Elsevier

American Heart Journal

Volume 151, Issue 2, February 2006, Pages 501-507
American Heart Journal

Clinical Investigation
Coronary Artery Disease
Trends in community mortality due to coronary heart disease

https://doi.org/10.1016/j.ahj.2005.04.024Get rights and content

Background

Relatively little data are available, particularly from the more generalizable perspective of a population-based investigation, describing recent trends in death rates due to coronary heart disease (CHD). The objectives of this observational study were to describe changes over a twelve year period (1990-2001) in death rates due to CHD and acute myocardial infarction (AMI) in residents of the Worcester, Massachusetts, metropolitan area (2000 census = 478,000). A secondary study goal was to describe changes in death rates attributed to CHD over time separately in men and in women, in persons of different ages, and according to location of death.

Methods

Death datatapes were obtained from the Massachusetts Department of Public Health for greater Worcester residents who died over the period 1990 to 2001.

Results

Marked declines were observed in the population death rates (per 100,000) due to CHD (1990 death rate = 322; 2001 death rate = 224) and AMI (1990 death rate = 137; 2001 death rate = 87) in the greater Worcester population. Declines in the annual death rates attributed to CHD were observed in both the hospital (4.4% decline) and out-of-hospital setting (1.6% decline) as well as for patients dying from AMI (annual declines of 4.8% and 1.9% respectively). Reductions in CHD death rates over time were observed in men and in women and in persons of all ages.

Conclusions

The present results demonstrate encouraging declines in community death rates due to CHD and AMI over time and the impact of evolving primary and secondary prevention efforts.

Section snippets

Methods

Death datatapes were obtained from the Massachusetts Department of Public Health for purposes of the present investigation. The study sample was restricted to adult residents (≥25 years) of the Worcester metropolitan area (2000 estimated census = 478,000) who died over the period 1990 to 2001. This period was chosen for purposes of examining trends in hospital and out-of-hospital deaths due to CHD since location of death was not coded on Massachusetts death certificates prior to 1989. These

Magnitude of Deaths due to CHD

Over the twelve year period under study, there were a total of 9479 deaths attributed to CHD in greater Worcester residents. Of these, 3177 (34%) occurred in the hospital setting while the remainder occurred out-of-hospital. Of the out-of-hospital deaths, 1844 (29%) occurred in personal residences while an additional 2377 deaths (38%) occurred among nursing home residents.

A total of 4158 deaths attributed to AMI occurred in greater Worcester residents between 1990 and 2001. Of these, 1661 (40%)

Discussion

The results of the present investigation show encouraging declines in death rates due to CHD and AMI over time in the greater Worcester population. Between 1990 and 2001, the age-adjusted death rate from CHD fell by 42% while the age-adjusted death rates from AMI declined by 47%. Out-of-hospital deaths attributed to CHD declined by an average of 1.6% per year while hospital deaths from CHD decreased by more than 4% annually between 1990 and 2001. Over this period, annual hospital death rates

References (14)

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Grant support for this project was provided by the National Heart, Lung and Blood Institute (R01 HL35434).

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