EPIDEMIOLOGY OF DECLINE IN HEART DISEASE MORTALITY

我们建议继续研究冠心病的趋势 阿勒格尼县35-44岁白色男性的死亡率。 我们有 仔细评估了死因死亡地点 可能的突然死亡，既往心脏病史， 住院治疗，所有心血管和验尸官证明的非创伤 1970年至1981年死亡。 这项最初的研究是对所有死亡证明的回顾性研究 冠心病、所有其他心血管死亡和 都是非创伤性的可能是突然死亡的死因都是验尸官确认的 的 审查包括尸检记录，验尸官报告，医院记录， 从认证医生的信息，并采访了下一个 亲属或其他证人。 共有807例死亡病例纳入研究， 包括556例冠心病患者。 当时的比较是 在研究人员审查记录后， 医生和死亡证明上的潜在死亡原因。 一个 大约一半的死亡病例有尸检报告。 验尸官记录 在50.7%中，医院记录占31.3%，医生报告占6.4%， 15.8%的人从近亲处获得信息。 与会者一致认为， 90%的死亡病例都是由这个原因造成的 在12年的 随访时冠心病死亡率下降50.3%。 大约70%的死亡 在医院外面 死亡率下降80%以上 是由于院外死亡大多是突发性的 大部分的 这种下降是由于没有心脏病史的突然死亡 疾病，从1972年的40.3/1000下降到1979-81年的19.6/1000。 的 这项初步研究的结果清楚地表明：1） 冠心病死亡率是真实的。 2)它主要与 医院死亡 3)下降的主要因素可能是 突发性死亡和每年约5%的下降率 在20世纪90年代早期或更早的时候， 心脏病死亡人数将几乎消失。

We propose to continue our study of the trends in coronary heart disease mortality among white men aged 35-44 in Allegheny County. We have carefully evaluated the accuracy of the cause of death, the place of death, probable suddeness of death, prior history of heart disease, length of hospitalization, for all cardiovascular and coroner certified non-traumatic deaths between 1970 and 1981. This initial study was a retrospective review of all death certificates certified to coronary heart disease, all other cardiovascular deaths and all nontraumatic, possibly sudden deaths certified by the coroner. The review included autopsy records, coroners reports, hospital records, information from the certifying physician, and interviews with the next of kin or other witnesses. A total of 807 deaths were included in the study, including 556 due to coronary heart disease (CHD). The comparison was then done of the cause of death after the review of the record by the study physicians and the underlying cause of death on the death certificate. An autopsy report was available in about half of the deaths. Coroners records in 50.7%, hospital records in 31.3%, a physician's report in 6.4%, and information from the next of kin in 15.8%. There was agreement as to the cause of death in about 90% of the deaths. During the 12 years of follow-up, CHD death rate declined 50.3%. Approximately 70% of the deaths were outside of the hospital. Over 80% of the decline in the death rate was due to out of hospital deaths mostly sudden. The larger proportion of the decline was due to sudden deaths without a prior history of heart disease, falling from 40.3/1000 in 1972 to 19.6/1000 in 1979-81. The results of this initial study clearly demonstrate: 1) That the decline in CHD mortality is real. 2) That it was predominantly related to out of hospital deaths. 3) That the major factor in the decline is probably sudden deaths and that of the rate of decline of about 5% per year continues in Allegheny County that by the early 1990's or sooner coronary heart disease deaths will practically disappear.