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Heart 1999;82:52-56; doi:10.1136/hrt.82.1.52
Copyright © 1999 BMJ Publishing Group Ltd & British Cardiovascular Society
Heart 1999;82:52-56 ( July )

Cardiovascular disease in the Netherlands, 1975 to 1995: decline in mortality, but increasing numbers of patients with chronic conditions

J B Reitsmaa, J A A Dalstraa, G J Bonsela, J H P van der Meulena, R W Kosterb, L J Gunning-Schepersc, J G P Tijssena

a Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, Netherlands, b Department of Cardiology, Academic Medical Centre, University of Amsterdam, c Institute of Social Medicine, Academic Medical Centre, University of Amsterdam

Correspondence to: Dr Reitsma.

Accepted for publication 2 March 1998

OBJECTIVE---To examine the relation between trends over time in mortality and hospital morbidity caused by various cardiovascular diseases in the Netherlands.
DESIGN---Trend analysis by Poisson regression of national data on mortality and hospital admissions from 1975 to 1995.
SUBJECTS---The Dutch population.
RESULTS---All cardiovascular diseases combined were responsible for 39% of all deaths and 16% of all hospital admissions in 1995. From 1975 to 1995, age adjusted cardiovascular mortality declined by an annual change of -2.0% (95% confidence intervals (CI) -2.1% to -1.9%), while in the same period age adjusted discharge rates increased annually by 1.3% (95% CI 1.1% to 1.5%). Around 60% of the gain in life expectancy in this period was related to lower cardiovascular mortality. For mortality, major reductions were seen in coronary heart disease (annual change -2.9%) and in stroke (-2.1%), whereas the increase in hospital admissions was mainly caused by chronic manifestations of coronary heart disease (5.1%), heart failure (2.1%), and diseases of the arteries (1.8%). In recent years, the gap between men and women at risk of dying from coronary heart disease became smaller for those aged =< 65 years.
CONCLUSIONS---Our findings of a decrease in cardiovascular mortality and an increase in admission rates for chronic conditions such as heart failure, chronic coronary syndromes, and diseases of the arteries, support the hypothesis that the longer survival of many patients with heart diseases is leading to a growing pool of patients at increased risk for subsequent cardiovascular complications in Western countries.


Keywords: epidemiology; time trends; mortality; hospital admissions; Netherlands

© 1999 by Heart
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