Trends In Heart Disease Mortality Research Articles

Ischemic heart disease mortality trends in Croatia between 1995 and 2011: a joinpoint regression analyisis

Cardiologia CROATICA Aim: In the last few decades, mortality from ischemic heart disease has been decreasing in many countries. The aim of this study was to analyze trends in ischemic heart disease mortality rates in Croatia between 1995 and 2011. Materials and methods: The data on deaths from ischemic heart diseases in Croatia were extracted from the WHO mortality database, and estimates of the Croatian population were derived from the Population Division of the Department of Economic and Social Affairs of the United Nations. Ischaemic heart diseases were defined as I20-I25 diagnoses in ICD-10. We used Joinpoint Regression analysis to describe mortality time trends, with up to 4 joinpoints and a Monte Carlo simulation to calculate p-values for a series of permutation tests. The joinpoint analysis was applied to the age-standardised rates (world population) and their standard errors, separately for each sex. Results: There were 165,432 deaths due to ischemic heart disease in Croatia in this 17-year period (51.2% females). The age-standardized ischemic heart disease mortality rates declined from 139.9/100,000 in men and 79.4/100,000 in women in 1995 to 118.9/100,000 and 67.6/100,000 in 2011, respectively. The trends showed a constant decrease, without any joinpoints in both men and women. In men, the best fitting model showed that in the period from 1995-2011 mortality rates significantly decreased (annual percent change (APC) of -1.0%; 95% CI -1.4 to -0.6), while in women trends were also decreasing (APC of -0.8%;95% CI -1.3 to -0.3) throughout the entire study period. Conclusion: Mortality rates for ischaemic heart disease showed a continuous decrease during this period, especially in men. However, it is still the leading cause of death, and it is important to monitor trends and focus on reduction of preventable risk factors.

Circulation : Clinical Summaries

<i>Circulation</i> : Clinical Summaries

Abstract P367: Trends in Mortality and Recurrent Coronary Heart Disease Events Following an Acute Myocardial Infarction Among Medicare Beneficiaries, 2001 - 2009

Background: Few contemporary studies examine trends in recurrent coronary heart disease (CHD) events and mortality following acute myocardial infarction (AMI). Therefore, we examined rates of mortality, recurrent AMI, and recurrent CHD events in the year following AMI overall and by race and sex in the national 5% random sample of Medicare beneficiaries. Methods: Beneficiaries were included if they were enrolled in traditional Medicare fee-for-service coverage (Parts A and B), were not enrolled in a Medicare Advantage plan, and experienced an index AMI (ICD9 410.xx except 410.x2) between January 1, 2001 and December 31, 2009. We used Poisson regression to calculate and examine linear changes in age-adjusted rates for all-cause mortality, recurrent AMI, and recurrent CHD events (defined as a hospitalization for AMI in the primary discharge diagnosis position, percutaneous coronary intervention, or coronary artery bypass graft surgery) during the 365 days following hospital discharge for the index AMI. To provide adequate sample size to investigate trends in outcomes by race-sex groups, we pooled calendar years into 3 time periods (2001-2003, 2004-2006, and 2007-2009). Results: Overall, 48,688 beneficiaries were included; 46% were men, 90% were white, and 7% were black. Changes in pooled 3 year rates for mortality, recurrent AMI, and recurrent CHD in the first year following an index AMI are shown in the table. Overall, we observed a -3.8% change in pooled 3 year age-adjusted rates for mortality, a -15.0% change in pooled 3 year age-adjusted rates for recurrent AMI, and a -11.1% change in pooled 3 year age-adjusted rates for recurrent CHD events. However, mortality following AMI decreased only in white men, and reductions in recurrent AMI or CHD occurred only for white men and women and black men but not black women. Conclusions: Despite the overall favorable trends in lower mortality and recurrent AMI and CHD events following an index AMI, more efforts in reducing disparities in CHD by race and sex are needed.

