very low chd mortality among men aged 35-44 in several states in the united states akira sekikawa,...
TRANSCRIPT
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
• 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
•Background•Methods•Results
Very low CHD mortality among men aged 35-44 in several states in
the United States
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, USA
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
180
200
220
240
20-34 35-44 45-54 55-64 65-74 Age
Tot
al C
hole
ster
ol (
mg/
dl)
1960-621976-80 1988-94
Trends in the levels of total cholesterol
in men in the Unite States
0
20
40
60
80
20-34 35-44 45-54 55-64 65-74Age
Pre
vale
nce
of h
yper
tens
ion
1960-621976-80 1988-94
Trends in the prevalence of hypertension
in men in the Unite States
0
20
40
60
80
18-24 25-34 35-44 45-64 65-Age
Pre
vale
nce
of c
igar
ette
sm
okin
g
196519851995
Trends in the prevalence of cigarette smoking
in men in the Unite States
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)
• 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)
•Background•Methods•Results
Very low CHD mortality among men aged 35-44 in several states in
the United States
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, USA
Mortality data on CHDCDC Wonder
Age (35-44)-, sex (men)-, race (white and black)-, and state-specific data in 1994
for domestic comparisonCHD (ICD codes 410-414, 429.2)
for international comparisonCHD (ICD codes 410-414)
Mortality data which were not valid because of the small number were excluded from the analysis
Mortality data - InternationalWHO 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
• 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
0
20
40
60
80
100
5.2 5.4 5.6 5.8 6 6.2 6.4
Total cholesterol (mmol/l)
Age
-sta
ndar
dize
d C
HD
mor
tali
ty i
n m
en
aged
35-
64 (
/100
,000
)
•Background•Methods•Results
Very low CHD mortality among men aged 35-44 in several states in
the United States
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, USA
CHD mortality (ICD 410-414, 429.2) among white men aged 35-44 in 1994 in the US by state (highest, middle, lowest)
0 10 20 30 40 50
KS
CO
TX
All
IL
KY
TN
CHD mortality (/100,000)
>= 42 32 - 42 25 - 32 < 25
CHD mortality (ICD 410-414, 429.2) among black men aged 35-44 in 1994 in the US by state (highest, middle, lowest)
0 20 40 60 80 100
NJ
CA
OH
All
TX
MO
MS
CHD mortality (/100,000)
>= 42 32 - 42 25 - 32 < 25
0 20 40 60 80 100
KS (W)
CO (W)
NJ (B)
CA (B)
KY (W)
TN (W)
MO (B)
MS (B)
0 20 40 60 80 100
All
NJ
NY
PA
OH
IL
SC
MO
MS
WhiteBlack
0 20 40 60 80 100
Japan
France
Australia
US white
Greece
Finland
US black
Poland
Hungary
0 20 40 60 80 100
Japan
Whites in WA
France
Blacks in MD
Greece
Finland
Whites in TN
Poland
Blacks in MS
Hungary
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
0
20
40
60
80
100
0 50 100 150 200 250 300
LC mortality
CH
D m
orta
lity
White
Black
0
10
20
30
40
50
60
70
0 10 20 30 40 50
% of not high school graduate
CH
D m
orta
lity
White
Black
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
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
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