Statistical methods for the analysis of trends in coronary heart disease

冠心病是澳大利亚死亡率、发病率和医疗费用的主要原因。在五六十年代，冠状动脉疾病的发病率迅速上升，然后在六十年代末开始下降。这种下降趋势已经持续了30年。虽然其他一些西方国家也有同样的经历，但在东欧和许多发展中国家，冠状动脉疾病正在增加。从动物和人类实验研究以及许多国家的人口研究中获得的大量证据表明，冠状动脉疾病的主要决定因素是高血压、吸烟和高胆固醇（及其他脂质）以及饮食因素、肥胖和缺乏身体活动。最近几项大型多中心研究意外地发现，心脏病风险因素与发病率之间的关联较弱。据推测，这是由于不适当的分析，其中合并了冠状动脉流行不同阶段人群的数据。这项研究的目的是发展改进的统计方法，以帮助理解最近大规模研究的结果，如世界卫生组织的MONICA项目、美国的ARIC研究和七国研究。它将为它们的实施提供新的理论结果和统计软件。从公共卫生的角度来看，最重要的结果将是澄清最近关于确定的危险因素和有效治疗在人群水平上减少冠心病的重要性的明显异常发现。

Coronary heart disease is a leading cause of mortality, morbidity and medical costs in Australia. During the 1950's and 1960's, rates of coronary disease increased rapidly, then in the late 1960's they started to decline. This decrease has continued steadily for 30 years. While some other westernised countries have had this same experience, in Eastern Europe and in many developing countries coronary disease is increasing. There is a huge amount of evidence from experimental studies in animal and human subjects and population studies in many countries that the major determinants of coronary disease are high blood pressure, cigarette smoking and high cholesterol (and other lipids) as well as dietary factors, obesity and physical inactivity. Recently several large multicentre studies have found unexpectedly weaker associations between heart risk factors and disease rates. It is hypothesised that this is due to inappropriate analyses in which data from populations at different stages of the coronary epidemic have been combined. The aim of this study is to develop improved statistical methodology to help understand recent findings from large scale studies, such as the World Health Organization's MONICA Project, the US ARIC study and the Seven Countries study. It will provide new theoretical results and statistical software for their implementation. From a public health perspective the most important outcome will be clarification of recent apparently anomalous findings about the importance of established risk factors and effective treatments in reducing coronary disease at the population level.