, 1960-64, 1970-74, 1980-84) were available from the Netherlands Central Bureau of Statistics. Standardised mortality ratios were calculated, and the logarithms of these were related to three sociodemographic characteristics using multiple, ordinary least squares regression analysis. SETTING--This study used data for the whole Dutch population. MAIN RESULTS--Although the geographical mortality pattern has been rather stable over the last decades, a clear tendency towards convergence is also apparent. Approximately 90% of the current excess mortality in the southern part of the country is due to cardiovascular diseases. The results of regression analysis show that the excess mortality is primarily related to the high percentage of Roman Catholics in this part of the country, and additionally to a slightly lower average income. In The Netherlands, a higher percentage of Roman Catholics in the population is linked with higher all cause mortality rates, as well as with higher mortality rates for lung cancer, ischaemic heart disease, cerebrovascular disease, arterial disease, and chronic non-specific lung disease. Survey data show that these associations are partly due to a higher prevalence of smoking among Roman Catholics. As in many other countries, a lower average income is linked with high all cause mortality rates in The Netherlands. Cause specific data show negative associations for stomach cancer, ischaemic heart disease, cerebrovascular disease, chronic non-specific lung disease, and traffic accidents. Since the early 1950s the association between geographical mortality patterns and the percentage of Roman Catholics in the population has gradually become less strongly positive. This suggests that the convergence of the mortality rates in the South towards the national average may be related to a gradual lessening of differences in lifestyle between population groups. CONCLUSIONS--Both cultural and economic factors are important in the explanation of geographical mortality patterns in The Netherlands.     

Health Disparities in Ischaemic Heart Disease Mortality in Hungary From 1970 to 2010: An Age-Period-Cohort Analysis

Background

The objective of this study was to examine long-term trends in rates of ischaemic heart disease (IHD) mortality, a leading cause of mortality in Hungary. The study examined the effects of age, period, and cohort on IHD mortality rates and compared mortality rates between the capital (Budapest) and non-capital counties.

Methods

Data on IHD deaths and population censuses were obtained from the Hungarian Central Statistical Office. Age-period-cohort analysis utilized nine age-group classes for ages 40 to 84 years, eight time periods from 1970 to 2009, and 16 birth cohorts from 1886 to 1969.

Results

Age-adjusted IHD mortality rates for men and for women generally increased from 1970 to 1993 and from 1980 to 1999, respectively, decreasing thereafter for both sexes. IHD mortality rates for men and for women from Budapest were lower from 1991 and from 1970, respectively, than corresponding rates in non-capital counties, with the difference increasing after 1999. Age had a more significant influence on mortality rates for women than for men. The period effect increased from 1972 to 1982 and decreased thereafter for men, while the period effect decreased consistently for women from 1972 to 2007. The decline in period effect for both sexes was larger for individuals from the capital than for those from non-capital counties. The cohort effect for both sexes declined from birth years 1890 to 1965, with a steeper decline for individuals from the capital than for those from non-capital counties.

Conclusions

The findings indicate a need for programs in Hungary for IHD prevention, especially for non-capital counties.Key words: ischaemic heart disease, mortality, age-period-cohort, Hungary     

Divergence of the recent trends in coronary mortality for the four major race-sex groups in the United States

Since 1976 there has been a leveling off or slowdown in the rate of decline in coronary heart disease (CHD) mortality. The age-adjusted absolute annual rate of decline in CHD mortality rates during 1968-75 (delta rate/100,000 population/year) was virtually identical for White males (-7.54), Black males (-7.85), and Black females (-7.20), and somewhat lower for White females (-4.25). During 1976-85, however, the secular trends diverged considerably. Age-adjusted rates continued to decline at the same annual rate for White males, while the decline was approximately half as steep for the other three race-sex groups. During 1976-85 there was also a leveling off in the average annual per cent change in age-adjusted CHD mortality for Black males and females and White females when compared to 1968-75, while there was no change for White males. As a result, more than 40,000 White and Black females and Black males died of CHD in 1985 than would have died if CHD rates would have continued to decline at the 1968-75 trends. All comparisons were based on a reclassification of cause-of-death codes to maximize comparability between the 8th and 9th Revisions of the International Classification of Disease. These results suggest that the factors which have led to the continued decline in coronary heart disease may not have influenced all the demographic groups in this country equally over the last decade.     