PT443 Burden of Rheumatic Heart Disease in the Solomon Islands

O ST E R A B ST R A C T S improvements are yet to be seen in many developing countries and in Indigenous populations defined by ethnicity or geographical location. Recent estimates of the global burden of RHD have highlighted the paucity of reliable data documenting mortality from RHD from places where RHD prevalence is high. Objectives: To investigate rheumatic heart disease (RHD) mortality rates and trends for Indigenous compared with non-Indigenous Australians in the Northern Territory (NT) for the period 1977-2005 and semi-nationally from 1997-2005. Methods: Indigenous identification in death registrations has been of high quality in the NT since 1977 and in four other states since 1997. Using national cause of death and population data, we investigated RHD mortality for the NT for 19772005 and five jurisdictions combined, for 1997-2005 examining RHD as the underlying cause of death. These jurisdictions include 84% of Indigenous Australians. We examined the number of deaths, age-specific and age-adjusted death rates; and for theNT only, regression analysis of time trends over a 29year period. All analysis was by undertaken by Indigenous status, gender, age at death. Results: In the NT for the period 1977-2005 there were 280 deaths from RHD; 90% were in Indigenous people and 59% in females. For non-Indigenous people death rates were low for all age-groups except 65+ age-group. Indigenous death rates increased with age and were higher for females than males in all age-groups. Death rates decreased between 1997 and 2005 for both Indigenous and non-Indigenous people in the NT, but the decrease was greater for non-Indigenous people. RHD death rates were lower for Indigenous people in other parts of Australia than in the NT, but were still much higher than non-Indigenous rates. Conclusion: Indigenous people are much more likely to die from RHD than other Australians. Rates of death from RHD among Indigenous people in the NT exceed other states in Australia and those reported in many industrialised countries over a century ago. The majority of deaths among non-Indigenous Australians occur in people aged over 65 years and reflect a time in the mid-last century when rheumatic fever and RHD were more common in the overall Australian population. Disclosure of Interest: None Declared

Explaining trends in Scottish coronary heart disease mortality between 2000 and 2010 using IMPACTSEC model: retrospective analysis using routine data

Objective To quantify the contributions of prevention and treatment to the trends in mortality due to coronary heart disease in Scotland.Design Retrospective analysis using IMPACTSEC, a previously validated policy model,...

Decreasing trends in cardiovascular mortality in Turkey between 1988 and 2008.

BackgroundCardiovascular disease (CVD) mortality increased in developed countries until the 1970s then started to decline. Turkey is about to complete its demographic transition, which may also influence mortality trends. This study evaluated trends in coronary heart disease (CHD) and stroke mortality between 1988 and 2008.MethodsThe number of deaths by cause (ICD-8), age and sex were obtained from the Turkish Statistical Institute (TurkStat) annually between 1988 and 2008. Population statistics were based on census data (1990 and 2000) and Turkstat projections. European population standardised mortality rates for CHD and stroke were calculated for men and women over 35 years old. Joinpoint Regression was used to identify the points at which a statistically significant (p < 0.05) change of the trend occurred.ResultsThe CHD mortality rate increased by 2.9% in men and 2.0% in women annually from 1988 to 1994, then started to decline. The annual rate of decline for men was 1.7% between 1994–2008, whilst in women it was 2.8% between 1994–2000 and 6.7% between 2005–2008 (p < 0.05 for all periods).Stroke mortality declined between 1990–1994 (annual fall of 3.8% in both sexes), followed by a slight increase between 1994–2004 (0.6% in men, 1.1% in women), then a further decline until 2008 (annual reduction of 4.4% in men, 7.9% in women) (p < 0.05 for all periods).ConclusionsA decrease in CVD mortality was observed from 1995 onwards in Turkey. The causes need to be explored in detail to inform future policy priorities in noncommunicable disease control.

The (possibly) deceptive figures of decreased coronary heart disease mortality in Europe: Figure 1

