Very%20low%20CHD%20mortality%20among%20men%20aged%2035-44%20in%20several%20states%20in%20the%20United%20States - PowerPoint PPT Presentation

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Very%20low%20CHD%20mortality%20among%20men%20aged%2035-44%20in%20several%20states%20in%20the%20United%20States

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Age (35-44)-, sex (men)-, race (white and black)-, and state-specific data in 1994 ... Differences in CHD mortality among black and white men aged 35-44 by state are ... – PowerPoint PPT presentation

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Title: Very%20low%20CHD%20mortality%20among%20men%20aged%2035-44%20in%20several%20states%20in%20the%20United%20States


1
Very low CHD mortality among men aged 35-44 in
several states in the United States
  • Akira Sekikawa, MD, PhD, PhD
  • Lewis H Kuller, MD, DrPH

Department of Epidemiology, Graduate School of
Public Health, University of Pittsburgh, USA
2
Learning objectives
  • To learn the trends in risk factors for coronary
    heart disease in the US
  • To learn some unique features of mortality from
    CHD among men aged 35-44
  • To learn geographic variation in mortality from
    CHD by state and race in the US
  • To learn possible reasons for this variation in
    CHD mortality in the US

3
Very low CHD mortality among men aged 35-44 in
several states in the United States
  • Background
  • Methods
  • Results

Department of Epidemiology, Graduate School of
Public Health, University of Pittsburgh, USA
4
  • Important changes in lifestyle that have major
    effects on risk of CHD have occurred since the
    end of World War II
  • decline in total serum cholesterol
  • decline in prevalence of cigarette smoking
  • improved treatment of high blood pressure
  • increase in prevalence of obesity

Post World War II birth cohort aged 35-44 are
most likely to be affected by these changes
5
Trends in the levels of total cholesterol in men
in the Unite States
6
Trends in the prevalence of hypertension in men
in the Unite States
7
Trends in the prevalence of cigarette smoking in
men in the Unite States
8
Why young adult men (aged 35-44)?
Mortality rates from CHD among men aged 35-44
are 29/100,000 in the US
9
Several unique features of mortality in this
young age group (35-44 year old men)
  • Cohort alternations in risk factors would emerge
    more rapidly in younger age groups
  • Deaths from CHD in this age group are most likely
    to be incident, rather than from long-standing
    chronic clinical CHD
  • Data on this age group would describe the
    difference between white and black better than
    older age groups and age-adjusted rates (cohort
    selection effect)

10
Very low CHD mortality among men aged 35-44 in
several states in the United States
  • Background
  • Methods
  • Results

Department of Epidemiology, Graduate School of
Public Health, University of Pittsburgh, USA
11
  • Mortality data on CHD
  • CDC Wonder
  • Age (35-44)-, sex (men)-, race (white and
    black)-, and state-specific data in 1994
  • for domestic comparison
  • CHD (ICD codes 410-414, 429.2)
  • for international comparison
  • CHD (ICD codes 410-414)
  • Mortality data which were not valid because of
    the small number were excluded from the analysis

12
  • Mortality data - International
  • WHO Statistics Annuals
  • Country specific mortality among men aged 35-44
    in 1994
  • CHD (ICD codes 410-414)

Australia, Canada, Chile, Finland, Greece,
Mexico, Hong Kong, Hungary, Israel, Japan,
Poland, Singapore, South Korea, Spain,
Switzerland, Trinidad, and UK
13
Ecological Analyses
  • Sex-, state-, and race-specific mortality from
    cancer of lung and bronchus (age-adjusted data) -
    surrogate of cigarette smoking CDC Wonder
  • State-, and race-specific data on percent of
    not-a-high-school graduate in the largest 25
    states in 1992 Current Population Survey by
    Census Bureau

14
Very low CHD mortality among men aged 35-44 in
several states in the United States
  • Background
  • Methods
  • Results

Department of Epidemiology, Graduate School of
Public Health, University of Pittsburgh, USA
15
CHD mortality (ICD 410-414, 429.2) among white
men aged 35-44 in 1994 in the US by state
(highest, middle, lowest)
16
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17
CHD mortality (ICD 410-414, 429.2) among black
men aged 35-44 in 1994 in the US by state
(highest, middle, lowest)
18
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19
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21
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22
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23
Why are there such differences in CHD mortality
among men aged 35-44 in the US by state and race?
Accuracy of diagnosis on death certificate Quality
of medical care Differences in risk factors
24
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26
Conclusions I
Differences in CHD mortality among black and
white men aged 35-44 by state are as large as the
differences observed between Poland and France,
one of the highest and the lowest in
the mortality from CHD around the world.
Department of Epidemiology, Graduate School of
Public Health, University of Pittsburgh, USA
27
Conclusions II
The relatively strong correlation between CHD
mortality and educational attainment as well as
lung cancer mortality suggests that smoking and
other CHD risk factors are the potential
candidates for the CHD mortality difference.
Department of Epidemiology, Graduate School of
Public Health, University of Pittsburgh, USA
28
Conclusions III
If the differences are attributed to the
variations in the distribution of traditional
risk factors, the reduction of these risk factors
could substantially reduce the mortality from CHD.
Department of Epidemiology, Graduate School of
Public Health, University of Pittsburgh, USA
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