The falling mortality from coronary heart disease: a clinicopathological perspective. The United Kingdom Heart Attack Study (UKHAS) Collaborative Group.

OBJECTIVE

(1) To compare mortality estimates based on clinicopathological diagnoses of death from acute coronary heart disease with official estimates of coronary heart disease mortality; (2) to compare present day mortality figures with those from earlier reports.

DESIGN

Prospective community study over the two years 1994 and 1995.

SETTING

The health districts of Brighton, South Glamorgan, and York.

SUBJECTS

1589 men and women under 75 years of age who, based on our study criteria, died from acute coronary events were compared with certified cases of coronary death in the same age group.

MAIN OUTCOME MEASURES

(1) Comparison of the underlying cause recorded on death certificates with the diagnosis of acute coronary death defined by our study criteria; (2) comparison of age specific mortality figures of the present with earlier studies.

RESULTS

Up to age 65, age specific mortality for coronary heart disease, using study criteria, was similar to official estimates. However, at ages 65-74 years there was a shortfall in study deaths of about 20% compared with official figures. One reason for this was that many death certificates in elderly people attributed death to coronary disease in the absence of confirmatory evidence. Despite this, deaths in the under 65 age group in the 1990s appear to be occurring in people who are about 10 years older than was the case during the 1970s.

CONCLUSIONS

There are differences, most noticeable in elderly subjects, between estimates of coronary mortality made according to strict clinical and pathological definitions and official rates based on death certification. Recognition of these differences will be important for future epidemiological studies.