Cerebrovascular Disease Mortality Research Articles

PS 09-02 BURDEN & CORRELATES OF DIAGNOSED & UNDIAGNOSED HYPERTENSION

Objective: Hypertension is a silent major risk factor for cardiovascular and cerebro-vascular disease (CVD) related morbidity & mortality. The objectives of the study were to measure the prevalence of doctor diagnosed hypertension (DDH), undiagnosed hypertension and assessment of the associations of socio-demographic and behavioral factors. Design and Method: WHO classification of hypertension and gradations were used in the cross sectional study of 5347 adults of an established urban longitudinal population cohort of West Bengal, India. Information gathered from pre-tested questionnaire, anthropometry and brachial arterial blood pressure obtained with electronic sphygmomanometer. Results: Among the participants, 2083 (38.96%) were male and 3264 (61.04%) were female. 1712 (32.05%) were hypertensive, 1039 (19.48%) had DDH out of which 963 (92.69%) were on medications. Among DDH, 512 (49.28%) were uncontrolled hypertensives while majority on treatment .Undiagnosed hypertensives were 664 (12.42%). Increasing age is associated with DDH [AOR = 1.08, 95% CI: (1.08–1.09), p < .0001] and overall hypertension [AOR = 1.09, 95% CI: (1.08–1.10), p < .0001]. Ex-smokers and ex-drinkers were associated with DDH [AOR = 1.60, 95% CI: (1.15–2.22), p = 0.0055] and [AOR = 1.74, 95% CI: (1.14–2.63), p = 0.0096] respectively. Always snorers were associated with DDH [AOR = 2.05, 95% CI: (1.71–2.47), p < .0001] and overall hypertension [AOR = 1.71, 95% CI: (1.44–2.02), p < .0001]. Obese persons were associated with DDH [AOR = 3.21, 95% CI: (2.48–4.16), p < .0001] and overall hypertension [AOR = 2.85, 95% CI: (2.44–3.63), p < .0001]. Participants consuming additional salt always [AOR = 1.85, 95% CI: (1.45–2.36), p < .0001] or sometimes [AOR = 1.66, 95% CI: (1.25–2.20), p = 0.0005] with food were associated with undiagnosed hypertension. Conclusions: Nearly one third of the adult cohort was hypertensive and one fifth was doctor diagnosed. Half of DDH remained uncontrolled while 93% being on treatment. Majority of risk factors noted were reversible therefore targeted evidence based intervention is expected to reduce the burden of hypertension and related complications.

Is outdoor work associated with elevated rates of cerebrovascular disease mortality? A cohort study based on iron-ore mining.

BackgroundA cohort study that examined iron ore mining found negative associations between cumulative working time employed underground and several outcomes, including mortality of cerebrovascular diseases. In this cohort study, and using the same group of miners, we examined whether work in an outdoor environment could explain elevated cerebrovascular disease rates.MethodsThis study was based on a Swedish iron ore mining cohort consisting of 13,000 workers. Poisson regression models were used to generate smoothed estimates of standardized mortality ratios and adjusted rate ratios, both models by cumulative exposure time in outdoor work.ResultsThe adjusted rate ratio between employment classified as outdoor work ≥25 years and outdoor work 0–4 years was 1.62 (95 % CI 1.07–2.42). The subgroup underground work ≥15 years deviated most in occurrence of cerebrovascular disease mortality compared with the external reference population: SMR (0.70 (95 % CI 0.56–0.85)).ConclusionsEmployment in outdoor environments was associated with elevated rates of cerebrovascular disease mortality. In contrast, work in tempered underground employment was associated with a protecting effect.

