Uemura K, Pisa Z
Division of Epidemiological Surveillance, World Health Organization, Geneva.
World Health Stat Q. 1988;41(3-4):155-78.
In most industrialized countries, mortality in general, and cardiovascular disease mortality in particular, have shown decreasing trends since around 1970, following stagnation or increases observed during the 1950s and 1960s. In some countries, however (e.g. in Eastern Europe), male mortality from cardiovascular diseases increased during recent years. The levels and trends of mortality from cardiovascular diseases vary considerably among countries. Measured in terms of age-standardized rates, the ratio between the highest and the lowest rates around 1985 was about 2 for total mortality but about 4 for all cardiovascular diseases combined. With further breakdowns the ratio was even greater, i.e. 4-5 for heart diseases and 6-7 for cerebrovascular disease. For ischaemic heart disease alone, the ratio reached as high as 10, though part of this wide range should be attributed to artefacts due to the varying diagnostic practices followed in different countries. The speed of mortality changes also differed among countries, ranging from a rapid decrease to a rapid increase. In general, the trends were much more favourable in females than in males. Consequently, sex differentials have been widened. The male/female ratio in mortality for ischaemic heart disease has now exceeded 3 in a number of countries. The ratio for cerebrovascular diseases, which used to be close to 1 in many countries in the early 1950s, has also increased, often reaching the level of 1.5 or higher. Differentials were observed also among different age groups in some countries. There seems to be a tendency for mortality change, either an increase or a decrease, to be quicker in younger age groups than in older ones. These varying levels and trends in cardiovascular disease mortality have no doubt been caused by a multitude of risk factors operating in each country, affecting the incidence of cardiovascular diseases and their prognosis. Much is already known about these risk factors and about the measures to be taken by the health services as well as by individuals for prevention and effective therapy. The considerable variation in mortality levels and trends observed among different countries points to the possibility for action by countries heavily affected by cardiovascular diseases. Mortality surveillance in each country and at the international level thus reveals how each country's situation and trends compare with others and provides a basis for action and further research. Progress in WHO's MONICA (MONItoring of trends and determinants in CArdiovascular disease) project will clarify various aspects of the role played by risk factors in different communities.
在大多数工业化国家，总体死亡率，尤其是心血管疾病死亡率，自20世纪70年代左右以来呈下降趋势，此前在20世纪50年代和60年代曾出现停滞或上升。然而，在一些国家（如东欧），近年来男性心血管疾病死亡率有所上升。各国心血管疾病死亡率的水平和趋势差异很大。以年龄标准化率衡量，1985年左右总死亡率最高与最低率之比约为2，但所有心血管疾病合并后的比率约为4。进一步细分后，该比率甚至更大，即心脏病为4至5，脑血管疾病为6至7。仅缺血性心脏病的比率就高达10，不过这种广泛差异的部分原因应归因于不同国家采用的不同诊断方法所导致的人为因素。各国死亡率变化的速度也有所不同，从快速下降到快速上升不等。总体而言，女性的趋势比男性更为有利。因此，性别差异有所扩大。在一些国家，缺血性心脏病死亡率的男女比率现已超过3。脑血管疾病的比率在20世纪50年代初许多国家曾接近1，如今也有所上升，常常达到1.5或更高的水平。在一些国家的不同年龄组之间也观察到了差异。似乎存在一种趋势，即死亡率的变化，无论是上升还是下降，在较年轻年龄组中比在较年长年龄组中更快。心血管疾病死亡率的这些不同水平和趋势无疑是由每个国家存在的多种风险因素造成的，这些因素影响着心血管疾病的发病率及其预后。关于这些风险因素以及卫生服务机构和个人为预防和有效治疗应采取的措施，人们已经了解很多。不同国家之间观察到的死亡率水平和趋势的巨大差异表明，受心血管疾病严重影响的国家有可能采取行动。因此，各国以及国际层面的死亡率监测揭示了每个国家的情况和趋势与其他国家的比较情况，并为采取行动和进一步研究提供了依据。世界卫生组织的MONICA（心血管疾病趋势和决定因素监测）项目的进展将阐明风险因素在不同社区中所起作用的各个方面。
