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Heart disease, cancer, and stroke mortality trends and their interrelations. An international perspective
1Epidemiology and Biometry Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.
Insights
Mortality trends for heart disease, stroke, and lung cancer show similar patterns across countries, influencing overall mortality rates. These concordant trends suggest common causes and potential for shared preventive strategies against major diseases.
Area of Science:
- Epidemiology
- Public Health
- Biostatistics
Background:
- Significant attention has been given to changes in mortality from heart disease, cancer, and stroke.
- Comprehensive analyses of these trends and their impact on total mortality have been limited.
- The relationship between mortality trends of different diseases remains largely unknown.
Purpose of the Study:
- To analyze concurrent trends in mortality from heart disease, cancer, and stroke.
- To assess the concordance of mortality trends across 27 countries.
- To investigate the potential for common causes and shared preventive measures.
Main Methods:
- Utilized age-adjusted death rates from 1950-1987 for ages 35-74 from WHO statistical reports.
- Assessed mortality trend concordance using visual inspection and semiquantitative measurements.
- Employed time-lag analysis to explore relationships between disease-specific trends.
Main Results:
- Heart disease and stroke mortality declined significantly in most industrialized nations starting in the 1960s/1970s.
- Lung cancer mortality trends shifted from steep increases to slower growth or declines, lagging behind heart disease and stroke.
- Concordance was observed between heart disease and lung cancer trends, and between heart disease and stroke trends over time.
Conclusions:
- Mortality trends for heart disease, stroke, and lung cancer exhibit international similarity, impacting total mortality trends.
- Concordance in disease mortality trends suggests shared underlying causes and responsiveness to common preventive interventions.
- Further research into international mortality trends is recommended to guide public health strategies.
Background:
Changes in mortality from heart disease, cancer, and stroke over recent decades in many countries have received much attention. However, comprehensive and concurrent analyses of these trends and their effect on total mortality have been lacking. Moreover, the extent to which the trends for one disease may relate to those for another disease is unknown. Concordance of trends for major diseases would suggest that they have common causes and thus may be responsive to the same preventive measures.
Methods And Results:
Age-adjusted death rates for total mortality and mortality from heart disease, stroke, lung cancer, and cancer other than lung cancer were obtained for the years 1950 to 1987 in 27 countries by sex and ages 35 to 74 years from the World Health Organization statistical reports. Concordance of mortality trends was assessed for ages 35 to 74 between 1950 and 1983 through visual inspection and semiquantitative measurements of percentage change over time. The epidemic increase in heart disease mortality ended in the 1960s or 1970s in most industrialized countries; death rates often declined very steeply. Stroke mortality also changed from an increase to a decline or from a modest to a steep decline in the 1960s or 1970s. Lung cancer mortality slopes generally changed from a steep increase to either a modest increase, a flat trend, or a decline; the changes in slope are lagging behind those for heart disease and stroke. These improvements influenced trends for total mortality. Cancer other than lung cancer trends are less distinct than those for the three other causes of mortality. Yet, testing them for concordance with heart disease trends reveals that they are mostly concordant on a time-lag analysis that assumes that heart disease responds more rapidly to a change in lifestyle or environment than cancer. Trends for heart disease and lung cancer in men also tend to be concordant on time-lag analysis. Heart disease and stroke trends have become more concordant with time.
Conclusions:
Trends for mortality from heart disease, stroke, lung cancer, and, less distinctly, cancer other than lung cancer, tend to be similar in different countries, leading to a corresponding similarity in total mortality trends. An analysis of trends for pairs of diseases within countries indicates a tendency toward concordance of trends, suggesting the existence of common causes amenable to the same preventive measures. This analysis of international mortality trends is intended to stimulate further research along these lines, as a guide to preventive and therapeutic action.