Secular trends in ischemic heart disease mortality: regional variation

We compared secular trends in ischemic heart disease (IHD) mortality in four southeastern states (North Carolina, Georgia, South Carolina, and Virginia) with those in three selected other states (California, New York, and Utah). Mortality data were obtained from U.S. vital statistics and population information from the U.S. Census Bureau. Age-adjusted IHD mortality increased until 1968 in the southeastern states and then declined and declines were greatest in the nonwhite female population. In contrast, IHD mortality in all groups in California and in the female population in New York and Utah began to decline in the early 1950s, with accelerated declines since 1968. In all states the decline in rates in nonwhite populations have been greatest in the younger age groups. This has not been true in the white populations. Declining IHD mortality correlated moderately well with the decline in death from all cardiovascular disease and from all causes, but not with the declining cerebrovascular disease mortality. Respiratory cancer mortality increased in similar proportions in California and South Carolina, two states with dissimilar IHD trends. These findings suggest that improved control of hypertension and changing patterns of cigarette smoking may not be responsible for the recent decline in IHD mortality.