Geographic variation in sudden coronary death

To describe geographic variations in an indicator of sudden coronary death, data from the National Center for Health Statistics were examined for deaths occurring out of hospital or in emergency rooms in 1984 to 1986 in 42 states. In white males aged 55 to 64 years, the percent of ischemic heart disease deaths coded as occurring out of hospital or in the ER ranged from 49.6% to 70.4%. The percents tended to be higher in mountain states and around Lake Michigan. However, neighboring states sometimes had very different percents. Within regions, percents were higher in nonmetropolitan than in metropolitan areas. Standard mortality ratios for white males of all ages revealed that several states had relatively high rates of death out of hospital or in the ER. These included New York, Michigan, and Wisconsin. High rates of coronary death out of hospital or in the ER may be due to high overall coronary death rates, high percent of coronary deaths occurring out of hospital or in the ER, or both. Further studies are needed of geographic variation in sudden coronary death and cardiac arrest and factors that might explain the variation such as emergency medical services. Place of death data from death certificates may be useful in monitoring efforts to prevent sudden coronary death.