Circulation, Vol 90, 574-582, Copyright © 1994 by American Heart Association
TJ Thom and FH Epstein
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.
ARTICLES
Heart disease, cancer, and stroke mortality trends and their interrelations. An international perspective
Epidemiology and Biometry Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.
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