RESUMO
BACKGROUND: It is well known that increasing age is the strongest risk factor of stroke. Therefore, it has been a common belief in many countries including Finland that the numbers of stroke patients will increase considerably during the next two decades because the population is rapidly ageing. METHODS: The FINMONICA and FINSTROKE registers operated in Finland in the Kuopio area and city of Turku from 1983 to 1997. The results showed that the incidence, mortality and case fatality of stroke declined significantly during that period. Importantly, it was established that the trends in incidence and mortality were also declining among the elderly (>74 years). We used these results to create a model for the entire country. The model was based on the trends present in these registers from Turku and Kuopio area and age-specific population projections up to the year 2030 that were obtained from Statistics Finland. RESULTS: In the year 2000, the number of new first stroke cases was estimated to be 11 500. If the declining trend were to level off totally after the year 2000, the number of new strokes would be 20 100 in the year 2030 due to the ageing of the population. It would be 12 100 if the trend continued as favourable as during the years 1983-1997. CONCLUSIONS: Ageing of the population will not inevitably increase the burden of stroke in Finland if the present declining trends are maintained, but the annual number of cases will almost double if the incidence remains at the level of the year 2000.
Assuntos
Envelhecimento/fisiologia , Efeitos Psicossociais da Doença , Acidente Vascular Cerebral , Adulto , Distribuição por Idade , Fatores Etários , Idoso , Envelhecimento/patologia , Feminino , Finlândia/epidemiologia , Humanos , Incidência , Tábuas de Vida , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Dinâmica Populacional , Vigilância da População , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controleRESUMO
AIM: To investigate to what extent the changes in traditional risk factors (total cholesterol, smoking, hypertension) explain the changes in socioeconomic (defined by occupational class and household income) differences in cardiovascular mortality in Finland during the past 20 years. DESIGN: Study population comprised 14,642 men and women aged 35-64 years who were selected from population-based FINRISK surveys in 1987, 1992, 1997 or 2002 in three areas of Finland. The 1982 and 1987 FINRISK cohorts were used to determine a model for the probability of cardiovascular death based on risk factor values at the baseline for each socioeconomic group. These predicted changes in cardiovascular mortality were then contrasted with observed mortality rates in different socioeconomic groups to determine the contribution of the changes in risk factors to changes in actual mortality. RESULTS: We found that among men during 1987-97, when risk factor levels were improving in all socioeconomic groups, the model explained 29-44% of the observed mortality decline. The risk factors explained a larger part of the decline among lower socioeconomic groups. During the period 1997-2002 the risk factor levels stopped improving in all socioeconomic groups but observed mortality rates kept declining. The predicted mortality rates were 16-34% of the observed rates during the period 1987-2002. CONCLUSIONS: Changes in traditional risk factors no longer provide a good explanation of the changes in cardiovascular mortality and its socioeconomic differences. However, risk factors did explain the cardiovascular mortality decline among lower socioeconomic groups.
Assuntos
Doenças Cardiovasculares/mortalidade , Adulto , Doenças Cardiovasculares/etiologia , Colesterol/sangue , Feminino , Finlândia/epidemiologia , Inquéritos Epidemiológicos , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Fatores SocioeconômicosRESUMO
OBJECTIVE: To analyse the risk of coronary heart disease (CHD) events and total mortality among patients who had coronary artery bypass graft (CABG) surgery during 1988-1992. METHODS: A population-based myocardial infarction (MI) register included data on invasive cardiac procedures among residents of the study area. The subjects aged 35-64 years were followed-up for 12 years for non-fatal and fatal CHD events and all-cause mortality, excluding events within 30 days of the CABG operation. CABG was performed on 1158 men and 215 women. RESULTS: The overall survival of men who underwent CABG was similar to the survival of the corresponding background population for about ten years but started to worsen after that. At twelve years of follow-up, 23% (n=266, 95% CI 234-298) of the men who had undergone the operation had died, while the expected proportion, based on mortality in the background population, was 20% (n=231, 95% CI 226-237). The CHD mortality of men who had undergone the operation was clearly higher than in the background population. Among women, the mortality after CABG was about twice the expected mortality in the corresponding background population. In Cox proportional hazards models age, smoking, history of MI, body mass index and diabetes were significant predictors of mortality. CONCLUSIONS: The prognosis of male CABG patients did not differ from the prognosis of the corresponding background population for about ten years, but started to deteriorate after that. History of MI prior to CABG and major cardiovascular risk factors was a predictor of an adverse outcome.
