CHD INCIDENCE, MORTALITY, RISK FACTOR RELATIONSHIPS

为明尼苏达州罗切斯特的6万名居民提供医疗和医院护理， 几乎全部由马约诊所和奥姆斯特德医疗集团提供 及其附属医院。 这些机构的记录和 其他提供程序已被组装到单个诊断检索中 几十年来，它一直是一个独特的资源， 严重慢性病的人群流行病学研究。 罗切斯特冠心病的既往研究 人口建立了1950-82年的发病率队列。 这个数据库有 提供了心绞痛（AP）、心肌梗死 (MI)意外猝死（Sudden Unexpected Death，SUD） 当地的后续行动 人口是非常好的，并提供了最佳的估计， 心绞痛队列的长期生存率、梗死率，以及 初始MI组的再梗死率， 内膜下梗死 建议延长最近的发病率， 到1988年的趋势研究，以确定是否有继续 趋势如女性MI发病率增加， 男性。 在同一时期，SUD有所下降 发病率和1970年代病死率急剧下降， MI. 在AP队列中，MI发生率有所下降， 存活率有所改善;而在MI队列中，存活率没有下降 再梗死率和长期生存率没有改善。 冠心病发病率将为监测各种 侵入性和非侵入性诊断程序，并导致合理的规划 以满足未来治疗程序的需要， 设备、人工心脏、用于冠状动脉狭窄的激光导管等。 比较转诊和当地实践将有助于确定 报告的冠心病患者特征和预后的转诊偏倚 文学作品 此外，对冠心病发病率的影响， 引入诊断相关组（DRG）和强制性 将评估DRG系统应用的诊断列表。 美国关于AP、MI或 SUD是CHD的初始表现，而不是房颤， 罗切斯特数据。 这些数据是对国家统计数据的重要补充。 死亡率数据。

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.