Age and secular trends in risk factors for cardiovascular disease in Busselton

Abstract: Mortality rates from heart disease and stroke in Australia have been falling for more than 20 years. No completely satisfactory explanations for this trend exist However, it is believed to be due, at least in part, to changes in the incidence of cardiovascular disease arising from changes in the prevalence and severity of risk factors for cardiovascular disease. The adult community of Busselton in Western Australia participated in cross-sectional health surveys every three years from 1966 to 1981. This paper describes secular trends from 1966 to 1981 and age trends from 25 to 80 years for cardiovascular risk factors in Busselton men and women. Downwards secular trends were observed for mean blood pressure and smoking for men and women, upwards trends were observed for body mass index in men, and mean cholesterol was approximately constant over this period. The age and secular trends were consistent with other Australian studies conducted in the 1980s and with overseas studies. An estimated 67 per cent of the decline in cardiovascular mortality rates among Busselton men and 22 per cent of the decline among Busselton women may be attributed to changes in the prevalence of risk factors for cardiovascular disease.     

Trends in mortality due to cardiovascular diseases in Andalusia, Spain (1975-2004)

BACKGROUND: Cardiovascular diseases are ranked among the leading causes of death in the industrialized countries. This study is aimed at ascertaining the mortality trends by ischemic heart disease (IHD) and cerebrovascular diseases (CVD) in Andalusia within the 1975-2004 period. METHOD: Based on the official IHD and CVD death statistics and the related populations, the gross rates (GR) and age-adjusted rates (TS) and the Potential Years of Life Lost (PYLL) were calculated. To quantify the trends and their change points, a joinpoint regression analysis was made. RESULTS: The number of IHD deaths for females rose from 2,086 deaths in 1975 to 3,336 in 2004, the TS having dropped from 74.29 to 50.94 deaths/100,000 females, the PYLL having dropped from 173.65 years to 90.56 years/100,000 females. The number of deaths for males rose from 2,854 deaths in 1975 to 4,085 in 2004, the TS having dropped from 147, 67 to 104.96 deaths /100,000 males. The PYLL showed a like behaviour from the first to the last year of the series, showing values of 716.46 and 460.04 years / 100,000 males. For the IHD in females, the number of deaths in absolute numbers dropped from 4,712 to 4,221, the TS having dropped from 166.00 to 62.08 deaths in females, and the PYLL from 338.08 to 87.63 years / 100,000 females. For males, the number of deaths dropped from 3,714 to 2,951, the TS from 206.88 deaths /100,000 males in 1975 to 76.12 /100,000 males in 2004, and the PYLL dropping from 533.12 to 182.38 years / 100,000 males. CONCLUSIONS: The trend in mortality due to IHD was not constant either among females or males, although it has always been a downward trend, the drop being statistically significant. The drop in the CVD has been such a major one that both the absolute numbers and the gross rates are lower for the most recent years that the first years in the series studied despite the aging of Andalusias population.     

Trends in asthma mortality in Italy and Spain, 1980–1996

Asthma is a major public health problem, with variable trends in several countries. We analysed mortality trends from asthma in Italy and Spain between 1980 and 1996. Overall asthma-related mortality at all ages increased between 1980 and 1987 in both sexes in Italy, from 16.6 in 1980–1981 to 29.0 in 1986–1987 per million males, and from 8.0 in 1980–1981 to 13.8 in 1986–1987 per million females, but decreased thereafter to reach 14.6 per million in males and 8.7 in females in 1996. The downward trends after 1987 were consistent in middle age and elderly population, but asthma mortality tended to rise in children and young adults over the last few years. In Spain, overall age-standardized mortality rates from asthma declined in men from 37.8 in 1980–1981 to 10.1 in 1996, and from 19.5 in 1980–1981 to 13.2 per million females in 1996. In women, the fall in mortality rates was smaller, and overall mortality was higher than in males since early 1990s. Trends of asthma mortality in Italy and Spain were favourable over the last decade.     

Declining mortality from ischemic heart disease and changes in coronary risk factors in Japan, 1956-1980

Mortality from ischemic heart disease has declined in Japan since 1970. This paper addresses the declining mortality from ischemic heart disease and the possible contributing factors for 1956-1980. Mortality figures were obtained from Vital Statistics reports by the Ministry of Health and Welfare in Japan. National trends in blood pressure levels, prevalence of hypertension, Keys' lipid factor phi instead of the serum cholesterol level, and body mass index were obtained from the National Nutrition Survey which is carried out annually from random samples in Japan. The smoking rate which was obtained from other national surveys was also reviewed for this purpose. The age-adjusted (30-69 years) mortality from ischemic heart disease declined by 24% and 37% for men and women, respectively, between 1968 and 1978. It seemed that the decline in blood pressure levels and in the prevalence of hypertension and the increasing treatment rate for cardiovascular disease might contribute to the declining mortality from ischemic heart disease. The decline in cigarette smoking may, in part, also play a role. On the other hand, the increase in intake of lipids which resulted in Keys' lipid factor phi was compatible with the increase in mortality from ischemic heart disease during 1956-1970. The experience in Japan shows that the treatment of hypertension or the lowering of blood pressure and the recommendation to stop smoking help to prevent ischemic heart disease.     