Assuntos
Ponte de Artéria Coronária , Infarto do Miocárdio/cirurgia , Adulto , Fatores Etários , Índice de Massa Corporal , Causas de Morte , Ponte de Artéria Coronária/mortalidade , Complicações do Diabetes/mortalidade , Feminino , Finlândia/epidemiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Distribuição de Poisson , Vigilância da População , Prognóstico , Modelos de Riscos Proporcionais , Sistema de Registros , Fatores de Risco , Fatores Sexuais , Fumar/efeitos adversos , Taxa de SobrevidaRESUMO
AIMS/HYPOTHESIS: We compared the risk of acute coronary events in diabetic and non-diabetic persons with and without prior myocardial infarction (MI), stratified by age and sex. METHODS: A Finnish MI-register study known as FINAMI recorded incident MIs and coronary deaths (n=6988) among people aged 45 to 74 years in four areas of Finland between 1993 and 2002. The population-based FINRISK surveys were used to estimate the numbers of persons with prior diabetes and prior MI in the population. RESULTS: Persons with diabetes but no prior MI and persons with prior MI but no diabetes had a markedly greater risk of a coronary event than persons without diabetes and without prior MI. The rate of recurrent MI among non-diabetic men with prior MI was higher than the incidence of first MI among diabetic men aged 45 to 54 years. The rate ratio was 2.14 (95% CI 1.40-3.27) among men aged 50. Among elderly men, diabetes conferred a higher risk than prior MI. Diabetic women had a similar risk of suffering a first MI as non-diabetic women with a prior MI had for suffering a recurrent MI. CONCLUSIONS/INTERPRETATION: Both persons with diabetes but no prior MI, and persons with a prior MI but no diabetes are high-risk individuals. Among men, a prior MI conferred a higher risk of a coronary event than diabetes in the 45-54 year age group, but the situation was reversed in the elderly. Among diabetic women, the risk of suffering a first MI was similar to the risk that non-diabetic women with prior MI had of suffering a recurrent MI.
Assuntos
Diabetes Mellitus/epidemiologia , Angiopatias Diabéticas/complicações , Angiopatias Diabéticas/epidemiologia , Infarto do Miocárdio/complicações , Infarto do Miocárdio/epidemiologia , Fatores Etários , Idoso , Angiopatias Diabéticas/mortalidade , Feminino , Finlândia/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Recidiva , Sistema de Registros , Análise de Regressão , Fatores de Risco , Fatores SexuaisRESUMO
AIM: To investigate the incidence of clinical diabetes as determined by the incidence of diabetes drug reimbursements within a 5-year period after the first myocardial infarction (MI) in patients who were non-diabetic at the time of their first MI. RESEARCH DESIGN AND METHODS: A population-based MI register, FINMONICA/FINAMI, recorded all coronary events in persons of 35-64 years of age between 1988 and 2002 in four study areas in Finland. These records were used to identify subjects sustaining their first MI (n = 2632). Participants of the population-based risk factor survey FINRISK (surveys 1987, 1992, 1997 and 2002), who did not have diabetes or a history of MI, served as the control group (n = 7774). The FINMONICA/FINAMI study records were linked with the National Social Security Institute's drug reimbursement records, which include diabetes medications, using personal identification codes. The records were used to identify subjects who developed diabetes during the 5-year follow-up period (n = 98 in the MI group and n = 79 in the control group). RESULTS: Sixteen per cent of men and 20% of women sustaining their first MI were known to have diabetes and thus were excluded from this analysis. Non-diabetic men having a first MI were at more than twofold {hazard ratio (HR) 2.3 [95% confidence interval (CI) 1.6-3.4]}, and women fourfold [HR 4.3 (95% CI 2.4-7.5)], risk of developing diabetes mellitus during the next 5 years compared with the control population without MI. CONCLUSIONS: Many patients who do not have diabetes at the time of their first MI develop diabetes in the following 5 years.