Analysis of cerebrovascular disease mortality in Costa Rica between the years 1920-2009

To analyze the trend in mortality from cerebrovascular diseases in Costa Rica and its impact on overall mortality from 1920 to 2009. Crude rates by triennium and quinquennium were obtained. We also obtanied age standardized rates in the age group 35-74 years during the period 1970-2009. Finally we got the death percentage from stroke in relation to overall mortality. The trend for the period 1920-1969 was to the upside (r=0.82, r2=0.67, betha 0.30; P≤0.00) whereas for the period 1970 occurred otherwise (r=0.42, r2=0.18, betha -0064; P=0.01). Adjusted for the group 35-74 years between 1970-2009 rates decreased by 58.03% was statistically significant trend for both sexes; men r2=0.94, betha: -0.73; women: r2=0.97, betha: 0.95. The maximum percentage of mortality from stroke in relation to the overall mortality was 7.22 in the period 1985-1989 reached down to 5.92% in 2005-2009. In the Latin American context, stroke mortality rates in Costa Rica are low but still represent a serious public health problem by the high mortality, morbidity and disability that they cause, despite a downward trend.

Analysis of cerebrovascular mortality trends in Spain from 1980 to 2011

IntroductionIn recent decades, mortality rates for cerebrovascular diseases (CVD) have declined significantly in many countries. This study analyses changes in CVD mortality rates in Spain (1980-2011) to determine if previously observed trends remain. Patients and methodsData on CVD mortality rates and the population data needed for the analysis were provided by Spain's National Statistics Institute. We calculated age-specific mortality rate, age-standardised overall mortality, and age-truncated mortality (35-64 years) using the direct method and standard European population structure. Joinpoint analysis was used to estimate the percentage of annual change in rates and identify significant changes in trends. ResultsCVD mortality rate decreased considerably and continuously over the last 32 years in all age groups and in both sexes in Spain. For both sexes, joinpoint analysis identifies a final period with more marked decline: 2005-2011 in women (−6.3%) and 2007-2011 in men (−7.2%). ConclusionsCVD mortality rates displayed a marked and continuous decline in Spain between 1980 and 2011. Due to the ageing of the population, doctors expect an increase in CVD prevalence and therefore its magnitude in terms of disability and healthcare costs, which poses a challenge to our health system.

Trends in Mortality From Ischemic Heart Disease and Cerebrovascular Disease in Europe: 1980 to 2009.

Trends in cardiovascular mortality across Europe demonstrate significant geographical variation, and an understanding of these trends has a central role in global public health. Ischemic heart disease and cerebrovascular disease age-standardized death rates (as per International Classification of Diseases, ninth and tenth revisions) were collated from the World Health Organization mortality database for member states of the European Union. Trends were characterized by using Joinpoint regression analysis. An overall trend for reduction in ischemic heart disease mortality was observed, most pronounced in Western Europe (>60% for the Netherlands, United Kingdom, and Ireland) for both sexes from 1980 to 2009. Eastern European states, Romania, Croatia, and Slovakia, had modest mortality reductions. Most recently (2009), Lithuania had the highest mortality for males and females (318.1/100 000 and 166.1/100 000, respectively), followed by Latvia and Slovakia. France had the lowest mortality: 39.8/100 000 for males and 14.7/100 000 for females. Analysis of cerebrovascular disease mortality revealed that Austria had the largest reduction for both sexes (76.8% males, 76.5% females) from 1980 to 2009. The smallest improvement over this period was seen in Lithuania, Poland, and Cyprus (-5% to +20% approximately). France has the lowest present-day cerebrovascular disease mortality for both males and females (23.9/100 000 and 17.3/100 000, respectively). There is a growing disparity in cardiovascular mortality between Western and Eastern Europe, for which diverse explanations are discussed. The need for population-wide health promotion and primary prevention policies is emphasized.

Performance on Specific Cognitive Domains and Cause of Death: A Prospective Population-Based Study in Non-Demented Older Adults (NEDICES).

