CEREBROVASCULAR-DISEASE MORTALITY IN SPAIN, 1955-1992 - AN AGE-PERIOD-COHORT ANALYSIS

The purpose of this study was to assess the contributions of period an d birth cohort effects to changes in cerebrovascular disease (CVD) mor tality in Spain over the period 1955-1992. Poisson regression models w ere fitted to age- and sex-specific CVD mortality rates obtained from National Vital Statistics, In the period 1955-1975, CVD mortality rema ined stable, In the period 1975-1992: CVD mortality declined by 54% (r ate ratio, RR: 0.46; 95% confidence interval, Cl: 0.43-0.49) in males and 62% (RR: 0.38; 95% Cl: 0.34-0.42) in females, The cohort effect wa s very small up to the generation born in 1905, moving clearly downwar d thereafter. CVD mortality for subjects born in the period 1945-1949 was lower than for those born in the period 1905-1909 by 68% (RR: 0.32 ; 95% Cl: 0.16-0.63) in males and 82% (RR: 0.18; 95% Cl: 0.07-0.45) in females, Among the possible partial explanations for these effects ar e the decline in ischemic heart disease and rheumatic fever mortality, the drop in salt and alcohol intake, the reduction in smoking among m ales and blood pressure among females, and the widespread use of antih ypertensive treatments in Spain over the last 20 years.