Assuntos
Diabetes Mellitus/etiologia , Infarto do Miocárdio/complicações , Adulto , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/epidemiologia , Feminino , Finlândia/epidemiologia , Seguimentos , Humanos , Hipoglicemiantes/uso terapêutico , Incidência , Masculino , Pessoa de Meia-Idade , Vigilância da População/métodos , Fatores de RiscoRESUMO
OBJECTIVE: To examine patterns of ever smoking among Finnish adults by gender and birth cohort from 1978 to 2001, with special emphasis on the possible effects of the 1976 Tobacco Control Act (TCA). METHODS: The data were derived from independent, annual cross sectional postal surveys among 15-64 year olds (n = 91,342), average response rate 75%. For the analyses 13 five year birth cohorts from 1916 to 1980 were constructed. Birth cohort variations in ever regular smoking were first examined graphically, and then logistic models were used to test the impact of the TCA. RESULTS: Among men there was a decrease in smoking from older to younger cohorts. For women an increase in smoking was observed between successive cohorts. A clear decline in the prevalence of ever smokers concurrent with the TCA was found among both men and women. CONCLUSIONS: The smoking behaviour trends across successive birth cohorts suggest the impact of tobacco policy in decreasing smoking initiation in youth. These findings thus support the acceptability and effectiveness of antismoking and smoke free policy measures in society.
Assuntos
Inquéritos Epidemiológicos , Fumar/tendências , Adolescente , Adulto , Fatores Etários , Idade de Início , Efeito de Coortes , Estudos de Coortes , Feminino , Finlândia/epidemiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Sexuais , Fumar/epidemiologia , Fumar/legislação & jurisprudência , Abandono do Hábito de Fumar/legislação & jurisprudência , Abandono do Hábito de Fumar/psicologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Out-of-hospital deaths constitute the majority of all coronary heart disease (CHD) deaths and are therefore of considerable public health significance. METHODS AND RESULTS: We used population-based myocardial infarction register data to examine trends in out-of-hospital CHD deaths in Finland during 1983 to 1997. We included in out-of-hospital deaths also deaths in the emergency room and all deaths within 1 hour after the onset of symptoms. Altogether, 3494 such events were included in the analyses. The proportion of out-of-hospital deaths of all CHD deaths depended on age and gender. In the age group 35 to 64 years, it was 73% among men and 60% among women. These proportions did not change during the study. The annual average decline in the age-standardized out-of-hospital CHD death rate was 6.1% (95% CI, -7.3, -5.0%) among men and 7.0% (-10.0, -4.0%) among women. These declines contributed among men 70% and among women 58% to the overall decline in CHD mortality rate. In all, 58% of the male and 52% of the female victims of out-of-hospital CHD death had a history of symptomatic CHD. Among men with a prior history of myocardial infarction, the annual average decline in out-of-hospital CHD deaths was 5.3% (-7.2, -3.2%), and among men without such history the decline was 2.9% (-4.4, -1.5%). Among women, the corresponding changes were -7.8% (-14.2, -1.5%) and -4.5% (-8.0, -1.0%). CONCLUSIONS: The decline in out-of-hospital CHD deaths has contributed the main part to the overall decline in CHD mortality rates among persons 35 to 64 years of age in Finland.
