CLINICAL STUDIES
Secular trends in cardiovascular disease mortality, incidence, and case fatality rates in adults in the United States

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Purpose

To assess the effects of changes in cardiovascular disease incidence and case fatality rates on secular trends in mortality in the U.S. population between 1971–1982 and 1982–1992.

Methods

Using data from the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, two cohorts (10,869 subjects in the 1971–1982 cohort and 9774 in the 1982–1992 cohort) of participants aged 35 to 74 years were created. Baseline medical history questionnaires were administered in 1971–1975 and 1982–1984, with follow-up interviews, hospital record reviews, and death certificate searches conducted in 1982–1984, 1986, 1987, and 1992.

Results

Between 1971–1982 and 1982–1992, age-standardized cardiovascular disease mortality declined from 79.1 (95% confidence interval [CI]: 75.2 to 83.0) to 53.0 (95% CI: 49.5 to 56.5) per 10,000 person-years, while cardiovascular disease incidence rates decreased from 293.5 (95% CI: 284.5 to 302.4) to 225.1 (95% CI: 216.6 to 233.5) per 10,000 person-years. The 28-day case fatality rate for cardiovascular disease declined from 15.7% (95% CI: 14.5% to 16.8%) to 11.7% (95% CI: 10.3% to 13.0%). After adjustment for age, sex, and race, rates were 31% lower for cardiovascular disease mortality, 21% lower for incidence, and 28% lower for 28-day case fatality in the 1982–1992 cohort than in the 1971–1982 cohort (each P <0.001).

Conclusion

The decrease in cardiovascular disease mortality between 1971–1982 and 1982–1992 was due to declines in both the incidence and case fatality rates in this national sample. These findings suggest that both primary and secondary prevention and treatment contributed to the decline in cardiovascular disease mortality in the United States.

Section snippets

NHANES I epidemiologic follow-up study

The NHANES I comprised a representative sample of the civilian noninstitutionalized population of the United States. The NHANES I survey was conducted between 1971 and 1975, and data collection included medical history, standardized medical examination, dietary history, laboratory tests, and anthropometric measurements (22). The NHANES I Epidemiologic Follow-up Study cohort included 14,407 persons 25 to 74 years of age who had completed the NHANES I medical examination (23). Follow-up data were

Mortality

Overall, age-standardized mortality for cardiovascular disease, coronary heart disease, acute myocardial infarction, and stroke declined significantly between 1971–1982 and 1982–1992 (Figure 1, top panel). These declines were significant in all sex and race groups (Table 1), except for declines in myocardial infarction mortality among white women (−6.3%, P = 0.2). Age, race, and sex-adjusted mortality declined by 31% for cardiovascular disease, 33% for coronary heart disease, 37% for myocardial

Discussion

We found that cardiovascular disease mortality, incidence, and case fatality rates declined in a large national sample of adults from 1971–1982 to 1982–1992, and that age, race, and sex-adjusted cardiovascular disease mortality was 31% lower in the 1982–1992 cohort. This downward trend was similar among all race and sex groups. Further, that the decrease in cardiovascular disease mortality was accompanied by a decline in incidence and improvements in 28-day case fatality and long-term survival

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