This editorial refers to ‘Cardiovascular disease in Europe: epidemiological update’[†][1], by M. Nichols et al. , on page 3028 and ‘Trends in age-specific coronary heart disease mortality in the European Union over three decades: 1980–2009’[‡][2], by M. Nichols et al. , on page 3017 Nichols et al . have presented updated data on the distribution of cardiovascular disease in Europe,1 and describe the trends observed in coronary heart disease (CHD) mortality in the European Union over a period of 30 years, from 1980 to 2009.2 The authors analyse sex-specific data from the World Health Organization (WHO), with the intention of determining the burden of cardiovascular disease in European countries, and whether the known overall decrease in CHD mortality has been uniform during this period of time, across countries, sex, and age groups. Unfortunately, cardiovascular disease remains the leading cause of mortality in Europe, accounting for 46% of the total number of deaths, with ∼20% related to coronary artery disease and 12% to stroke. It still is the leading cause of death among both men and women. In a few countries, mainly from Western and Southern Europe, however, cancer has become the leading cause of death. Perhaps more importantly still, cardiovascular disease caused the premature death of 1.5 million people before the age of 75. When comparing the most recent data for age-standardized mortality across European countries, huge differences can be observed, with lower rates in Israel, France, Spain, and The Netherlands, and up to seven-fold higher rates in Eastern countries such as the Russian Federation or Uzbekistan. Beyond mortality, cardiovascular disease also has a major impact on morbidity, although figures on hospitalization for cardiovascular disease represent a gross approximation of the burden this condition may represent. Between-country and time comparisons are, however, difficult to make, as the reported rates are … [1]: #fn-2 [2]: #fn-3

OP53 Explaining Scottish Coronary Heart Disease Mortality Trends between 2000 and 2010: Socioeconomic Analyses using the Impact Sec Model

BackgroundCoronary heart disease (CHD) mortality rates have halved in recent decades. However, CHD remains the largest cause of death in Scotland generating persistent socioeconomic inequalities. A socioeconomic quantification of the...

PPO1 Predicting Future Coronary Heart Disease Mortality trends in England and Wales in 2020: a Bayesian age Period Cohort Approach

BackgroundAlthough Coronary Heart Disease (CHD) death rates have halved since the 1970s, CHD remains a major cause of mortality in the UK. Furthermore, population ageing plus recent increases in obesity...

Trends in age-specific coronary heart disease mortality in the European Union over three decades: 1980–2009

AimsRecent decades have seen very large declines in coronary heart disease (CHD) mortality across most of Europe, partly due to declines in risk factors such as smoking. Cardiovascular diseases (predominantly CHD and stroke), remain, however, the main cause of death in most European countries, and many risk factors for CHD, particularly obesity, have been increasing substantially over the same period. It is hypothesized that observed reductions in CHD mortality have occurred largely within older age groups, and that rates in younger groups may be plateauing or increasing as the gains from reduced smoking rates are increasingly cancelled out by increasing rates of obesity and diabetes. The aim of this study was to examine sex-specific trends in CHD mortality between 1980 and 2009 in the European Union (EU) and compare trends between adult age groups.MethodsSex-specific data from the WHO global mortality database were analysed using the joinpoint software to examine trends and significant changes in trends in age-standardized mortality rates. Specific age groups analysed were: under 45, 45–54, 55–64, and 65 years and over. The number and location of significant joinpoints for each country by sex and age group was determined (maximum of 3) using a log-linear model, and the annual percentage change within each segment calculated. Average annual percentage change overall (1980–2009) and separately for each decade were calculated with respect to the underlying joinpoint model.ResultsRecent CHD rates are now less than half what they were in the early 1980s in many countries, in younger adult age groups as well as in the population overall. Trends in mortality rates vary markedly between EU countries, but less so between age groups and sexes within countries. Fifteen countries showed evidence of a recent plateauing of trends in at least one age group for men, as did 12 countries for women. This did not, however, appear to be any more common in younger age groups compared with older adults. There was little evidence to support the hypothesis that mortality rates have recently begun to plateau in younger age groups in the EU as a whole, although such plateaus and even a small number of increases in CHD mortality in younger subpopulations were observed in a minority of countries.ConclusionThere is limited evidence to support the hypothesis that CHD mortality rates in younger age groups in the member states of the EU have been more likely to plateau than in older age groups. There are, however, substantial and persistent inequalities between countries. It remains vitally important for the whole EU to monitor and work towards reducing preventable risk factors for CHD and other chronic conditions to promote wellbeing and equity across the region.

Comparing the decline in coronary heart disease and stroke mortality in neighbouring countries with different healthcare systems

ObjectiveTo examine age and gender specific trends in coronary heart disease (CHD) and stroke mortality in two neighbouring countries, the Republic of Ireland (ROI) and Northern Ireland (NI).DesignEpidemiological study of...

