REGRESSION-ANALYSIS OF RECENT CHANGES IN CARDIOVASCULAR MORBIDITY ANDMORTALITY IN THE NETHERLANDS

Objectives: To test whether recent declines in mortality from coronary heart disease were associated with increased mortality from other car diovascular diseases. Design: Poisson regression analysis of national data on causes of death and hospital discharges. Setting and subjects: Population of the Netherlands, 1969-93. Main outcome measures: Annual changes in mortality from coronary heart disease, stroke, and other c ardiovascular diseases and annual changes in hospital discharge rates for acute coronary events, stroke, and congestive heart failures. Resu lts: Patterns of cardiovascular mortality changed abruptly in 1987-93. Annual decline in mortality from coronary heart disease increased sha rply 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 o ther 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% t o 2.0%) and 1.9% (1.5% to 2.3%) in 1987-93. Hospital discharge rates f or 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 fail ure increased. Conclusion: Improved management of coronary heart disea se seems to have reduced mortality, but some of the gains are lost to deaths from stroke and other cardiovascular diseases. The increasing n umbers of patients with coronary heart disease who survive will increa se demands on health services for long term care.