Trends in the incidence of myocardial infarction and in mortality due to coronary heart disease, 1987 to 1994
Trends in the incidence of myocardial infarction and in mortality due to coronary heart disease, 1987 to 1994
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DOI：
10.1056/nejm199809243391301
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发表时间：
1998-09-24
影响因子：
158.5
通讯作者：
Heiss, G
中科院分区：
文献类型：
--
作者：
Rosamond, WD;Chambless, LE;Heiss, G
背景和方法为了阐明当代冠心病（CHD）死亡率趋势的决定因素，我们对美国4个不同规模社区的35 ~ 74岁居民（1994年共352，481人）中因心肌梗死住院和因CHD住院及院外死亡的情况进行了监测。在1987年至1994年期间，我们估计有11，869人因心肌梗死住院（基于抽样的8572例住院病例）和3407例致死性冠状动脉事件结果白色男性冠心病死亡率年平均下降幅度最大（死亡率变化，-4.7%; 95%置信区间，-2.2%至-7.1%），其次是白色女性（-4.5%; 95%置信区间，-0.7%至-8.2%），黑人女性（-4.1%; 95%置信区间，-10.3%至+2.5%），黑人男性（-2.5%; 95%置信区间，-6.9%至+2.2%）。总体而言，CHD的院内死亡率每年下降5.1%，而院外死亡率每年下降3.6%。没有证据表明男性或女性因首次心肌梗死住院的发生率下降;事实上，黑人女性的住院率每年增加7.4%（95%置信区间，0.5%至14.8%），黑人男性每年增加2.9%（95%置信区间，-3.6%至+9.9%）。心肌梗死复发率下降，心肌梗死后生存率提高。结论从1987年至1994年，我们观察到一个稳定或略有增加的心肌梗死住院率。尽管如此，冠心病的死亡率每年都有显著下降。我们研究的四个社区的死亡率下降可能主要是由于心肌梗死治疗和二级预防的改善。（N Engl J Med 1998;339：861-7）（C）1998，马萨诸塞州医学会。
Background and Methods To clarify the determinants of contemporary trends in mortality from coronary heart disease (CHD), we conducted surveillance of hospital admissions for myocardial infarction and of in-hospital and out-of-hospital deaths due to CHD among 35-to-74-year-old residents of four communities of varying size in the United States (a total of 352,481 persons in 1994). Between 1987 and 1994, we estimate that there were 11,869 hospitalizations for myocardial infarction (on the basis of 8572 hospitalizations sampled) and 3407 fatal coronary events (3023 sampled).Results The largest average annual decrease in mortality due to CHD occurred among white men (change in mortality, -4.7 percent; 95 percent confidence interval, -2.2 to -7.1 percent), followed by white women (-4.5 percent; 95 percent confidence interval, -0.7 to -8.2 percent), black women (-4.1 percent; 95 percent confidence interval, -10.3 to +2.5 percent), and black men (-2.5 percent; 95 percent confidence interval, -6.9 to +2.2 percent). Overall, in-hospital mortality from CHD fell by 5.1 percent per year, whereas out-of-hospital mortality declined by 3.6 percent per year. There was no evidence of a decline in the incidence of hospitalization for a first myocardial infarction among either men or women; in fact, such hospital admissions increased by 7.4 percent per year (95 percent confidence interval, 0.5 to 14.8 percent) among black women and 2.9 percent per year (95 percent confidence interval, -3.6 to +9.9 percent) among black men. Rates of recurrent myocardial infarction decreased, and survival after myocardial infarction improved.Conclusions From 1987 to 1994, we observed a stable or slightly increasing incidence of hospitalization for myocardial infarction. Nevertheless, there were significant annual decreases in mortality from CHD. The decline in mortality in the four communities we studied may be due largely to improvements in the treatment and secondary prevention of myocardial infarction. (N Engl J Med 1998;339:861-7) (C)1998, Massachusetts Medical Society.