Assuntos
Doença das Coronárias/mortalidade , Adulto , Distribuição por Idade , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Sistema de Registros/estatística & dados numéricos , Distribuição por SexoRESUMO
AIMS: To analyse the trends in incidence, recurrence, case fatality, and treatments of acute coronary events in Finland during the 15-year period 1983-97. METHODS AND RESULTS: Population-based MI registration has been carried out in defined geographical areas, first as a part of the FINMONICA Project and then continued as the FINAMI register. During the study period, 6501 coronary heart disease (CHD) events were recorded among men and 1778 among women aged 35-64 years. The CHD mortality declined on average 6.4%/year (95% confidence interval -5.4, -7.4%) among men and 7.0%/year (-4.7, -9.3%) among women. The mortality from recurrent events declined even more steeply, 9.9%/year (-8.3, -11.4%) among men and 9.3%/year (-5.1, -13.4%) among women. The proportion of recurrent events of all CHD events also declined significantly in both sexes. Of all coronary deaths, 74% among men and 61% among women took place out-of-hospital. The decline in 28-day case fatality was 1.3%/year (-0.3, -2.3%) among men and 3.1%/year (-0.7, -5.5%) among women. CONCLUSIONS: The study period was characterized by a marked reduction in the occurrence of recurrent CHD events and a relatively modest reduction in the 28-day case fatality. The findings suggest that primary and secondary prevention have played the main roles in the decline in CHD mortality in Finland.
Assuntos
Doença das Coronárias/mortalidade , Adulto , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Revascularização Miocárdica/estatística & dados numéricos , Recidiva , Sistema de Registros , Distribuição por Sexo , Terapia Trombolítica/estatística & dados numéricosRESUMO
Low socioeconomic status (SES) is associated with increased mortality from stroke, but usually no distinction is made between stroke subtypes. We analyzed the relationship of SES with mortality and morbidity of subarachnoid hemorrhage (SAH). In the FINMONICA Stroke Register, 956 consecutive SAH events were recorded during 1983-1992 in patients aged 25-74 years. We used taxable income stratified into three categories, low, middle, and high, as an indicator of SES. The age-standardized incidence of SAH among men and women aged 25-44 years was approximately three times higher in the low-income group than in the high-income group. In older individuals, differences between the income groups were less pronounced. Among survivors of the acute stage, a poorer prognosis was observed in patients with low income than in those with high income. In conclusion, there is a clear excess mortality and morbidity of SAH in young individuals with low income, particularly among men.
Assuntos
Sistema de Registros/estatística & dados numéricos , Fatores Socioeconômicos , Hemorragia Subaracnóidea/epidemiologia , Adulto , Fatores Etários , Idoso , Feminino , Finlândia/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Hemorragia Subaracnóidea/fisiopatologiaRESUMO
BACKGROUND AND PURPOSE: It has been shown that low socioeconomic status is associated with death from stroke. More-detailed data have, however, remained scanty. The purpose of the present study was to examine the association of socioeconomic status with ischemic stroke. Besides mortality, we analyzed the incidence, case-fatality ratio, and prognosis of ischemic stroke events. METHODS: Our population-based study included 6903 first stroke events registered by the FINMONICA Stroke Register in 3 areas of Finland during 1983 to 1992. Indicators of socioeconomic status, such as taxable income and education, were obtained by record linkage of the stroke register data with files of Statistics Finland. RESULTS: Incidence, case-fatality ratio, and mortality rates for ischemic stroke were all inversely related to income. Furthermore, 28 days after the onset of symptoms, a greater proportion of patients with low income than of those with high income was still in institutionalized care and/or in need of help for their activities of daily living. Population-attributable risk of the incidence of first ischemic stroke due to low socioeconomic status was 36% for both sexes. For the death from first ischemic stroke, it was 56% for both sexes. CONCLUSIONS: Persons with low socioeconomic status have considerable excess rates of morbidity and mortality from ischemic stroke in Finland. A reduction in this excess could markedly decrease the burden of ischemic stroke to the society and thus constitute an important public health improvement.