Factors in health initiative success: learning from Nepal's newborn survival initiative

Like many OECD countries New Zealand has experienced a large increase in the number of working-age people receiving incapacity benefits in the last 3 decades, despite apparent improvements in population health. This paper examines trends in mortality rates of people receiving sickness benefit or invalid's benefit (SBIB) between 1981 and 2004 using repeated cohort studies (linking the 1981, 1986, 1991, 1996, and 2001 censuses to mortality data). Mortality rates, standardised for age and ethnicity, were calculated for each census cohort for 25-64 year olds by benefit receipt status. Standardised rate differences and rate ratios and 95% confidence intervals were calculated to measure disparities on both absolute and relative scales. Between 1981 and 2004 overall SBIB receipt increased from 2% to 5% of the working age population. Mortality rates were at least three times higher in the SBIB than the non-SBIB group at all points in time for men and women. Mortality rates declined in all groups, for example in men receiving SBIB, mortality decreased from 2354/100,000 in the 1981-84 cohort to 1371/100,000 in the 2001-04 cohort. Absolute inequalities between SBIB and non-SBIB declined in both men and women (for example in women standardised rate differences decreased from 954/100,000 to 688/100,000) but relative inequalities remained largely stable (for example in men the risk ratio increased from 4.27 to 4.54). Mortality rates declined more in sickness benefit than invalid's benefit recipients. The substantial expansion of SBIB receipt in New Zealand has not been accompanied by any reduction in the excess mortality risk experienced by SBIB recipients. These findings are likely to reflect the changing nature of the economy, labour force and disability experience in New Zealand.     

Mortality trends and the epidemiological transition in Nauru

This article aims to examine the epidemiological transition in Nauru through analysis of available mortality data. Mortality data from death certificates and published material were used to construct life tables and calculate age-standardized mortality rates (from 1960) with 95% confidence intervals. Proportional mortality was calculated from 1947. Female life expectancy (LE) varied from 57 to 61 years with no significant trend. Age-standardized mortality for males (15-64 years) doubled from 1960-1970 to 1976-1981 and then decreased to 1986-1992, with LE fluctuating since then from 49 to 54 years. Proportional mortality from cardiovascular disease and diabetes increased substantially, reaching more than 30%. Nauru demonstrates a very long period of stagnation in life expectancy in both males and females as a consequence of the epidemiological transition, with major chronic disease mortality in adults showing no sustained downward trends over 40 years. Potential overinterpretation of trends from previous data due to lack of confidence intervals was highlighted.     

Urban-rural inequalities in ischemic heart disease in Scotland, 1981-1999

OBJECTIVES: We sought to describe the pattern and magnitude of urban-rural variation in ischemic heart disease (IHD) in Scotland and to examine the associations among IHD health indicators, level of rurality, and degree of socioeconomic deprivation. METHODS: We used routine population and health data on the population aged 40-74 years between 1981 and 1999 and living in 826 small areas (average population=5600) in Scotland. Three IHD health indicators-mortality rates (deaths per 100,000 population), rates of continuous hospital stays (discharges per 100,000 population), and rates of mortality in the hospital or within 28 days of discharge (MH+) were analyzed with multilevel Poisson models. A 4-level rurality classification was used: urban areas, remote small towns, accessible rural areas, and remote rural areas. RESULTS: Rates of mortality, continuous hospital stays, and MH+ increased with area socioeconomic deprivation. After adjustment for population age, gender, and deprivation, the relative risk of IHD mortality in remote rural areas was similar to that of urban areas in 1981; the relative risk of a continuous hospital stay was significantly lower (relative risk [RR] = 0.70; 95% confidence interval [CI] = 0.64, 0.76) and the relative risk of MH+ was higher (RR=1.18; 95% CI=1.04, 1.35) in remote rural areas. Mortality and MH+ declined for all ruralities over time. However, MH+ remains highest in remote rural areas and remote towns. CONCLUSIONS: Low standardized ratios of IHD continuous hospital stays and mortality in remote rural areas mask health problems among rural populations. Although absolute and relative differences between urban and rural rates of MH+ have diminished, the relative risk of MH+ remains high in remote rural areas.     

