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Trends in total mortality and mortality from heart disease in 26 countries from 1950 to 1978
Insights
Heart disease death rates varied significantly by country and sex. While many countries saw declines in women, men in some nations experienced increasing mortality, though trends began to shift in the 1970s.
Area of Science:
- Cardiovascular epidemiology
- International health trends
- Public health surveillance
Background:
- Heart disease mortality rates show significant international variation.
- Trends in heart disease mortality have differed between sexes and countries over time.
- Understanding these trends is crucial for public health interventions.
Purpose of the Study:
- To analyze international trends in heart disease mortality for men and women aged 45-64 between 1950-1978.
- To identify variations in mortality rates and trends across 26 countries.
- To explore factors contributing to differing mortality patterns.
Main Methods:
- Analysis of death rates for total mortality and heart disease (non-rheumatic heart disease and hypertension).
- Data collected for men and women aged 45-64 across 26 countries over six time periods (1950-1978).
- Comparison of mortality rates, proportionate mortality, and sex ratios between countries and over time.
Main Results:
- Significant variation in heart disease death rates among men, with high-rate countries having triple the rates of low-rate countries.
- Marked increases in heart disease mortality for men in most countries, but a slowing or reversal of this trend in 13 countries during the 1960s/1970s.
- Long-term declines in heart disease mortality for women in 22 countries, with stable or declining proportionate mortality.
- Widening north/south gradient in Europe and male/female mortality ratios.
- Countries maintained characteristic mortality rate ranges despite observed changes.
Conclusions:
- Heart disease mortality trends are complex and country-specific, with notable differences between men and women.
- The observed variations and trend shifts warrant further investigation into underlying causes.
- Continued research, such as the WHO MONICA programme, is essential to understand and address disparities in heart disease mortality.
Abstract:
Death rates for total mortality and for non-rheumatic heart disease and hypertension ('heart disease') are described for men and women ages 45-64 in six time periods during 1950-78 for 26 countries. Rates for men in high-rate countries are three times those in low-rate countries. This variation is more striking for men than women. There were marked increases for heart disease in men in most countries, but in 13 countries there was a slowing or reversal of that trend in the 1960's or 1970's or acceleration of an already downward trend. In 22 countries long-term declines for heart disease occurred in women. There was a widening of the north/south gradient in Europe and of the male/female ratio of heart disease mortality. Countries with high heart disease death rates in men had high ratios of heart disease to total death. Other countries experienced a rise in proportionate mortality. In women, proportionate mortality for heart disease remained flat or declined in most countries. In spite of these changes in rates, each country seems to have a range for heart disease mortality that is characteristic of its population and environmental setting so that profound changes in rates do not substantially alter their relative ranking. Our intent is to stimulate the search for reasons why heart disease mortality recently declined in some countries but not in others (already begun in the WHO-sponsored MONICA programme). Our forthcoming monograph on international mortality trends for the major causes of death will be a next step in this process.