Evidence regarding the relationship between performance on specific cognitive domains and cause of death is scarce. We assessed whether specific cognitive domains predicted mortality and the presence of any association with specific causes of death in a population-dwelling sample of non-demented older adults. In this population-based, prospective study (NEDICES), 2,390 non-demented subjects ≥65 years completed a brief neuropsychological battery. Cox's proportional hazards models, adjusted by sociodemographic and comorbidity factors, global cognitive performance, educational level, and premorbid intelligence were used to assess the risk of death. Participants were followed for a median of 9.2 years (range 0.01-10.7), after which the death certificates of those who died were examined. 880 (36.8%) of 2,390 participants died over a median follow-up of 5.5 years (range 0.01-10.5). Using adjusted Cox regression models, we found that hazard ratios for mortality in participants within the lowest tertiles (worse performance) were 1.31 (speed of cognitive processing, p = 0.03); 1.22 (semantic fluency, p = 0.04), 1.32 (delayed free recall, p = 0.003), and 1.23 (delayed logical memory, p = 0.03). Poor performance on delayed recall and speed of cognitive processing tests were associated with dementia and cerebrovascular disease mortality, respectively. Further, poor performance on semantic fluency was associated with decreased cancer mortality. In this study of community dwelling non-demented older adults, worse neuropsychological performance was associated with increased risk of mortality. Performance on specific cognitive domains were related to different causes of death. Of particular note there appears to be an inverse association between poor semantic fluency and cancer mortality.

Thirty-Year Trends in Mortality from Cerebrovascular Diseases in Korea.

Background and ObjectivesCerebrovascular disease is a leading cause of mortality and morbidity in Korea. Understanding of cerebrovascular disease mortality trends is important to reduce the health burden from cerebrovascular diseases. We examined the changing pattern of mortality related to cerebrovascular disease in Korea over 30 years from 1983 to 2012.Subjects and MethodsNumbers of deaths from cerebrovascular disease, hemorrhagic stroke, and cerebral infarction were obtained from the national Cause of Death Statistics. Crude and age-adjusted mortality rates were calculated for men and women for each year. Penalized B-spline methods, which reduce bias and variability in curve fitting, were used to identify the trends of 30-year mortality and identify the year of highest mortality.ResultsDuring the 30 years, cerebrovascular disease mortality has markedly declined. The age-adjusted cerebrovascular disease mortality rate has decreased by 78% in men and by 68% in women. In the case of hemorrhagic stroke, crude mortality peaked in 2001 but age-adjusted mortality peaked in 1994. Between 1994 and 2012, age-adjusted mortality from hemorrhagic stroke has decreased by 68% in men and 59% in women. In the case of cerebral infarction, crude and age-adjusted mortality rates steeply increased until 2004 and 2003, respectively, and both rates decreased rapidly thereafter.ConclusionCerebrovascular disease mortality rate has significantly decreased over the last 30 years in Korea, but remains a health burden. The prevalence of major cardiovascular risk factors are still highly prevalent in Korea.

Asian dust effect on cause-specific mortality in five cities across South Korea and Japan

Desert dust is considered to be potentially toxic and its toxicity may change during long-range transportation. In Asian countries, the health effects of desert dust in different locations are not well understood. We therefore evaluated the city-combined and city-specific effects of Asian dust events on all-cause and cause-specific mortality in five populous cities in South Korea (Seoul) and Japan (Nagasaki, Matsue, Osaka and Tokyo). We obtained daily mean concentrations of Asian dust using light detection and ranging (lidar) between 2005 and 2011. We then evaluated city-specific and pooled associations of Asian dust with daily mortality for elderly residents (≥65 years old) using time-series analyses. Each 10 μg/m3 increase in the concentration of same-day (lag 0) or previous-day (lag 1) Asian dust was significantly associated with an elevated pooled risk of all-cause mortality (relative risk (RR): 1.003 [95% CI: 1.001–1.005] at lag 0 and 1.001 [95% CI: 1.000–1.003] at lag 1) and cerebrovascular disease (RR: 1.006 [95% CI: 1.000–1.011] at lag 1). This association was especially apparent in Seoul and western Japan (Nagasaki and Matsue). Conversely, no significant associations were observed in Tokyo, which is situated further from the origin of Asian dust and experiences low mean concentrations of Asian dust. Adverse health effects on all-cause and cerebrovascular disease mortality were observed in South Korea and Japan. However, the effects of Asian dust differed across the cities and adverse effects were more apparent in cities closer to Asian dust sources.

