CORONARY HEART-DISEASE MORTALITY, MORBIDITY, AND CASE-FATALITY IN 5 EAST AND WEST-GERMAN CITIES 1985-1989

Cardiovascular mortality (CVD; International Classification of Disease s [ICD] 390-458) is higher in East than in West Germany, but the diffe rences in official coronary heart disease mortality (CHD; ICD 410-414) are not so pronounced. The aim of this study was to validate the offi cial mortality statistics based on the five German AMI registers and t o analyze whether these mortality differences are due to differences i n the attack rates of acute myocardial infarction (AMI) or to differen ces in the 28-day case fatality rates. This comparison includes the MO NICA study cities of Augsburg and Bremen, both in West Germany, as wel l as the cities of Chemnitz, Erfurt, and Zwickau in East Germany (form er the German Democratic Republic), The rates were calculated on the b asis of all MONICA cases of definite AMI or coronary death aged 35 to 64 years occurring in the respective study populations between 1985 an d 1989. All study populations except women in Augsburg showed higher c oronary death rates compared to the rates based on the official cause of death statistics (ICD 410-414), but this difference was significant only for men in Chemnitz. In men there were no significant difference s in the register-based coronary death rates between these urban areas (160/100,000 in Zwickau to 170/100,000 in Chemnitz) nor in the AMI at tack rates (327/100,000 in Augsburg to 363/100,000 in Chemnitz), and c onsequently no significant center differences in the overall 28-day ca se fatality. However, the prehospital case fatality was significantly higher in Erfurt (34%) than in Bremen (27%). There were no significant differences in the AMI attack rates in women as well (60/100,000 in C hemnitz to 70/100,000 in Bremen and Erfurt), but the overall 28-day ca se fatality showed a clear gradient from the East (61-71%) to the West German cities (48-56%) and therefore also the register-based coronary death rates (38-50/100,000 and 34-38/100,000, respectively). However, the higher 28-day case fatality in women found in the MONICA register s in East compared to West Germany is not reflected in the CHD mortali ty statistics because of a stronger underestimation of the official mo rtality rates in East than in West Germany, in particular in women. Ne vertheless, the total mortality rates and in most cases also the CVD m ortality rates were in women significantly higher in the East German c ompared to the West German cities. The East German official preunifica tion CHD mortality data cannot be used for national and international comparisons. The results of the MONICA AMI registers in East and West Germany indicate, furthermore, the need to improve coronary care in wo men in the eastern part of the country. Nevertheless, because of the r elatively high AMI attack rates in both parts of Germany primary preve ntion must generally be intensified.