GEOGRAPHIC AND SOCIOECONOMIC VARIATION IN THE ONSET OF DECLINE OF CORONARY HEART-DISEASE MORTALITY IN WHITE WOMEN

Background. Regional, metropolitan, and socioeconomic factors related to the onset decline of coronary heart disease (CHD) mortality among W hite women are reported. Such studies are important for planning popul ation-level interventions. Methods. Mortality data for 1962 to 1978 we re used, to estimate the year of onset of decline. Ecological analyses of socioeconomic data from the US census were used to emphasize struc tural and organizational aspects of changes in disease, rather than as a substitute for an individual-level design. Results. Onset of declin e of CHD mortality among White women was estimated to have occurred by 1962 in 53% of 507 state economic areas (SEAs), ranging from 79% in t he Northeast to 39% in the South. Metropolitan areas experienced earli er onset of decline than did nonmetropolitan areas. Average income, ed ucation, and occupational levels were highest in early onset areas and declined across onset categories. Conclusions. The results provide ad ditional evidence for previously observed geographic and social patter ns of CHD decline. Emphasis on structural economic factors determining the shape of the CHD epidemic curve does not detract from the medical importance of risk factors, but underscores the importance of communi ty development to public health improvements. The results are consiste nt with the idea that the course of the CHD epidemic in the United Sta tes has been strongly influenced by socioeconomic development.