Abstract 17097: Substantial Improvement of Primary Cardiovascular Prevention by a Systematic Score-based Multimodal and Lifestyle Approach: A Randomized Endpoint-Study - The Preford-Study

Background: The optimization of primary preventive cardiovascular (CV) strategies is urgently needed. The objective of the present study was to evaluate the long-term effects of a standardized multimodal and lifestyle based therapeutic approach in high-risk-subjects according to the ESC-SCORE on predefined cardiovascular end-points. The ESC-SCORE allows a systematic estimation of the 10-year-risk for fatal CV events. Methods: The individual CV risk was assessed in a cohort of 4.196 employees of the Ford-Company, Germany, using the ESC-SCORE. Subjects were subsequently classified into three risk-groups. Subjects at high-risk, (ESC-SCORE ≥ 5%; n=447), were randomized either into a multimodal 15-week lifestyle based outpatient intervention program (INT n=224) or into a usual care group (UC n=223) and followed up for 36 months. The primary endpoint was a reduction of the ESC-SCORE in the INT as compared to the UC at the end of the trial. Secondary endpoints were a composite of fatal and non-fatal CV events (coronary artery disease, cerebrovascular or peripheral arterial disease, CV death and total mortality) and the time to the first CV event. An intention to treat analysis was performed. Results: After 36 months a difference of the ESC-SCORE development favoring the INT was achieved (INT: 8.70 to 10.03% vs. UC: 8.49 to 12.09%; p&lt;0.016). Moreover, a reduction in the composite secondary endpoint was observed (INT: n=11 vs. UC: n=27; p=0.032; HR 0.45 (CI 0.22 - 0.94). Conclusions: Our results demonstrate an intermediate-term improvement of the ESC-SCORE as well as a reduction of predefined CV endpoints by a primary CV prevention program within 36 months in a cohort of persons determined to be at high CV risk by assessment with the ESC-SCORE.

Trends in standardized mortality rates for select groups of cardiovascular diseases in Slovakia between 1980 and 2010

ObjectivesReducing mortality due to cardiovascular diseases especially in people less than 65 years is one of the main targets of WHO preventive programs. This work aimed to analyse recent trends in cardiovascular mortality rates in Slovakia. Study designA descriptive study was implemented with a Joinpoint analysis. MethodsAnalysis was of annual all circulatory, acute myocardial infarction mortality, and cerebrovascular disease mortality rates, between 1980 and 2010 for Slovakia. Data were stratified by sex and 10-year age group (age 25–85 years). The annual percentage change (APC) and significant changes in the trend were identified using joinpoint Poisson regression. ResultsThe standardized mortality rate for all cardiovascular diseases declined in Slovakia between 1980 and 2010 by 25.7% and 30.5% for men and women, respectively. Joinpoint analysis of all cardiovascular disease mortality rates demonstrated statistically significant changes in trends of APC decline for both genders. For men, acceleration in the rate of decline between 2001 and 2010 was observed APC −2.2 (95% CI = −3.5, −1.2) following a slowing of the rate of decline between 1980 and 2001, when the APC reached −0.5 (95% CI = −0.8, −0.3). For women the trend was similar. Between 2003 and 2010 acceleration in the decline was demonstrated APC −2.8 (95% CI = −4.3, −1.4). ConclusionThe results of our analysis demonstrate the need to constantly address issues of cardiovascular diseases, as mortality rates in Slovakia are among the highest within the European Union countries in the long term.

Interdisciplinary Analysis of Annual Space Weather Activity in Relation to Mortality Associated with Cerebrovascular Disease: A Novel Model of Solar-Terrestrial Interaction

