Siskind V, Bain C, Wilson A
Dept. of Social and Preventive Medicine, U. of Queensland, Herston, Australia.
Am J Epidemiol. 1987 Nov;126(5):871-81. doi: 10.1093/oxfordjournals.aje.a114724.
Routine data on mortality and hospital activity were used to estimate changes in coronary heart disease mortality, case fatality, and hospitalizations in the Australian state of Queensland over the decade 1971-1980. Acute myocardial infarction (International Classification of Diseases (ICD) 410) and other ischemic heart disease (ICD 411-414) were considered separately. For acute myocardial infarction, age-adjusted total mortality declined by about one fourth in both men and women; in-hospital mortality decreased somewhat more and deaths out of hospital correspondingly less. The age-adjusted case fatality ratio fell by the same amount (29%), in both sexes. Similar trends occurred at all ages. Admission rates decreased 11% in men and 18% in women. Similar patterns were evident for other ischemic heart disease except for admissions, which rose 23% among men and remained at the same level in women. These findings suggest that both declining incidence, particularly in the form of fewer deaths out of hospital, and improvements in care may have contributed to the general decline in coronary heart disease mortality in this community. Without direct measures of incidence or changing disease severity, the relative contributions of each factor cannot be examined.
利用死亡率和医院活动的常规数据，估算了1971年至1980年这十年间澳大利亚昆士兰州冠心病死亡率、病死率和住院率的变化情况。急性心肌梗死（国际疾病分类（ICD）410）和其他缺血性心脏病（ICD 411 - 414）分别进行了考量。对于急性心肌梗死，男性和女性的年龄调整总死亡率均下降了约四分之一；住院死亡率下降幅度稍大，院外死亡相应减少。年龄调整病死率在两性中均下降了相同幅度（29%）。所有年龄段均出现类似趋势。男性的住院率下降了11%，女性下降了18%。除住院率外，其他缺血性心脏病也呈现类似模式，男性住院率上升了23%，女性则保持在同一水平。这些发现表明，发病率下降，尤其是院外死亡人数减少，以及医疗护理的改善，可能共同促成了该社区冠心病死亡率的总体下降。由于没有发病率或疾病严重程度变化的直接测量数据，无法考察每个因素的相对贡献。
