Decline of coronary heart disease mortality is strongly effected by changing patterns of underlying causes of death: an analysis of mortality data from 27 countries of the WHO European region 2000 and 2013

Susanne Stolpe,Andreas Stang,Bernd Kowall

doi:10.1007/s10654-020-00699-0

Abstract

Mortality rates for coronary heart disease (CHD) experience a longstanding decline, attributed to progress in prevention, diagnostics and therapy. However, CHD mortality rates vary between countries. To estimate whether national patterns of causes of death impact CHD mortality, data from the WHO “European detailed mortality database” for 2000 and 2013 for populations aged ≥ 80 years was analyzed. We extracted mortality rates for total mortality, cardiovascular diseases, neoplasms, dementia and ill-defined causes. We calculated proportions of selected causes of death among all deaths, and proportions of selected cardiovascular causes among cardiovascular deaths. CHD mortality rates were recalculated after re-coding ill-defined causes of death. Association between CHD mortality rates and proportions of CHD deaths was estimated by population-weighted linear regression. National patterns of causes of death were divers. In 2000, CHD was assigned as cause of death in 13–53% of all cardiovascular deaths. Until 2013, this proportion changed between − 65% (Czech Republic) and + 57% (Georgia). Dementia was increasingly assigned as underlying cause of death in Western Europe, but rarely in eastern European countries. Ill-defined causes accounted for between < 1% and 53% of all cardiovascular deaths. CHD mortality rates were closely linked to a countries’ proportion of cardiovascular deaths assigned to CHD (R2 = 0.95 for 2000 and 0.99 for 2013). We show that CHD mortality is considerably influenced by national particularities in certifying death. Changes in CHD mortality rates reflect changes in certifying competing underlying causes of death. This must be accounted for when discussing reasons for the CHD mortality decline.

Highlights

Coronary mortality rates have been declining worldwide— a trend called the “success story of the last 4 decades of the 20th century”; possible causes and implications are in continuing discussion [1]
In this paper we describe the different and changing patterns of assigning a specific cardiovascular disease as underlying cause of death as well as the frequency of ill-defined cardiovascular causes of death and how this effects coronary heart disease (CHD) mortality rates
The proportion of cardiovascular deaths attributed to CHD varied broadly in the WHO European region and predicted the reported CHD mortality rate to a great extent (Fig. 5)

Summary

Introduction

Coronary mortality rates have been declining worldwide— a trend called the “success story of the last 4 decades of the 20th century”; possible causes and implications are in continuing discussion [1]. Country-specific declines in CHD have been attributed to about 90% to effects of primary and secondary prevention, namely risk factor reduction and treatment [4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20] In these analyses the role of divergent and changing patterns in assigning cardiovascular diseases as underlying cause of death has not been taken into account

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Conclusion