A combination of heliobiological and biometeorological perspectives on human biology and epidemiology has recently yielded many intriguing results suggesting relationships with various measures of space weather. The convergence of empirical results with quantitative dimensional analyses has also proven incredibly effective in explaining similar results and in constructing new models of solar-terrestrial interaction. In the current study, we applied these approaches to the analysis of annual mortality rates associated with cerebrovascular diseases in Canada from 1979 to 2009 to determine potential overlap with our previous work on hypertensive disease mortality with heliogeophysical factors and derive values for constructing a novel model of solar influence on terrestrial biology. Annual cerebrovascular disease mortality displayed a strong non-linear trend over time. As suspected, correlation analyses with various measures of solar, geomagnetic, and cosmic ray features suggested a significant relationship between cerebrovascular mortality and the plasma beta function for solar wind pressures which was phase shifted by ~5 to 6 years. After removing a fourth-order polynomial trend from cerebrovascular data, the dominant cycle demonstrated was ~14.60 years, offset from the ~10.90 year cycle of the average plasma beta by approximately 6 years. Finally, we employed relevant values from these results for dimensional analysis using physical constants from physics, neuroscience, and astronomy in order to help describe an Earth-Sun circuit connected by magnetic flux lines through which pressure waves might propagate, resulting in a lagged or cumulative influence on cerebrovascular-related death.

Social Determinants of Risk and Outcomes for Cardiovascular Disease: A Scientific Statement From the American Heart Association.

An Institute of Medicine report titled U.S. Health in International Perspective: Shorter Lives, Poorer Health documents the decline in the health status of Americans relative to people in other high-income countries, concluding that “Americans are dying and suffering from illness and injury at rates that are demonstrably unnecessary.”1 The report blames many factors, “adverse economic and social conditions” among them. In an editorial in Science discussing the findings of the Institute of Medicine report, Bayer et al2 call for a national commission on health “to address the social causes that have put the USA last among comparable nations.” Although mortality from cardiovascular disease (CVD) in the United States has been on a linear decline since the 1970s, the burden remains high. It accounted for 31.9% of deaths in 2010.3 There is general agreement that the decline is the result, in equal measure, of advances in prevention and advances in treatment. These advances in turn rest on dramatic successes in efforts to understand the biology of CVD that began in the late 1940s.4,5 It has been assumed that the steady downward trend in mortality will continue into the future as further breakthroughs in biological science lead to further advances in prevention and treatment. This view of the future may not be warranted. The prevalence of CVD in the United States is expected to rise 10% between 2010 and 2030.6 This change in the trajectory of cardiovascular burden is the result not only of an aging population but also of a dramatic rise over the past 25 years in obesity and the hypertension, diabetes mellitus, and physical inactivity that accompany weight gain. Although there is no consensus on the precise causes of the obesity epidemic, a dramatic change in the underlying biology of Americans is …

Interdisciplinary Analysis of Annual Space Weather Activity in Relation to Mortality Associated with Cerebrovascular Disease: A Novel Model of Solar-Terrestrial Interaction

A combination of heliobiological and biometeorological perspectives on human biology and epidemiology has recently yielded many intriguing results suggesting relationships with various measures of space weather. The convergence of empirical results with quantitative dimensional analyses has also proven incredibly effective in explaining similar results and in constructing new models of solar-terrestrial interaction. In the current study, we applied these approaches to the analysis of annual mortality rates associated with cerebrovascular diseases in Canada from 1979 to 2009 to determine potential overlap with our previous work on hypertensive disease mortality with heliogeophysical factors and derive values for constructing a novel model of solar influence on terrestrial biology. Annual cerebrovascular disease mortality displayed a strong non-linear trend over time. As suspected, correlation analyses with various measures of solar, geomagnetic, and cosmic ray features suggested a significant relationship between cerebrovascular mortality and the plasma beta function for solar wind pressures which was phase shifted by ~5 to 6 years. After removing a fourth-order polynomial trend from cerebrovascular data, the dominant cycle demonstrated was ~14.60 years, offset from the ~10.90 year cycle of the average plasma beta by approximately 6 years. Finally, we employed relevant values from these results for dimensional analysis using physical constants from physics, neuroscience, and astronomy in order to help describe an Earth-Sun circuit connected by magnetic flux lines through which pressure waves might propagate, resulting in a lagged or cumulative influence on cerebrovascular-related death.

Cerebrovascular Diseases in Workers at Mayak PA: The Difference in Radiation Risk between Incidence and Mortality.

