Statistical methods for the analysis of trends in coronary heart disease

在澳大利亚，冠心病是死亡率、发病率和医疗费用的主要原因。在20世纪50年代的S和60年代的S期间，冠心病发病率迅速上升，然后在20世纪60年代末S开始下降。这一下降趋势已经持续了30年。虽然其他一些西化国家也有同样的经历，但在东欧和许多发展中国家，冠心病正在增加。在许多国家的动物和人类实验研究以及人口研究中，有大量证据表明，冠心病的主要决定因素是高血压、吸烟、高胆固醇(和其他血脂)以及饮食因素、肥胖和缺乏体育活动。最近，几项大型多中心研究发现，心脏风险因素和发病率之间的关联出人意料地弱。据推测，这是由于不适当的分析，其中合并了冠状动脉流行病不同阶段的人口数据。这项研究的目的是开发改进的统计方法，以帮助理解大规模研究的最新结果，如世界卫生组织的莫尼卡项目、美国的ARIC研究和七个国家的研究。它将为其实施提供新的理论成果和统计软件。从公共卫生的角度来看，最重要的结果将是澄清最近明显不正常的发现，即确定的危险因素和有效治疗在人口一级减少冠状动脉疾病的重要性。

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.