Analyzing Recent Coronary Heart Disease Mortality Trends in Tunisia between 1997 and 2009

BackgroundIn Tunisia, Cardiovascular Diseases are the leading causes of death (30%), 70% of those are coronary heart disease (CHD) deaths and population studies have demonstrated that major risk factor levels are increasing.ObjectiveTo explain recent CHD trends in Tunisia between 1997 and 2009.MethodsData Sources: Published and unpublished data were identified by extensive searches, complemented with specifically designed surveys.AnalysisData were integrated and analyzed using the previously validated IMPACT CHD policy model. Data items included: (i)number of CHD patients in specific groups (including acute coronary syndromes, congestive heart failure and chronic angina)(ii) uptake of specific medical and surgical treatments, and(iii) population trends in major cardiovascular risk factors (smoking, total cholesterol, systolic blood pressure (SBP), body mass index (BMI), diabetes and physical inactivity).ResultsCHD mortality rates increased by 11.8% for men and 23.8% for women, resulting in 680 additional CHD deaths in 2009 compared with the 1997 baseline, after adjusting for population change. Almost all (98%) of this rise was explained by risk factor increases, though men and women differed. A large rise in total cholesterol level in men (0.73 mmol/L) generated 440 additional deaths. In women, a fall (−0.43 mmol/L), apparently avoided about 95 deaths. For SBP a rise in men (4 mmHg) generated 270 additional deaths. In women, a 2 mmHg fall avoided 65 deaths. BMI and diabetes increased substantially resulting respectively in 105 and 75 additional deaths. Increased treatment uptake prevented about 450 deaths in 2009. The most important contributions came from secondary prevention following Acute Myocardial Infarction (AMI) (95 fewer deaths), initial AMI treatments (90), antihypertensive medications (80) and unstable angina (75).ConclusionsRecent trends in CHD mortality mainly reflected increases in major modifiable risk factors, notably SBP and cholesterol, BMI and diabetes. Current prevention strategies are mainly focused on treatments but should become more comprehensive.

Unequal Trends in Coronary Heart Disease Mortality by Socioeconomic Circumstances, England 1982–2006: An Analytical Study

BackgroundCoronary heart disease (CHD) remains a major public health burden, causing 80,000 deaths annually in England and Wales, with major inequalities. However, there are no recent analyses of age-specific socioeconomic trends in mortality. We analysed annual trends in inequalities in age-specific CHD mortality rates in small areas in England, grouped into deprivation quintiles.MethodsWe calculated CHD mortality rates for 10-year age groups (from 35 to ≥85 years) using three year moving averages between 1982 and 2006. We used Joinpoint regression to identify significant turning points in age- sex- and deprivation-specific time trends. We also analysed trends in absolute and relative inequalities in age-standardised rates between the least and most deprived areas.ResultsBetween 1982 and 2006, CHD mortality fell by 62.2% in men and 59.7% in women. Falls were largest for the most deprived areas with the highest initial level of CHD mortality. However, a social gradient in the pace of fall was apparent, being steepest in the least deprived quintile. Thus, while absolute inequalities narrowed over the period, relative inequalities increased. From 2000, declines in mortality rates slowed or levelled off in the youngest groups, notably in women aged 45–54 in the least deprived groups. In contrast, from age 55 years and older, rates of fall in CHD mortality accelerated in the 2000s, likewise falling fastest in the least deprived quintile.ConclusionsAge-standardised CHD mortality rates have declined substantially in England, with the steepest falls in the most affluent quintiles. However, this concealed contrasting patterns in underlying age-specific rates. From 2000, mortality rates levelled off in the youngest groups but accelerated in middle aged and older groups. Mortality analyses by small areas could provide potentially valuable insights into possible drivers of inequalities, and thus inform future strategies to reduce CHD mortality across all social groups.