Assuntos
Sistema de Registros , Classe Social , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/mortalidade , Adulto , Idoso , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/mortalidade , Isquemia Encefálica/terapia , Feminino , Finlândia/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Vigilância da População , Prognóstico , Modelos de Riscos Proporcionais , Acidente Vascular Cerebral/terapia , Taxa de SobrevidaRESUMO
OBJECTIVE: To examine socioeconomic differences in case fatality and prognosis of myocardial infarction (MI) events, and to estimate the contributions of incidence and case fatality to socioeconomic differences in coronary heart disease (CHD) mortality. DESIGN: A population-based MI register study. METHODS: The FINMONICA MI Register recorded all MI events among persons aged 35-64 years in three areas of Finland during 1983-1992. A record linkage of the MI Register data with the files of Statistics Finland was performed to obtain information on socioeconomic indicators for each individual registered. First MI events (n=8427) were included in the analyses. MAIN RESULTS: The adjusted risk ratio of prehospital coronary death was 2.11 (95% CI 1.82, 2.46) among men and 1.68 (1.14, 2.48) among women with low income compared with those with high income. Even among persons hospitalised alive the risk of death during the next 12 months was markedly higher in the low income group than in the high income group. Case fatality explained 51% of the CHD mortality difference between the low and the high income groups among men and 38% among women. Incidence contributed 49% and 62%, respectively. CONCLUSIONS: Considerable socioeconomic differences were observed in the case fatality of first coronary events both before hospitalisation and among patients hospitalised alive. Case fatality explained a half of the CHD mortality difference between the low and the high income groups among men and more than a third among women.
Assuntos
Doença das Coronárias/mortalidade , Infarto do Miocárdio/mortalidade , Adulto , Análise de Variância , Estudos de Coortes , Feminino , Finlândia/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/terapia , Prognóstico , Sistema de Registros , Características de Residência , Fatores de Risco , Classe SocialRESUMO
BACKGROUND: Male gender is an established risk factor for first myocardial infarction, but some studies have suggested that among myocardial infarction survivors, women fare worse than men. Therefore, we examined the long-term prognosis of incident myocardial infarction survivors in a large, population-based MI register, addressing gender differences in mortality as well as the number of events and time intervals between recurrent events. METHODS AND RESULTS: Study subjects included 4900 men and women, aged 25-64 years, with definite or probable first myocardial infarctions who were alive 28 days after the onset of symptoms. At first myocardial infarction, women were older and more likely to be hypertensive or diabetic than men, and had a greater proportion of probable vs definite events. After adjustment for age and geographic region, men had 1.74 times the risk of fatal coronary heart disease relative to women (hazard ratio=1.63 and 1.55 for cardiovascular disease and all-cause mortality, respectively) over an average of 5.9 years of follow-up. Number and time intervals between any recurrent event--fatal and non-fatal--did not differ by gender. CONCLUSION: These data suggest that men are far more likely to have a fatal recurrent event than women despite comparable numbers of events.
Assuntos
Infarto do Miocárdio/mortalidade , Fatores Sexuais , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Prognóstico , Modelos de Riscos Proporcionais , Recidiva , Análise de Regressão , SobreviventesRESUMO
We examined the association of socioeconomic status (SES) with the incidence, mortality and case fatality of intracerebral hemorrhage (ICH). During 1982-1992, 909 ICH events were registered among persons aged 25-74 years. Taxable income was used as an indicator of SES. It was stratified into three categories: low, middle and high. The age-standardized incidence and mortality of ICH were significantly higher in the low- than in the high-income group in both genders. Among men aged 25-59 years, the adjusted odds ratio (OR) of ICH death within 1 year after the onset of the event was twice as high in the low-income group as in the high-income group (OR = 2.12, 95% confidence interval 1.02-4.40). In conclusion, marked socioeconomic differences were found in the incidence and mortality of ICH, in particular among working aged men.
