Trends in the Incidence of Myocardial Infarction and in Mortality Due to Coronary Heart Disease, 1987 to 1994
Wayne D. Rosamond, Ph.D., Lloyd E. Chambless, Ph.D., Aaron R. Folsom, M.D., Lawton S. Cooper, M.D., David E. Conwill, M.D., Limin Clegg, Ph.D., Chin-Hua Wang, Ph.D., and Gerardo Heiss, M.D., Ph.D.
Background and Methods To clarify the determinants of contemporarytrends in mortality from coronary heart disease (CHD), we conductedsurveillance of hospital admissions for myocardial infarctionand of in-hospital and out-of-hospital deaths due to CHD among35-to-74-year-old residents of four communities of varying sizein the United States (a total of 352,481 persons in 1994). Between1987 and 1994, we estimate that there were 11,869 hospitalizationsfor myocardial infarction (on the basis of 8572 hospitalizationssampled) and 3407 fatal coronary events (3023 sampled).
Results The largest average annual decrease in mortality dueto CHD occurred among white men (change in mortality, 4.7percent; 95 percent confidence interval, 2.2 to 7.1percent), followed by white women (4.5 percent; 95 percentconfidence interval, 0.7 to 8.2 percent), blackwomen (4.1 percent; 95 percent confidence interval, 10.3to +2.5 percent), and black men (2.5 percent; 95 percentconfidence interval, 6.9 to +2.2 percent). Overall, in-hospitalmortality from CHD fell by 5.1 percent per year, whereas out-of-hospitalmortality declined by 3.6 percent per year. There was no evidenceof a decline in the incidence of hospitalization for a firstmyocardial infarction among either men or women; in fact, suchhospital admissions increased by 7.4 percent per year (95 percentconfidence interval, 0.5 to 14.8 percent) among black womenand 2.9 percent per year (95 percent confidence interval, 3.6to +9.9 percent) among black men. Rates of recurrent myocardialinfarction decreased, and survival after myocardial infarctionimproved.
Conclusions From 1987 to 1994, we observed a stable or slightlyincreasing incidence of hospitalization for myocardial infarction.Nevertheless, there were significant annual decreases in mortalityfrom CHD. The decline in mortality in the four communities westudied may be due largely to improvements in the treatmentand secondary prevention of myocardial infarction.
Source Information
From the Departments of Epidemiology (W.D.R., G.H.) and Biostatistics (L.E.C., L.C., C.-H.W.), School of Public Health, University of North Carolina, Chapel Hill; the Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis (A.R.F.); the National Heart, Lung, and Blood Institute, Bethesda, Md. (L.S.C.); and the Division of Epidemiology, Department of Preventive Medicine, University of Mississippi Medical Center, Jackson (D.E.C.).
Address reprint requests to Dr. Rosamond at the Department of Epidemiology, University of North Carolina at Chapel Hill, CB 7400, McGavran-Greenberg Hall, Chapel Hill, NC 27599.
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