THE FALLING MORTALITY FROM CORONARY HEART-DISEASE - A CLINICOPATHOLOGICAL PERSPECTIVE

Objective-(1) To compare mortality estimates based on clinicopathologi cal diagnoses of death from acute coronary heart disease with official estimates of coronary heart disease mortality; (2) to compare present day mortality figures with those from earlier reports. Design-Prospec tive community study over the two years 1994 and 1995. Setting-The hea lth districts of Brighten, South Glamorgan, and York. Subjects-1589 me n and women under 75 years of age who, based on our study criteria, di ed from acute coronary events were compared with certified cases of co ronary death in the same age group. Main outcome measures-(l) Comparis on of the underlying cause recorded on death certificates with the dia gnosis of acute coronary death defined by our study criteria; (2) comp arison of age specific mortality figures of the present with earlier s tudies. Results-Up to age 65, age mortality for coronary heart disease . using study criteria, was similar to official estimates. However, at ages 65-74 years there was a shortfall in study deaths of about 20% c ompared with official figures. One reason for this was that many death certificates in elderly people attributed death to coronary disease i n the absence of confirmatory evidence. Despite this, deaths in the un der 65 age group in the 1990s appear to be occurring in people who are about 10 years older than was the case during the 1970s. Conclusions- There are differences, most noticeable in elderly subjects, between es timates of coronary mortality made according to strict clinical and pa thological definitions and official rates based on death certification . Recognition of these differences will be important for future epidem iological studies.