Metropolitan and non-metropolitan trends in coronary heart disease mortality within Appalachia, 1980-1997

OBJECTIVES: In this article, we report on metropolitan and non-metropolitan trends in coronary heart disease (CHD) mortality within the Appalachian Region for the period 1980 to 1997. We hypothesized that trends in CHD mortality would be less favorable in non-metropolitan populations with diminished access to social, economic, and medical care resources at the community level. METHODS: Our study population consisted of adults aged 35 years and older who resided within the 399 counties of the Appalachian Region between 1980 and 1997. We examined mortality trends for sixteen geo-demographic groups, defined by gender, age, race, and metropolitan status of county of residence. For each geo-demographic group, we calculated annual age-adjusted CHD mortality rates. Line graphs of these temporal trends were created, and log-linear regression models provided estimates of the average annual percent change in CHD mortality from 1980 to 1997. Data on social, economic, and medical care resources for metropolitan vs. non-metropolitan counties were also analyzed. RESULTS: Rates of CHD mortality were consistently higher in non-metropolitan areas compared with metropolitan areas for blacks of all ages and for younger whites. CHD mortality declined among almost all geo-demographic groups, but rates of decline were slower among non-metropolitan vs. metropolitan residents, blacks vs. whites, women vs. men, and older vs. younger adults. Non-metropolitan areas had fewer socioeconomic and medical care resources than metropolitan areas in 1990. CONCLUSIONS: Appalachia, particularly non-metropolitan Appalachia, needs policies and programs that will enhance both primary and secondary prevention of CHD, and help diminish racial inequalities in CHD mortality trends.     

Death from cardiovascular disease in Italy, 1972-1981: decline in mortality rates and possible causes

Mortality rates for cardiovascular disease vary widely between countries, and epidemiological patterns (trends in incidence rates, prevalence of risk factors, availability of medical care) are heterogeneous even among industrialized nations. We studied mortality from cardiovascular disease in Italy from 1972 to 1981 and compared mortality to trends in risk factors during the same period. Age-adjusted mortality rates for acute ischaemic heart disease (IHD) have increased in Italy from 1972 to reach a peak in 1978 (180.53/100,000 in males, 51.55/100,000 in females), then declined between 1978 and 1981, by 7% in males and 5% in females. The decline was more evident in males and in the younger age groups. Deaths from chronic IHD reached a peak in 1973 in females and in 1975 in males, then decreased, respectively by 24.8% and 35.7% until 1981. Mortality for cerebrovascular disease declined from 1972 to 1981 by 16.2% in males and 21.5% in females. Data from national statistics and sample surveys in different areas of Italy show an increase in total calorie intake, in animal proteins, fats and dairy products and raised average serum cholesterol levels plus an increase in smoking prevalence but a possible decline in blood pressure levels. The roles of hypertension treatment and of access to specialized medical care are discussed as possible contributors to the new declining trend of IHD, and the need is stressed for preventive strategies in health promotion.     

Multiple cause-of-death analysis of hypertension-related mortality in New York State

Multiple cause-of-death data--that is, records of all medical conditions listed on death certificates--are used to study hypertension mortality in New York State during 1968-82. Mortality rates based on underlying causes for ischemic heart disease (IHD) and stroke are selected for comparison. During 1968-78, white women showed the largest age-adjusted decline of all race-sex groups for hypertension, as white men did for stroke and nonwhite men did for IHD. White men showed the largest age-adjusted decline for all three diseases for 1979-82. In general, declines in hypertension death rates are more comparable to declines in stroke mortality than to IHD mortality.     

Generational and regional differences in trends of mortality from ischemic heart disease in Japan from 1969 to 1992.

The authors compared generational and regional trends of premature mortality from ischemic heart disease (IHD) from 1969 to 1992 for persons aged 30-69 years. They selected Tokyo and Osaka prefectures as the most urbanized and compared them with the rest of Japan. The data were divided into two periods: period I (1969-1978, International Classification of Diseases, Eight Revision) and period II (1979-1992, International Classification of Diseases, Ninth Revision). In both populations, IHD mortality decreased for both sexes, but mortality from nonspecific heart disease remained constant in men and decreased in women. In Tokyo and Osaka prefectures, the percentage decline per year in IHD mortality for both sexes was significantly smaller in period II than in period I. However, in the rest of Japan, it did not decrease for either sex. Age-specific analysis showed that the percentage decline per year in period II was smallest for the group aged 30-49 years (men, 0.05%; women, 0.76%) in Tokyo and Osaka prefectures, while it was similar for all age groups in the rest of Japan. For men, the IHD mortality rate in 1991-1992 for those aged 30-49 years was higher in Tokyo and Osaka prefectures (9.4/100,000) than in the rest of Japan (5.4/100,000).     