A detailed analysis of cerebrovascular diseases (CeVD) for the cohort of workers at Mayak Production Association (PA) is presented. This cohort is especially suitable for the analysis of radiation induced circulatory diseases, due to the detailed medical surveillance and information on several risk factors. The risk after external, typically protracted, gamma exposure is analysed, accounting for potential additional internal alpha exposure. Three different endpoints have been investigated: incidence and mortality from all cerebrovascular diseases and incidence of stroke. Particular emphasis was given to the form of the dose-response relationship and the time dependence of the radiation induced risk. Young attained age was observed to be an important, aggravating modifier of radiation risk for incidence of CeVD and stroke. For incidence of CeVD, our analysis supports a dose response sub-linear for low doses. Finally, the excess relative risk per dose was confirmed to be significantly higher for incidence of CeVD compared to CeVD mortality and incidence of stroke. Arguments are presented for this difference to be based on a true biological effect.

Epidemiology of peripheral artery disease.

New data on the epidemiology of peripheral artery disease (PAD) are available, and they should be integrated with previous data. We provide an updated, integrated overview of the epidemiology of PAD, a focused literature review was conducted on the epidemiology of PAD. The PAD results were grouped into symptoms, diagnosis, prevalence, and incidence both in the United States and globally, risk factors, progression, coprevalence with other atherosclerotic disease, and association with incident cardiovascular morbidity and mortality. The most common symptom of PAD is intermittent claudication, but noninvasive measures, such as the ankle-brachial index, show that asymptomatic PAD is several times more common in the population than intermittent claudication. PAD prevalence and incidence are both sharply age-related, rising >10% among patients in their 60s and 70s. With aging of the global population, it seems likely that PAD will be increasingly common in the future. Prevalence seems to be higher among men than women for more severe or symptomatic disease. The major risk factors for PAD are similar to those for coronary and cerebrovascular disease, with some differences in the relative importance of factors. Smoking is a particularly strong risk factor for PAD, as is diabetes mellitus, and several newer risk markers have shown independent associations with PAD. PAD is strongly associated with concomitant coronary and cerebrovascular diseases. After adjustment for known cardiovascular disease risk factors, PAD is associated with an increased risk of incident coronary and cerebrovascular disease morbidity and mortality.

Mortality from Circulatory System Diseases among French Uranium Miners: A Nested Case-Control Study.

A significant association has been observed between radon exposure and cerebrovascular disease (CeVD) mortality among French uranium miners, but risk factors for circulatory system diseases (CSD) have not been previously considered. We conducted new analyses in the recently updated (through 2007) French cohort of uranium miners (n = 5,086), which included 442 deaths from CSD, 167 of them from ischemic heart disease (IHD) and 105 from CeVD. A nested case-control study was then set up to collect and investigate the influence of these risk factors on the relationships between mortality from CSD and occupational external gamma ray and internal ionizing radiation exposure (radon and long-lived radionuclides) in this updated cohort. The nested case-control study included miners first employed after 1955, still employed in 1976 and followed up through 2007. Individual information about CSD risk factors was collected from medical files for the 76 deaths from CSD (including 26 from IHD and 16 from CeVD) and 237 miners who had not died of CSD by the end of follow-up. The exposure-risk relationships were assessed with a Cox proportional hazard model weighted by the inverse sampling probability. A significant increase in all CSD and CeVD mortality risks associated with radon exposure was observed in the total cohort [hazard ratios: HRCSD/100 working level months (WLM) = 1.11, 95% confidence interval (1.01; 1.22) and HRCeVD/100 WLM = 1.25 (1.09; 1.43), respectively]. A nonsignificant exposure-risk relationship was observed for every type of cumulative ionizing radiation exposure and every end point [e.g., HRCSD/100WLM = 1.43 (0.71; 2.87)]. The adjustment for each CSD risk factor did not substantially change the exposure-risk relationships. When the model was adjusted for overweight, hypertension, diabetes, hypercholesterolemia and smoking status, the HR/100WLM for CSD, for example, was equal to 1.21 (0.54; 2.75); and when it was adjusted for risk factors selected with the Akaike information criterion, it was equal to 1.44 (0.66; 3.14). To our knowledge, this is the first study to use a uranium miner cohort to consider the major standard CSD risk factors in assessing the relationships between ionizing radiation exposure and the risk of death from these diseases. These results suggest that the significant relationship between CeVD risk and radon exposure observed in the total French cohort is probably not affected by the CSD risk factors. Extending the collection of information about CSD risk factors to a larger subsample would be useful to confirm this result.