Assuntos
Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/mortalidade , Sistema de Registros , Adulto , Idoso , Feminino , Finlândia/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Índice de Gravidade de Doença , Fatores SocioeconômicosRESUMO
This paper aims at studying the development and the risk factors for stroke prospectively during a 6-year follow-up in the Turku Elderly Study, Turku, Finland. The study cohort consisted of 1032 people aged 70 years at baseline. The stroke events (ICD-9 codes 430-434) were identified by computer linkage from the hospital discharge and death registers, and from a follow-up questionnaire. During the 6 years of follow-up, 71 patients (6.9%) suffered a stroke. Previous stroke (RR 5.82), history of transient ischemic attack (RR 4.14), diabetes mellitus (RR 2.50), poorly controlled hypertension (RR 2.42), smoking (RR 1.94) and male sex (RR 1.65) were independent risk factors for stroke. Atrial fibrillation, cardiac failure and previous myocardial infarction did not appear to be significant independent predictors of stroke in the elderly. The risk of stroke in the elderly population appears to be strongly related to the concomitant clinical disease, and this should be remembered when identifying persons at increased risk of stroke. Poorly controlled hypertension was associated with an increased risk of stroke. Thus, achieving a good control of blood pressure in elderly hypertensives receiving treatment has the potential to prevent strokes.
RESUMO
BACKGROUND: Low socioeconomic status (SES) is associated with increased coronary heart disease mortality rates. There are, however, very little data on the relation of SES to the incidence, recurrence, and prognosis of myocardial infarction (MI) events. METHODS AND RESULTS: The FINMONICA MI Register recorded detailed information on all MI events among men and women aged 35 to 64 years in 3 areas of Finland during the period of 1983 to 1992. We carried out a record linkage of the MI register data with files of Statistics Finland to obtain information on indicators of SES, such as taxable income and education, for each individual who is registered. In the analyses, income was grouped into 3 categories (low, middle, and high), and education was grouped into 2 categories (basic and secondary or higher). Among men with their first MI event (n=6485), the adjusted incidence rate ratios were 1.67 (95% CI 1.57 to 1.78) and 1.84 (95% CI 1.73 to 1.95) in the low- and middle-income categories compared with the high-income category. For 28-day mortality rates, the corresponding rate ratios were 3.18 (95% CI 2.82 to 3.58) and 2.33 (95% CI 2.03 to 2.68). Significant differentials were observed for prehospital mortality rates, and they remained similar up to 1 year after the MI. Findings among the women were consistent with those among the men. CONCLUSIONS: The excess coronary heart disease mortality and morbidity rates among persons with low SES are considerable in Finland. To bring the mortality rates of low- and middle-SES groups down to the level of that of the high-SES group constitutes a major public health challenge.
Assuntos
Doença das Coronárias/mortalidade , Infarto do Miocárdio/mortalidade , Classe Social , Adulto , Escolaridade , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Finlândia/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Distribuição por SexoRESUMO
We assessed the validity of hospital discharge data on stroke in Finland and the feasibility of linked hospital discharge and causes-of-death data for epidemiological studies using the FINMONICA Stroke Register as the reference. The results showed that such data can, with some caution, be used for incidence studies and for identifying first stroke events. They cannot, however, be used for assessing secular trends in all stroke events.
