Bonneux L, Looman C W, Barendregt J J, Van der Maas P J
Department of Public Health, Erasmus University, Rotterdam, Netherlands.
BMJ. 1997 Mar 15;314(7083):789-92. doi: 10.1136/bmj.314.7083.789.
To test whether recent declines in mortality from coronary heart disease were associated with increased mortality from other cardiovascular diseases.
Poisson regression analysis of national data on causes of death and hospital discharges.
Population of the Netherlands, 1969-93.
Annual changes in mortality from coronary heart disease, stroke, and other cardiovascular diseases and annual changes in hospital discharge rates for acute coronary events, stroke, and congestive heart failures.
Patterns of cardiovascular mortality changed abruptly in 1987-93. Annual decline in mortality from coronary heart disease increased sharply for women and men: from -1.9% (95% confidence interval -2.2% to -1.6%) and -1.7% (-1.9% to -1.4%) respectively in 1979-86 to -3.1% (-3.5% to -2.6%) and -4.2% (-4.6% to -3.9%) in 1987-93. The longstanding decline in mortality from stroke levelled off: from annual change of -3.3% (-3.7% to -2.8%) and -3.2% (-3.7% to -2.8%) in 1979-86 to -0.1% (-0.7% to 0.4%) and -1.1% (-1.7% to -0.5%) in 1987-93. Mortality from other cardiovascular diseases, however, started to increase: from -2.0% (-2.4% to -1.6%) and -0.2% (-0.5% to 0.2%) in 1979-86 to 1.5% (1.0% to 2.0%) and 1.9% (1.5% to 2.3%) in 1987-93. Hospital discharge rates for acute coronary heart disease, congestive heart failure, and stroke increased during 1980-6. During 1987-93 discharge rates for stroke and coronary heart disease stabilised but rates for congestive heart failure increased.
Improved management of coronary heart disease seems to have reduced mortality, but some of the gains are lost to deaths from stroke and other cardiovascular diseases. The increasing numbers of patients with coronary heart disease who survive will increase demands on health services for long term care.
检验近期冠心病死亡率的下降是否与其他心血管疾病死亡率的上升相关。
对全国死因和医院出院数据进行泊松回归分析。
1969 - 1993年荷兰人口。
冠心病、中风和其他心血管疾病死亡率的年度变化，以及急性冠脉事件、中风和充血性心力衰竭的医院出院率的年度变化。
1987 - 1993年心血管疾病死亡率模式发生突变。冠心病死亡率的年度下降幅度在男性和女性中均大幅增加：从1979 - 1986年的分别为-1.9%（95%置信区间-2.2%至-1.6%）和-1.7%（-1.9%至-1.4%）增至1987 - 1993年的-3.1%（-3.5%至-2.6%）和-4.2%（-4.6%至-3.9%）。中风死亡率长期以来的下降趋于平稳：从1979 - 1986年的年度变化-3.3%（-3.7%至-2.8%）和-3.2%（-3.7%至-2.8%）降至1987 - 1993年的-0.1%（-0.7%至0.4%）和-1.1%（-1.7%至-0.5%）。然而，其他心血管疾病的死亡率开始上升：从1979 - 1986年的-2.0%（-2.4%至-1.6%）和-0.2%（-0.5%至0.2%）升至1987 - 1993年的1.5%（1.0%至2.0%）和1.9%（1.5%至2.3%）。1980 - 1986年期间，急性冠心病、充血性心力衰竭和中风的医院出院率上升。1987 - 1993年期间，中风和冠心病的出院率稳定，但充血性心力衰竭的出院率上升。
冠心病管理的改善似乎降低了死亡率，但部分获益因中风和其他心血管疾病导致的死亡而抵消。存活的冠心病患者数量增加将对长期护理的卫生服务提出更高要求。
