Transcript Very low CHD mortality among men aged 35

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
Very low CHD mortality among men
aged 35-44 in several states in the
United States
•Background
•Methods
•Results
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 3544 are most likely to be affected by these
changes
Trends in the levels of total cholesterol
Total Cholesterol (mg/dl)
in men in the Unite States
240
1960-62
1976-80
1988-94
220
200
180
20-34 35-44 45-54 55-64 65-74
Age
Trends in the prevalence of hypertension
in men in the Unite States
Prevalence of hypertension
80
60
1960-62
1976-80
1988-94
40
20
0
20-34
35-44
45-54
55-64
65-74
Age
Trends in the prevalence of cigarette smoking
Prevalence of cigarette
smoking
80
in men in the Unite States
60
1965
1985
1995
40
20
0
18-24
25-34
35-44
45-64
65-
Age
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)
Very low CHD mortality among men
aged 35-44 in several states in the
United States
•Background
•Methods
•Results
Department of Epidemiology, Graduate School of
Public Health, University of Pittsburgh, USA
Mortality data on CHD
CDC Wonder
Age (35-44)-, sex (men)-, race (white and
black)-, and state-specific data in 1994
for domestic comparison
CHD (ICD codes 410-414, 429.2)
for international comparison
CHD (ICD codes 410-414)
Mortality data which were not valid because of the small
number were excluded from the analysis
Mortality data - International
WHO 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
Age-standardized CHD mortality in men
aged 35-64 (/100,000)
Ecological Analyses
100
80
60
40
20
0
5.2
5.4
5.6
5.8
6
Total cholesterol (mmol/l)
• 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
6.2
6.4
Very low CHD mortality among men
aged 35-44 in several states in the
United States
•Background
•Methods
•Results
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)
TN
KY
IL
All
TX
CO
KS
0
10
20
30
40
50
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)
MS
MO
TX
All
OH
CA
NJ
0
20
40
60
80
100
CHD mortality (/100,000)
>= 42
32 - 42
25 - 32
< 25
MS (B)
MO (B)
TN (W)
KY (W)
CA (B)
NJ (B)
CO (W)
KS (W)
0
20
40
60
80
100
MS
MO
SC
IL
White
Black
OH
PA
NY
NJ
All
0
20
40
60
80
100
Hungary
Poland
US black
Finland
Greece
US white
Australia
France
Japan
0
20
40
60
80
100
Hungary
Blacks in MS
Poland
Whites in TN
Finland
Greece
Blacks in MD
France
Whites in WA
Japan
0
20
40
60
80
100
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
CHD mortality
100
80
60
40
20
0
Black
White
0
50
100
150
200
LC mortality
250
300
70
CHD mortality
60
50
40
30
20
10
0
Black
White
0
10
20
30
40
% of not high school graduate
50
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