上海医学可避免死亡率变化的归因分析

目的：通过分析上海市人1：7可避免死亡变化的原因,评价上海市卫生系统绩效,提出绩效改进方向。方法：根据国际上已经形成的标准确定可避免死亡的范围,从上海市疾病预防控制中心获得必要的人口和死亡数据,分析不同年龄组、性别以及疾病对可避免死亡率下降的贡献。结果：（1）1999—2010年上海市人口可避免死亡率呈下降趋势。（2）1999—2010年,65～74岁组人群可避免死亡的减少对全人群可避免死亡率下降的贡献最犬,为64．59％。（3）男性可避免死亡的减少对全人群可避免死亡率下降贡献为39．90％,女性为60．02％,明显高于男性。（4）对可避免死亡率下降贡献最大的疾病为脑血管疾病,贡献率为111．94％,其下降贡献最大的为65～74岁年龄组。负贡献最大的疾病为缺血性心脏病,贡献率为-18．20％,其上升贡献最大的是60～65岁年龄组。结论：上海市卫生系统绩效逐年提高;1999年至2010年期间,上海卫生系统总体在脑血管疾病、肾炎和肾病、肺炎,65～74岁组人群组以及女性的预防保健上取得一定成绩,尤其在65～74岁组脑血管疾病,50～55岁组女性乳腺癌疾病取得显著成效;但今后要加针对缺血性心脏病（重点60~65岁组）、女性乳腺癌（重点60—65岁组）的防治工作。     

Mortality from heart failure in an English population, 1979-2003: study of death certification

OBJECTIVE: It is widely held that there will be an epidemic of heart failure in Europe and North America as a result of increased survival from myocardial infarction and other coronary heart disease. The study objective was to discover if the decline in mortality from coronary heart disease has been accompanied by a rise in mortality from heart failure in the study population. DESIGN: Analysis of database of mortality records including all certified causes of death, not just the underlying cause, from 1979-2003. SETTING: Former Oxford NHS Region, England. PATIENTS: Data from death certificates of all who died in the population covered. MAIN RESULTS: Mortality rates for heart failure fell at very similar rates as those from coronary heart disease. In men, the average annual fall in mortality from coronary heart disease was -2.7% (95% confidence intervals -2.8 to -2.5) and that from heart failure was -2.9% (-3.2 to -2.5). In women, the average annual fall in mortality from coronary heart disease was -2.3% (-2.6 to -2.1) and that from heart failure was -2.6% (-3.0 to -2.3). CONCLUSIONS: The decline in mortality from coronary heart disease has not been accompanied by a rise in mortality from heart failure. A future epidemic of heart failure, as a consequence of the decline in mortality from coronary heart disease, seems unlikely.     

The new old epidemic of coronary heart disease

OBJECTIVES: This study quantified the consequences for prevalence of increased survival of coronary heart disease (CHD) in the Netherlands from 1980 to 1993. METHODS: A multistage life table fitted observed mortality and registration rates from the nationwide hospital register. The outcome was prevalence by age, sex, period, and disease state. RESULTS: The prevalence of CHD from 1980 to 1993 was 4.4% (men, aged 25 to 84 years) and 1.4% (women, aged 25 to 84 years). Between 1980-1983 and 1990-1993, the incidence changed little, but age-adjusted prevalence increased by 19% (men) and 59% (women). CONCLUSIONS: Sharply decreasing mortality but near-constant attack rates of CHD caused distinct increases in prevalence, particularly among the elderly.     

Differences in mortality rates due to major specific causes between Japanese male occupational groups over a recent 30-year period

It is assumed that differences in the mortality rates of occupational groups are explained by work-related factors, socioeconomic status, and health practices, etc. The present study focuses on the common factors contributing to differences in the mortality rates from all and major specific causes among Japanese male occupational groups. With respect to mortality rates, the following conditions were adopted as major specific causes of death: cerebrovascular disease (CVD), ischemic heart disease (IHD), stomach cancer (Stomach CA), lung cancer (Lung CA) and suicide. Occupations were classified into eight groups. Age-adjusted mortality rates due to each specific cause of death were calculated, using the age-specific population in 1985 as a standard, for every five years of census from 1965 until 1995. The number of significant correlation coefficients and their magnitude between mortality rates due to major specific causes, among the eight occupational groups, increased with advancing census year. Namely, the order of mortality rates for the major causes in Japanese male occupational groups became more similar over the recent 30 yr period. According to the principal component analysis of mortality rates due to major specific causes, the first main factor contributed 57.9% of the commonality in 1965, 76.5% in 1980, and 86.0% in 1995, respectively.