Unemployment, government healthcare spending, and cerebrovascular mortality, worldwide 1981-2009: an ecological study.

The global economic downturn has been associated with unemployment rises, reduced health spending, and worsened population health. This has raised the question of how economic variations affect health outcomes. We sought to determine the effect of changes in unemployment and government healthcare expenditure on cerebrovascular mortality globally. Data were obtained from the World Bank and World Health Organization. Multivariate regression analysis was used to assess the effect of changes in unemployment and government healthcare expenditure on cerebrovascular mortality. Country-specific differences in infrastructure and demographics were controlled for. One- to five-year lag analyses and robustness checks were conducted. Across 99 countries worldwide, between 1981 and 2009, every 1% increase in unemployment was associated with a significant increase in cerebrovascular mortality (coefficient 187, CI: 86.6-288, P = 0.0003). Every 1% rise in government healthcare expenditure, across both genders, was associated with significant decreases in cerebrovascular deaths (coefficient 869, CI: 383-1354, P = 0.0005). The association between unemployment and cerebrovascular mortality remained statistically significant for at least five years subsequent to the 1% unemployment rise, while the association between government healthcare expenditure and cerebrovascular mortality remained significant for two years. These relationships were both shown to be independent of changes in gross domestic product per capita, inflation, interest rates, urbanization, nutrition, education, and out-of-pocket spending. Rises in unemployment and reductions in government healthcare expenditure are associated with significant increases in cerebrovascular mortality globally. Clinicians may also need to consider unemployment as a possible risk factor for cerebrovascular disease mortality.

Evolution of Cardiovascular Diseases Mortality in the Counties of the State of Rio de Janeiro from 1979 to 2010.

BackgroundCardiovascular Diseases (CVD) are the leading cause of death in Brazil.ObjectiveTo estimate total CVD, cerebrovascular disease (CBVD), and ischemic heart disease (IHD) mortality rates in adults in the counties of the state of Rio de Janeiro (SRJ), from 1979 to 2010.MethodsThe counties of the SRJ were analysed according to their denominations stablished by the geopolitical structure of 1950, Each new county that have since been created, splitting from their original county, was grouped according to their former origin. Population Data were obtained from the Brazilian Institute of Geography and Statistics (IBGE), and data on deaths were obtained from DataSus/MS. Mean CVD, CBVD, and IHD mortality rates were estimated, compensated for deaths from ill-defined causes, and adjusted for age and sex using the direct method for three periods: 1979–1989, 1990–1999, and 2000–2010, Such results were spatially represented in maps. Tables were also constructed showing the mortality rates for each disease and year period.ResultsThere was a significant reduction in mortality rates across the three disease groups over the the three defined periods in all the county clusters analysed, Despite an initial mortality rate variation among the counties, it was observed a homogenization of such rates at the final period (2000–2010). The drop in CBVD mortality was greater than that in IHD mortality.ConclusionMortality due to CVD has steadily decreased in the SRJ in the last three decades. This reduction cannot be explained by greater access to high technology procedures or better control of cardiovascular risk factors as these facts have not occurred or happened in low proportion of cases with the exception of smoking which has decreased significantly. Therefore, it is necessary to seek explanations for this decrease, which may be related to improvements in the socioeconomic conditions of the population.

