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Very low CHD mortality among men aged 35-44 in several states in the United States. Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH. Department of Epidemiology , Graduate School of Public Health , University of Pittsburgh , USA. Learning objectives.

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very low chd mortality among men aged 35 44 in several states in the united states

Very low CHD mortality among men aged 35-44 in several states in the United States

Akira Sekikawa, MD, PhD, PhD

Lewis H Kuller, MD, DrPH

Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, USA

learning objectives
Learning objectives
  • To learn the trends in risk factors for coronary heart disease in the US
  • To learn some unique features of mortality from CHD among men aged 35-44
  • To learn geographic variation in mortality from CHD by state and race in the US
  • To learn possible reasons for this variation in CHD mortality in the US
very low chd mortality among men aged 35 44 in several states in the united states1

Very low CHD mortality among men aged 35-44 in several states in the United States

  • Background
  • Methods
  • Results

Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, USA

slide4

Important changes in lifestyle that have major effects on risk of CHD have occurred since the end of World War II

    • decline in total serum cholesterol
    • decline in prevalence of cigarette smoking
    • improved treatment of high blood pressure
    • increase in prevalence of obesity

Post World War II birth cohort aged 35-44 are most likely to be affected by these changes

why young adult men aged 35 44
Why young adult men (aged 35-44)?

Mortality rates from CHD among men aged 35-44 are

29/100,000 in the US

several unique features of mortality in this young age group 35 44 year old men
Several unique features of mortality in this young age group (35-44 year old men)
  • Cohort alternations in risk factors would emerge more rapidly in younger age groups
  • Deaths from CHD in this age group are most likely to be incident, rather than from long-standing chronic clinical CHD
  • Data on this age group would describe the difference between white and black better than older age groups and age-adjusted rates (cohort selection effect)
very low chd mortality among men aged 35 44 in several states in the united states2

Very low CHD mortality among men aged 35-44 in several states in the United States

  • Background
  • Methods
  • Results

Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, USA

slide11
Mortality data on CHD

CDC Wonder

Age (35-44)-, sex (men)-, race (white and black)-, and state-specific data in 1994

for domestic comparison

CHD (ICD codes 410-414, 429.2)

for international comparison

CHD (ICD codes 410-414)

Mortality data which were not valid because of the small number were excluded from the analysis

slide12
Mortality data - International

WHO Statistics Annuals

Country specific mortality among men aged 35-44 in 1994

CHD (ICD codes 410-414)

Australia, Canada, Chile, Finland, Greece, Mexico, Hong Kong, Hungary, Israel, Japan, Poland, Singapore, South Korea, Spain, Switzerland, Trinidad, and UK

ecological analyses
Ecological Analyses
  • Sex-, state-, and race-specific mortality from cancer of lung and bronchus (age-adjusted data) - surrogate of cigarette smoking CDC Wonder
  • State-, and race-specific data on percent of not-a-high-school graduate in the largest 25 states in 1992 Current Population Survey by Census Bureau
very low chd mortality among men aged 35 44 in several states in the united states3

Very low CHD mortality among men aged 35-44 in several states in the United States

  • Background
  • Methods
  • Results

Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, USA

slide15
CHD mortality (ICD 410-414, 429.2) among white men aged 35-44 in 1994 in the US by state (highest, middle, lowest)
slide16

CHD mortality (/100,000)

>= 42 32 - 42 25 - 32 < 25

slide17
CHD mortality (ICD 410-414, 429.2) among black men aged 35-44 in 1994 in the US by state (highest, middle, lowest)
slide18

CHD mortality (/100,000)

>= 42 32 - 42 25 - 32 < 25

why are there such differences in chd mortality among men aged 35 44 in the us by state and race
Why are there such differences in CHD mortality among men aged 35-44 in the US by state and race?

Accuracy of diagnosis on death certificate

Quality of medical care

Differences in risk factors

slide24

Black

White

slide25

Black

White

conclusions i
Conclusions I

Differences in CHD mortality among black and white men aged 35-44 by state are as large as the differences observed between Poland and France, one of the highest and the lowest in the mortality from CHD around the world.

Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, USA

conclusions ii
Conclusions II

The relatively strong correlation between CHD mortality and educational attainment as well as lung cancer mortality suggests that smoking and other CHD risk factors are the potential candidates for the CHD mortality difference.

Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, USA

conclusions iii
Conclusions III

If the differences are attributed to the variations in the distribution of traditional risk factors, the reduction of these risk factors could substantially reduce the mortality from CHD.

Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, USA