Nicholls E S, Jung J, Davies J W
Can Med Assoc J. 1981 Nov 1;125(9):981-92.
During the past two decades approximately one half of all deaths in Canada were due to cardiovascular diseases. Ischemic heart disease and cerebrovascular disease caused more than 60% and 20% of those deaths respectively. The mortality rates for ischemic heart disease in males increased slightly until 1965 and then dropped substantially, whereas the rates for females, which were declining at least since the early 1960s, accelerated in their decline. As a consequence, the rates for males remain almost twice as high as those for females. The reductions were initially observed in males 25 to 34 years old and in all age groups of females, but became apparent in a wider range of ages in the second period reviewed (1969 through 1977). The mortality of cerebrovascular disease has gradually diminished for both sexes since the 1950s, but the decline has been more pronounced among females, who originally had the higher rate. Marked geographic differences in mortality rates still exist in Canada despite the decline in death rates for both ischemic heart disease and cerebrovascular disease in all regions of the country. Surprising regional differences in times of onset of these declines have been demonstrated. For ischemic heart disease Ontario maintains the highest and the Prairies the lowest mortality rates. Quebec, despite a sustained decline, still ranks third, while the Pacific region shows the second-lowest rates in the country. The Atlantic region showed the lowest rates of decline in the period reviewed. The reduction in the mortality of ischemic heart disease in Canada (16.4% between 1969 and 1977) must be considered real for a variety of reasons. Direct evidence is not available to elucidate whether the reduction is the consequence of reduced incidence, increased survival or a combination of the two factors. The potential role of various factors that may have contributed to this decline is briefly discussed in this article.
在过去二十年中，加拿大约有一半的死亡是由心血管疾病导致的。缺血性心脏病和脑血管疾病分别导致了这些死亡的60%以上和20%以上。男性缺血性心脏病的死亡率在1965年前略有上升，之后大幅下降，而女性的死亡率至少自20世纪60年代初以来一直在下降，且下降速度加快。因此，男性的死亡率几乎是女性的两倍。最初在25至34岁的男性以及所有年龄段的女性中观察到了死亡率的下降，但在第二个审查期（1969年至1977年），更广泛的年龄段中也出现了明显下降。自20世纪50年代以来，两性脑血管疾病的死亡率都在逐渐下降，但女性的下降更为明显，她们最初的死亡率较高。尽管加拿大所有地区缺血性心脏病和脑血管疾病的死亡率都在下降，但死亡率仍存在明显的地域差异。这些下降开始时间上令人惊讶的地区差异也已得到证实。对于缺血性心脏病，安大略省的死亡率最高，草原地区最低。魁北克省尽管持续下降，但仍排名第三，而太平洋地区的死亡率在全国排名第二低。在审查期内，大西洋地区的下降率最低。加拿大缺血性心脏病死亡率的下降（1969年至1977年期间下降了16.4%），由于多种原因，必须被视为真实的。目前尚无直接证据来阐明这种下降是发病率降低、生存率提高还是这两个因素共同作用的结果。本文简要讨论了可能导致这种下降的各种因素的潜在作用。