Income and heart disease mortality trends in Sao Paulo, Brazil, 1996 to 2010

BackgroundReductions in heart disease mortality rates are variable according to socioeconomic status. MethodsWe performed a time trend analysis of all heart diseases (all circulatory diseases, except rheumatic, cerebrovascular, and aortic diseases) comparing three different household income levels (high, middle, and low) in the city of Sao Paulo from 1996 to 2010. ResultsA total of 197,770 deaths were attributed to heart diseases; 62% of them were due to coronary diseases. The rate of death due to heart diseases declined for the city as a whole. The annual percent change (APC) and 95% confidence intervals for men living in the high, middle and low income areas were −4.1 (−4.5 to −3.8), −3.0 (−3.5 to −2.6), and −2.5 (−2.8 to −2.1), respectively. The decline in death rate was greatest among men in the wealthiest area. The trend rates of women living in the high-income area had one joinpoint; APC was −4.4 (−4.8 to −3.9) from 1996–2005 and −2.6 (−3.8 to −1.4) from 2005–2010. Middle and low income areas had an APC of −3.6 (−4.1 to −3.1) and −3.0 (−3.2 to −2.7) from 1996–2010, respectively. During the last 5years of observation, there was a gradient of the decline of the risk of death, faster for people living in the wealthiest area and slower for people living in the more deprived neighborhoods. ConclusionReduction in deaths due to heart diseases is greatest for men and women living in the wealthiest neighborhoods.

Gender- and age-specific trends in coronary heart disease mortality in France from 2000 to 2007: results from the MONICA registers

Several recent studies in the USA, the UK and Australia have raised concern about a possible plateau or even reverse trend in coronary heart disease (CHD) mortality in younger populations. We aimed to assess the recent gender- and age-specific trends in CHD mortality among inhabitants aged 35-74 years from the three geographical areas covered by the French MONICA population registers. Registered events were fatal myocardial infarctions and coronary deaths selected after a thorough investigation by the physician who signed the death certificate, general practitioners and cardiologists, and by public and private hospitals for in-hospital deaths. From 2000 to 2007 age-standardized CHD mortality rates decreased significantly by 24% in men and 38% in women. In the age group 55-74, the estimated annual percentage change (EAPC) in mortality was -5.2 (95% confidence interval: -6.6 to -3.7; p < 10(-4)) among men and -9.0 (-11.6 to -6.4; p < 10(-4)) among women. In the 35-54 age group, the EAPC in mortality was -4.1 (-7.2 to -1.1; p < 10(-2)) among men and -2.5 (-8.7 to 3.7; p = 0.43) among women. These trends remained similar when possible coronary deaths were also accounted for, except in young men where the decline was no longer significant. A clear decline in recent CHD mortality rates was observed among subjects above 54 years, but not among younger subjects, particularly in women. These results may be due to unfavourable trends in some risk factors in the latter age group and call for a strengthening of primary prevention.

Racial and geographic variation in coronary heart disease mortality trends.

BackgroundMagnitudes, geographic and racial variation in trends in coronary heart disease (CHD) mortality within the US require updating for health services and health disparities research. Therefore the aim of this study is to present data on these trends through 2007.MethodsData for CHD were analyzed using the US mortality files for 1999–2007 obtained from the US Centers for Disease Control and Prevention. Age-adjusted annual death rates were computed for non-Hispanic African Americans (AA) and European Americans (EA) aged 35–84 years. The direct method was used to standardize rates by age, using the 2000 US standard population. Joinpoint regression models were used to evaluate trends, expressed as annual percent change (APC).ResultsFor both AA men and women the magnitude in CHD mortality is higher compared to EA men and women, respectively. Between 1999 and 2007 the rate declined both in AA and in EA of both sexes in every geographic division; however, relative declines varied. For example, among men, relative average annual declines ranged from 3.2% to 4.7% in AA and from 4.4% to 5.5% in EA among geographic divisions. In women, rates declined more in later years of the decade and in women over 54 years. In 2007, age-adjusted death rate per 100,000 for CHD ranged from 93 in EA women in New England to 345 in AA men in the East North Central division. In EA, areas near the Ohio and lower Mississippi Rivers had above average rates. Disparities in trends by urbanization level were also found. For AA in the East North Central division, the APC was similar in large central metro (−4.2), large fringe metro (−4.3), medium metro urbanization strata (−4.4), and small metro (−3.9). APC was somewhat higher in the micropolitan/non-metro (−5.3), and especially the non-core/non-metro (−6.5). For EA in the East South Central division, the APC was higher in large central metro (−5.3), large fringe metro (−4.3) and medium metro urbanization strata (−5.1) than in small metro (−3.8), micropolitan/non-metro (−4.0), and non-core/non-metro (−3.3) urbanization strata.ConclusionsBetween 1999 and 2007, the level and rate of decline in CHD mortality displayed persistent disparities. Declines were greater in EA than AA racial groups. Rates were greater in the Ohio and Mississippi River than other geographic regions.