Análisis de las tendencias en la mortalidad por enfermedades cerebrovasculares en España 1980-2011

IntroductionIn recent decades, mortality rates for cerebrovascular diseases (CVD) have declined significantly in many countries. This study analyses changes in CVD mortality rates in Spain (1980-2011) to determine if previously observed trends remain. Patients and methodsData on CVD mortality rates and the population data needed for the analysis were provided by Spain's National Statistics Institute. We calculated age-specific mortality rate, age-standardised overall mortality, and age-truncated mortality (35-64 years) using the direct method and standard European population structure. Joinpoint analysis was used to estimate the percentage of annual change in rates and identify significant changes in trends. ResultsCVD mortality rate decreased considerably and continuously over the last 32 years in all age groups and in both sexes in Spain. For both sexes, joinpoint analysis identifies a final period with more marked decline: 2005-2011 in women (−6.3%) and 2007-2011 in men (−7.2%). ConclusionsCVD mortality rates displayed a marked and continuous decline in Spain between 1980 and 2011. Due to the ageing of the population, doctors expect an increase in CVD prevalence and therefore its magnitude in terms of disability and healthcare costs, which poses a challenge to our health system.

Cerebrovascular diseases incidence and mortality in an extended Mayak Worker Cohort 1948-1982.

Incidence and mortality from cerebrovascular disease (CVD) [International Classification of Diseases 9th revision (ICD-9) codes: 430-438] was studied in a cohort of 22,377 workers first employed at the Mayak Production Association (Mayak PA) in 1948-1982 and followed up to the end of 2008. The cohort size was increased by 19% and follow-up extended by 3 years over the previous analysis. Radiation doses were estimated using an updated dosimetry system: Mayak Worker Dosimetry System 2008 (MWDS-2008). For the first time, in an analysis of this cohort, quantitative smoking data were used. Workers of the study cohort were exposed occupationally to prolonged external gamma rays and internal alpha particles. The mean (±standard deviation) total dose from external gamma rays was 0.54 ± 0.76 Gy (95% percentile 2.21 Gy) for males and 0.44 ± 0.65 Gy (95% percentile 1.87 Gy) for females. The mean plutonium body burden in the 31% of workers monitored for internal exposure was 1.32 ± 4.87 kBq (95% percentile 4.71 kBq) for males and 2.21 ± 13.24 kBq (95% percentile 4.56 kBq) for females. The mean total absorbed alpha-particles dose to the liver from incorporated plutonium was 0.23 ± 0.77 Gy (95% percentile 0.89 Gy) in males and 0.44 ± 2.11 Gy (95% percentile 1.25 Gy) in females. After adjusting for nonradiation factors (gender, age, calendar period, employment period, facility, smoking, alcohol consumption), there were significantly increasing trends in CVD incidence associated with total absorbed dose from external gamma rays and total absorbed dose to the liver from internal alpha-particle radiation exposure. Excess relative risks per Gy (ERR/Gy) were 0.46 (95% CI 0.37, 0.57) and 0.28 (95% CI 0.16, 0.42), respectively, based on a linear dose-response model. Adjustments for additional factors (hypertension, body mass index, duration of employment, smoking index and total absorbed dose to the liver from internal exposure during the analysis of external exposure and vice versa) had little effect on the results. The categorical analyses showed that CVD incidence was significantly higher among workers with total absorbed external gamma-ray doses greater than 0.1 Gy compared to those exposed to lower doses and that CVD incidence was also significantly higher among workers with total absorbed internal alpha-particle doses to the liver from incorporated plutonium greater than 0.01 Gy compared to those exposed to lower doses. The results of the categorical analyses of CVD incidence were in good agreement with a linear dose response for external gamma-ray doses but for internal alpha-particle doses the picture was less clear. For the first time an excess risk of CVD mortality was seen in workers whose livers were exposed to internal alpha-particle doses greater than 0.1 Gy compared to those workers who were exposed to doses of less than 0.01 Gy. A significant increasing trend for CVD mortality with internal alpha-particle dose was revealed in the subcohort of workers exposed at doses <1.0 Gy after having adjusted for nonradiation factors, ERR/Gy = 0.84 (95% CI, 0.09, 1.92). These updated results provide good evidence for a linear trend in risk of CVD incidence with external gamma-ray dose. The trend for CVD incidence with internal alpha-particle dose is less clear due to the impact of issues concerning the use of dose estimates based on below the limit of detection bioassay measurements.