Assuntos
Causas de Morte , Alta do Paciente/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Acidente Vascular Cerebral/classificação , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Atestado de Óbito , Estudos de Viabilidade , Finlândia/epidemiologia , Humanos , Incidência , Registro Médico Coordenado , Pessoa de Meia-Idade , Vigilância da População , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidadeRESUMO
OBJECTIVE: The purpose of this study was to produce stable estimates for the incidence, attack and mortality rates and case fatality of acute myocardial infarction (AMI) in Tallinn, the capital of Estonia. RESEARCH DESIGN AND METHODS: The Tallinn AMI register covers the population aged 25-64 years and official residents of Tallinn. The register follows the WHO MONICA project protocols in the data collection and diagnostic evaluation of the suspected AMI events and CHD death. RESULTS: Age-standardized annual incidence, attack rate and mortality in men aged 35-64 years were high, varying from (per 100000 per year) 352, 499 and 208, respectively, in 1991 to 438, 628 and 317, respectively, in 1993. In addition, in women, annual incidence, attack rate and mortality were high, varying from (per 100000 per year) 82, 100 and 31, respectively, in 1991 to 110 and 142 in 1993 for the incidence and attack rate, and to 61 in 1992 for mortality. The percentage of out-of-hospital coronary death (sudden death) increased in men from 33 to 52% and in women from 24 to 42% during 1991-94, and the 28-day case fatality increased in men from 42 to 58%, and in women from 32 to 50%. In Tallinn, women with AMI were treated as actively as men with invasive treatment (thrombolysis, angioplasty, bypass surgery) during the acute phase of MI. CONCLUSIONS: The incidence, attack rate and mortality of AMI were high in both men and women in Tallinn. The high 28-day case fatality observed was primarily due to the high proportion of out-of-hospital deaths.
Assuntos
Infarto do Miocárdio/epidemiologia , Distribuição por Idade , Estônia/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Sistema de Registros , Distribuição por SexoRESUMO
We compared the diagnoses obtained from the routine mortality statistics with the standardized World Health Organization (WHO) MONICA (multinational MONItoring of trends and determinants in CArdiovascular disease) classification in suspect coronary heart disease (CHD) deaths registered in the FINMONICA myocardial infarction (MI) register during 1983-1992. All CHD deaths from routine mortality statistics (International Classification of Diseases codes 410-414) were registered in the MI register. Of the CHD deaths in routine mortality statistics 1.7% in men and 4.8% in women did not fulfill the MONICA criteria for CHD death (P<0.001 for the difference between the sexes). In men 4.7% and in women 7.3% (P=0.004) of the deaths registered in the MI Register and classified as CHD deaths by MONICA criteria had another underlying cause of death than CHD in routine mortality statistics; this proportion increased over time in both sexes (P=0.002 in men and P=0.77 in women). The CHD mortality trends obtained separately from the routine mortality statistics and from the FINMONICA MI Register were very similar. In conclusion, the high CHD mortality in Finland reported by the routine mortality statistics is real. It is possible that some CHD deaths have escaped registration, but the decline seen in the CHD mortality is also real.
Assuntos
Doença das Coronárias/mortalidade , Infarto do Miocárdio/mortalidade , Adulto , Doença das Coronárias/diagnóstico , Feminino , Finlândia/epidemiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Valor Preditivo dos Testes , Sistema de Registros , Reprodutibilidade dos TestesRESUMO
BACKGROUND AND PURPOSE: Stroke mortality has been declining in Finland during the past 20 years. It is not known, however, whether this favorable development is attributable to the decline in the incidence or case-fatality of stroke. For this reason we examined the trends in case-fatality of stroke, including trends by subtype of stroke. METHODS: The analyses were carried out using data of the community-based FINMONICA Stroke Register, which was operating in three geographic areas of Finland during 1983 to 1992. All stroke events (n = 11,171) in persons aged 35 to 74 years were included in this register. RESULTS: The 28-day case-fatality of stroke fell yearly by 3.6% (P = .01) in men and by 2.6% (P = .2) in women. At the end of the study period, the average 28-day case-fatality of all strokes was 20% in men and 21% in women. Considerable differences by subtype of stroke were observed. The 28-day case-fatalities at the end of the study period were in men-56% for subarachnoid hemorrhage, 42% for intracerebral hemorrhage, and 14% for cerebral infarction. In women, the corresponding figures were 49%, 49%, and 14%. The 28-day case-fatality of subarachnoid hemorrhage did not change during the study period, but for intracerebral hemorrhage, a significant decline was observed in men and there was a declining trend also in women. The 28-day case-fatality of cerebral infarction declined significantly in both genders. CONCLUSIONS: With the exception of subarachnoid hemorrhage, the 28-day case-fatality of stroke has fallen in Finland. It is likely that this fall has contributed to the decline in stroke mortality.