Thom T J, Epstein F H
Epidemiology and Biometry Program, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.
Circulation. 1994 Jul;90(1):574-82. doi: 10.1161/01.cir.90.1.574.
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.
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.
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.
近几十年来，许多国家心脏病、癌症和中风死亡率的变化备受关注。然而，缺乏对这些趋势及其对总死亡率影响的全面和同步分析。此外，一种疾病的趋势与另一种疾病的趋势之间的关联程度尚不清楚。主要疾病趋势的一致性表明它们有共同的病因，因此可能对相同的预防措施有反应。
从世界卫生组织的统计报告中获取了1950年至1987年27个国家按性别和35至74岁年龄组划分的总死亡率以及心脏病、中风、肺癌和非肺癌癌症死亡率的年龄调整死亡率。通过目视检查和对随时间变化的百分比变化进行半定量测量，评估了1950年至1983年35至74岁年龄组死亡率趋势的一致性。在大多数工业化国家，心脏病死亡率的流行增长在20世纪60年代或70年代结束；死亡率往往急剧下降。中风死亡率在20世纪60年代或70年代也从上升变为下降，或从适度下降变为急剧下降。肺癌死亡率斜率通常从急剧上升变为适度上升、平稳趋势或下降；斜率变化滞后于心脏病和中风。这些改善影响了总死亡率趋势。非肺癌癌症趋势不如其他三种死因的趋势明显。然而，对其与心脏病趋势的一致性进行测试发现，在假设心脏病比癌症对生活方式或环境变化反应更快的时间滞后分析中，它们大多是一致的。男性心脏病和肺癌趋势在时间滞后分析中也往往一致。心脏病和中风趋势随着时间变得更加一致。
在不同国家，心脏病、中风、肺癌以及不太明显的非肺癌癌症的死亡率趋势往往相似，导致总死亡率趋势相应相似。对各国疾病对之间趋势的分析表明趋势有一致的倾向，这表明存在适合相同预防措施的共同病因。对国际死亡率趋势的这种分析旨在推动沿着这些思路的进一步研究，作为预防和治疗行动的指南。
