Article

The decline in ischemic heart disease mortality: prospective evidence from the Alameda County Study.

Human Population Laboratory, California Department of Health Services, Berkeley 94704.
American Journal of Epidemiology (impact factor: 5.22). 07/1988; 127(6):1131-42. pp.1131-42
Source: PubMed

ABSTRACT The contribution of secular changes in the distribution of ischemic heart disease risk factors and medical care utilization to the decline in ischemic heart disease mortality was investigated using data collected on the nine-year ischemic heart disease mortality experience of two cohorts selected to be representative of Alameda County, California, in 1965 and 1974. With adjustment for age, sex, race, and baseline ischemic heart disease conditions and symptoms, there was a 45% decline in the nine-year odds of ischemic heart disease mortality between the two cohorts (1965/1974, odds ratio (OR) = 1.82, p = 0.0001). Further adjustment for cohort differences in the following ischemic heart disease risk factors did not explain the decline: smoking status, leisure-time physical activity, self-assessed physical activity, alcohol consumption, body mass index, or social network participation; neither did adjustment for measures of education, utilization of preventive medical care, availability of a regular physician or clinic, health insurance coverage, number of physician visits during the last 12 months, or occupation. There was no change in the estimated ischemic heart disease decline when all adjustment variables were included in a logistic model (1965/1974, OR = 1.81, p = 0.0002). These variables do not appear to explain the large decline in nine-year ischemic heart disease mortality between these two cohorts.

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Keywords

Alameda County
 
baseline ischemic heart disease conditions
 
body mass index
 
estimated ischemic heart disease decline
 
following ischemic heart disease risk factors
 
health insurance coverage
 
ischemic heart disease mortality
 
ischemic heart disease risk factors
 
large decline
 
leisure-time physical activity
 
medical care utilization
 
nine-year ischemic heart disease mortality
 
nine-year ischemic heart disease mortality experience
 
physician visits
 
preventive medical care
 
secular changes
 
self-assessed physical activity
 
smoking status
 
social network participation
 
two cohorts