Gastric cancer in Tasmania (1978-1992)

A detailed analyses of gastric cancer incidence and mortality rates in Tasmania was done using fifteen years (1978-1992) of population based Tasmanian Cancer Registry data. The age standardised incidence rates for the period were 12.5 per 100,000 men (95% CI 11.4-13.6) and 5.2 per 100,000 women (95% CI 4.6-5.8). The age standardised mortality rates were 10.6 per 100,000 men (95% CI 9.6-11.6) and 4.1 per 100,000 women (95% CI 3.5-4.6). Male:Female ratio of mortality rates was 2.6. Gastric cancer mortality rates have now significantly declined among males (p = .03) and females (p = .02). No significant decline was observed for incidence rates among males (p = .1) and females (p = .3). For cases overall, there was a preponderance of intestinal type of gastric cancer (76.5%). No significant trend over time was observed in the mean rate of occurrence of intestinal or diffuse type of gastric cancer. The ratio of intestinal: diffuse was 6.5 for all ages. Among males, a significant (p = .03) upward trend in the incidence was observed for proximal tumours, while no such trend (p = .07) was observed among women. A significant decline in incidence of distal tumours was observed for males (p = .000) and females (p.007). Male:Female ratio for proximal tumour was 4.7:1. The results suggests that Tasmanians may have been a population at high risk of gastric cancer.     

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.     

Trends in chronic disease mortality in the Northern Territory Aboriginal population, 1997‐2004: using underlying and multiple causes of death

Objective: To assess trends in chronic disease mortality in the Aboriginal population of the Northern Territory (NT), using both underlying and multiple causes of death. Method: Death registration data from 1997 to 2004, were used for the analysis of deaths from five chronic diseases; ischaemic heart disease (IHD), diabetes, chronic obstructive pulmonary disease (COPD), renal failure and stroke. Negative binomial regression models were used to estimate the average annual change in mortality rates for each of the five diseases. Chi squared tests were conducted to determine associations between the five diseases. Results: The five chronic diseases contributed to 49.3% of all Aboriginal deaths in the NT. The mortality rate ratio of NT Aboriginal to all Australian death rates from each of the diseases ranged from 4.3 to 13.0, with the lowest rate ratio for stroke and highest for diabetes. There were significant statistical associations between IHD, diabetes, renal failure and stroke. The mortality rates for diabetes, COPD and stroke declined at estimated annual rates for NT Aboriginal males of 3.6%, 1.0% and 11.7% and for Aboriginal females by 3.5%, 6.1% and 7.1% respectively. There were increases in mortality rates for Aboriginal males and females for IHD and a mixed result for renal failure. Conclusion: NT Aboriginal people experience high chronic disease mortality, however, mortality rates appear to be declining for diabetes, COPD and stroke. The impact of chronic disease on mortality is greater than previously reported by using a single underlying cause of death. The results highlight the importance of integrated chronic disease interventions.     

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).     

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     

Trends in coronary heart disease mortality and morbidity in Auckland, New Zealand, 1974-1986

Routine mortality statistics show that coronary heart disease (CHD) death rates have declined consistently in Auckland men since 1968; in women, death rates declined between 1968 and 1986 but since 1981 there may have been a reduction in the rate of decline. Data from CHD registers conducted in Auckland, New Zealand in 1974, 1981, and since 1983 as part of the WHO MONICA Project, have been used to investigate the validity and reasons for the decline in the age group 35-64 years. In Auckland age-standardized sudden coronary death rates in men declined by approximately 2% per year between 1974 and 1986; there was no apparent decline in women. There was also an indication of a decline in age-standardized definite myocardial infarction rates but again only in men; 28 day case fatality in patients with a definite myocardial infarction has not changed significantly in the period 1981-1986. These results validate the mortality trends based on death certificates and in particular the differing recent trends in men and women. The decline in CHD mortality in men without a concomitant change in case fatality and the lack of recent decline in women, suggest that changes in the natural history of the disease rather than treatment are responsible for the mortality trends. Since disease events are rare in absolute numbers, long-term monitoring of coronary heart disease in large population groups will be necessary to usefully study disease trends, particularly in women.     

Age-specific trends in cardiovascular mortality rates in the Netherlands between 1980 and 2009

Recent analyses suggest the decline in coronary heart disease mortality rates is slowing in younger age groups in countries such as the US and the UK. This work aimed to analyse recent trends in cardiovascular mortality rates in the Netherlands. Analysis was of annual all circulatory, ischaemic heart disease (IHD), and cerebrovascular disease mortality rates between 1980 and 2009 for the Netherlands. Data were stratified by sex and 10-year age group (age 35–85+). The annual rate of change and significant changes in the trend were identified using joinpoint Poisson regression. For almost all age and sex groups examined the rate of IHD and cerebrovascular disease mortality in the Netherlands has more than halved between 1980 and 2009. The decline in mortality from both IHD and cerebrovascular disease is continuing for all ages and sex groups, with anacceleration in the decline apparent from the late 1990s/early 2000s. The decline in age-specific all circulatory, coronary heart disease and cerebrovascular disease mortality rates continues for all age and sex groups in the Netherlands.     