Analysing falls in coronary heart disease mortality in the West Bank between 1998 and 2009

ObjectivesTo analyse coronary heart disease (CHD) mortality and risk factor trends in the West Bank, occupied Palestinian territory between 1998 and 2009.DesignModelling study using CHD IMPACT model.SettingThe West Bank, occupied...

Trends in socioeconomic inequalities in mortality from ischaemic heart disease and stroke in Australia, 1979–2006

This study investigates secular trends in ischaemic heart disease (IHD) and stroke mortality by socioeconomic status (SES) in Australia to determine if absolute and relative differences between low and high SES areas have changed over time. IHD and stroke mortality data for adults aged 35-74 years and corresponding population data from Australian censuses for 1979-2006 were stratified into quintiles using an area-based measure of SES and analysed by quinquennia (and 2004-06). IHD and stroke (rates per 100,000) adjusted for age, country of birth, and rurality were compared across SES strata (separately by sex) using Poisson regression. Mortality declined monotonically over the study period in all SES groups and both sexes. Absolute differences between low and high SES groups narrowed for IHD in females (27 to 23 per 100,000) and stroke in males and females (16 to 13, and 13 to 7 per 100,000, respectively), although absolute differences widened for IHD in males (52 to 63 per 100,000). Relative declines were greater in high compared to low SES groups for IHD (28% average quinquennial decline in high SES; compared with 21% in low SES for males; 30% and 21% for females), and for stroke (25% average quinquennial decline in high SES; 21% in low SES for males; 26% and 23% for females). Differences in mortality rates between lower and higher SES groups narrowed for both IHD (in females) and stroke (in males and females) from 1979-2006, indicating that the epidemic decline is now at a late stage when low SES groups are benefiting more, in absolute terms, than high SES groups. However males in the lower SES groups are still at an earlier stage of the epidemic decline in IHD mortality.

Explaining recent coronary heart disease mortality trends in England by socioeconomic circumstances, 2000–2007

BackgroundThe continuing fall in coronary heart disease (CHD) mortality is widely celebrated. However, the impact of public policies and treatments on socio-economic gradients in health is poorly quantified. Understanding the...

O1-4.1 Explaining recent coronary heart disease mortality trends in England by socioeconomic circumstances, 2000-2007

Introduction The continuing fall in coronary heart disease mortality rates is widely celebrated. However, the impact of public policies and treatments is poorly quantified and hardly ever by socioeconomic group. Methods Using a previously validated epidemiological model we estimated the contribution of risk factor changes and evidence-based treatments to reduce CHD mortality in adults aged over 25 years between 2000 and 2007 in England, both overall and by deprivation quintiles. Results CHD mortality rates fell by 35% (219 to 142 deaths per 100 000), resulting in 38 070 fewer deaths in 2007 compared with 2000. Decreases in major cardiovascular risk factors were generally modest accounting for −37% of the total decrease in CHD mortality overall. This ranged from −50% in the most deprived quintile to −30% in the most affluent. The biggest contribution came from a fall in systolic blood pressure (−33%). Other gains were modest: total plasma cholesterol (−6%), smoking (−4%) and inactivity (−2%). Furthermore, these benefits were negated by increases in BMI and diabetes (+11%). Treatments accounted for approximately half the mortality decline across all social groups. The largest contributors were medical therapies in community settings for lipid reduction (−14%), chronic angina (−13%) and secondary prevention (−11%). Conclusions Much of the fall in CHD mortality in England between 2000 and 2007 was attributable to medical therapies, evenly distributed across social groups. This was unexpected, and probably reflects frustratingly small recent decreases in major cardiovascular risk factors, compounded by continuing rises in obesity and diabetes.