CHD INCIDENCE, MORTALITY, RISK FACTOR RELATIONSHIPS

为明尼苏达州罗切斯特市6万名居民提供医疗和医院护理， 几乎全部由梅奥诊所和奥姆斯特德医疗集团提供 以及他们的附属医院。这些机构的记录和 其他提供程序已组合到单个诊断检索中 系统，并在几十年内提供独特的资源 以人群为基础的严重慢性病流行病学研究。 罗切斯特地区先前对冠心病(CHD)的研究 人口建立了1950-82年的发病队列。这个数据库有 提供心绞痛(AP)、心肌梗塞的发病率 (Mi)和猝死(SUD)。为当地客户提供后续服务 人口状况异常良好，并提供了对 长期存活率，心绞痛队列中的梗死率，以及 首次心肌梗死组的再梗死率在跨壁和 心内膜下梗塞。建议将最近的发病率和 到1988年的趋势研究，以确定是否有持续的 例如，女性心肌梗塞发病率的增加和最近 男性。在同一时间段内，南部地区的发病率有所下降。 发病率和1970年代病例死亡率的急剧下降 密西西比。在AP队列中，MI率下降，长期 存活率有所提高；而在MI队列中，存活率没有下降 在再梗死率和长期存活率方面并没有提高。 CHD事件病例将为监测各种类型的 侵入性和非侵入性诊断程序，并导致合理的规划 以满足未来对治疗程序的需求，如脑室辅助 设备、人工心脏、激光冠状动脉狭窄导管等。 对转介和当地做法的比较将有助于确定 关于冠心病患者特征和预后的转诊偏倚 文学作品。此外，以下因素对冠心病发病率的影响 诊断相关小组(DRGs)简介和强制性 将对应用DRG系统的诊断清单进行评估。 美国几乎没有关于急性胰腺炎、心肌梗死或 除Framingham外的CHD的首发表现为SUD 罗切斯特数据。这些数据构成了对全国 死亡数据。

Medical and hospital care for the 60,000 residents of Rochester, Minnesota, is almost entirely provided by Mayo Clinic and the Olmsted Medical Group and their affiliated hospitals. The records of these institutions and other providers have been assembled into a single diagnostic retrieval system and provide, for several decades, a unique resource for population-based epidemiologic studies of serious chronic diseases. Previous studies of coronary heart disease (CHD) in the Rochester population established an incidence cohort for 1950-82. This data base has provided incidence rates for angina pectoris (AP), myocardial infarction (MI), and sudden unexpected death (SUD). Follow-up for the local population is exceptionally good and has provided optimal estimates of long-term survivorship, infarction rates in the angina cohort, and reinfarction rates in the initial MI group for both transmural and subendocardial infarctions. It is proposed to extend recent incidence and trend studies through 1988 to determine whether there is a continuation of trends such as increasing MI incidence in females and a recent decrease in males. There has been a decrease over the same time period in SUD incidence rates and a sharp fall in the 1970s in the case fatality rate for MI. In the AP cohort, MI rates have decreased and the long-term survivorship has improved; while in the MI cohort, there has been no drop in the reinfarction rates and long-term survivorship has not improved. The incident CHD cases will provide a basis for monitoring a variety of invasive and noninvasive diagnostic procedures and lead to sound planning for future needs for therapeutic procedures such as ventricular assist devices, artificial hearts, laser catheters for coronary stenosis, etc. Comparison of referral and local practices will help identify the effect of referral bias on patient characteristics and prognosis in CHD reported in the literature. Also, the effect on CHD incidence rates following the introduction of Diagnostic Related Groups (DRGs) and the mandatory diagnostic listing for application of the DRG system will be assessed. There are few, if any, long-term U.S. data on the occurrence of AP, MI or SUD as the initial manifestation of CHD other than Framingham and the Rochester data. These data form a crucial complement to the national mortality data.