Risk factor changes and mortality changes: a regional perspective on ischaemic heart disease in Norway 1966-85

This study from Oppland county, Norway, examines risk factor changes in three regions with different mortality time trends among middle-aged males, for ischaemic heart disease, including sudden, unexpected death (IHD/SUD). The study is partly based on vital statistics and on results from two health screening surveys conducted in 1976-78 and in 1981-83. Regional data for the following risk factors are considered: serum cholesterol, systolic blood pressure, body weight and prevalence of smoking. Risk factor data are from the group of men aged 40-49 years in 1976-78. Changes in risk factor levels from 1976-78 to 1981-83 did not differ substantially between regions with widely different mortality time trends. The north-western, rural part of Oppland county experienced 80% IHD/SUD-mortality increase (95% confidence interval 35%-124%) from 1966-70 to 1981-85, among males aged 40-59. The mean serum cholesterol level dropped by 1.7% (P less than 0.001) from 1976-78 to 1981-83, and the prevalence of smoking was also reduced in this region. The north-western rural region experienced a slightly more pronounced increase in mean body weight and in mean systolic blood pressure, compared to the remaining two regions of Oppland county, where the changes in IHD/SUD mortality were not statistically significant. This study has demonstrated that changes in main risk factors are not necessarily accompanied by contemporary IHD/SUD-mortality changes in the same direction. The explanation could be long time-lags before risk factors affect mortality levels. The results could also indicate the presence of other important risk factors, not evenly distributed between the regions.     

Epidemiologic aspects of coronary heart disease in Malm?, Sweden, 1935-1988

Mortality from coronary heart disease has declined for more than 20 years in several industrialized countries. Partly because of a lack of morbidity data, the reasons for the decline are not satisfactorily established. This community-wide survey of coronary heart disease morbidity and mortality in Malm?, Sweden, showed declining mortality rates beginning in the mid-1970s. Between the 3-year intervals 1975-1977 and 1984-1986, coronary heart disease mortality declined by 17% (2,610/100,000 inhabitants in 1984-1986) in men aged greater than or equal to 70 years and by 8% (938/100,000 inhabitants in 1984-1986) in men aged 60-69 years, while coronary heart disease mortality in men aged 50-59 years increased by 7% (355/100,000 inhabitants in 1984-1986). In women aged greater than or equal to 70 years, coronary heart disease mortality decreased by 12% between 1975-1977 and 1984-1986 (1,609/100,000 inhabitants in 1984-1986), while the decrease in women aged 60-69 years was 5% (242/100,000 inhabitants in 1984-1986). The decline in mortality was associated with a decline in both incidence rates and in-hospital case fatality rates for myocardial infarction. The authors suggest that the declining coronary heart disease mortality in Malm? was due partly to prevention of coronary heart disease but that improved medical care for acute and chronic coronary heart disease may also have contributed.     

Time trends in the mortality rates for tobacco- and alcohol-related cancers within the oral cavity and pharynx in Japan, 1950-94

Mortality data of oral cancer over 40 years in Japan were analyzed to investigate time trends of the disease site-specifically and discuss the relation between these trends and the changing patterns of consumption of tobacco and alcohol beverages. Mortality rates were adjusted to the world standard population. In the males, overall oral cancer (ICD-9: 141-149) mortality rates have increased consistently from the lowest value of 1.25 (per 100,000 per year) in 1956 to 2.40 in 1992. The rates for females were constantly lower than those for males, and formed a modest peak of 0.96 in 1979. Regarding site-specific mortality rates, tongue cancer (141) presented a decreasing trend, while oro/hypopharyngeal (146, 148) and mouth (143-145) cancers showed increasing patterns, particularly in males. When the changing patterns of male truncated rates for ages 35-64 were compared with those of the annual consumption of cigarette and alcohol per capita, the time trend of oro/hypopharyngeal cancer mortality was analogous to cigarette consumption rather than to alcohol consumption, mouth cancer vice versa, and tongue cancer was not related to tobacco or alcohol consumption. The present findings suggest that tobacco and alcohol have different site-specific effects on the development of cancers within the oral cavity and pharynx.     

The temporal relation between cigarette smoking and pancreatic cancer

Temporal trends in US cigarette smoking prevalence rates 1920 to 1978, were related to temporal trends in US pancreatic cancer mortality rates in both sexes. In males, the rise and fall in smoking prevalence was followed by a rise and recent fall in cancer rates. In females, the later rise in smoking prevalence has been accompanied by a rise in cancer rate, and a recent slight decline in smoking rate has been associated with a slowing of the rise in cancer rate.