Trends in community mortality due to coronary heart disease.

BACKGROUND: Relatively little data are available, particularly from the more generalizable perspective of a population-based investigation, describing recent trends in death rates due to coronary heart disease (CHD). The objectives of this observational study were to describe changes over a twelve year period (1990-2001) in death rates due to CHD and acute myocardial infarction (AMI) in residents of the Worcester, Massachusetts, metropolitan area (2000 census = 478,000). A secondary study goal was to describe changes in death rates attributed to CHD over time separately in men and in women, in persons of different ages, and according to location of death. METHODS: Death datatapes were obtained from the Massachusetts Department of Public Health for greater Worcester residents who died over the period 1990 to 2001. RESULTS: Marked declines were observed in the population death rates (per 100,000) due to CHD (1990 death rate = 322; 2001 death rate = 224) and AMI (1990 death rate = 137; 2001 death rate = 87) in the greater Worcester population. Declines in the annual death rates attributed to CHD were observed in both the hospital (4.4% decline) and out-of-hospital setting (1.6% decline) as well as for patients dying from AMI (annual declines of 4.8% and 1.9% respectively). Reductions in CHD death rates over time were observed in men and in women and in persons of all ages. CONCLUSIONS: The present results demonstrate encouraging declines in community death rates due to CHD and AMI over time and the impact of evolving primary and secondary prevention efforts.

Trends in mortality attributed to heart failure in Worcester, Massachusetts, 1992 to 2001.

Sparse data are available, particularly from the more generalizable perspective of a population-based investigation, that describe recent trends in community death rates due to heart failure (HF). The objectives of this study were to describe a decade-long trend (1992 to 2001) in mortality attributed to HF among residents of the metropolitan area of Worcester, Massachusetts. A secondary study goal was to describe changes in death rates due to HF in men and in women, in subjects of different ages, and according to location of death. Death data tapes were obtained from the Massachusetts Department of Public Health for greater Worcester residents who died between 1992 and 2001. A total of 2,677 deaths from HF occurred in metropolitan Worcester residents between 1992 and 2001. Increases in crude death rates (per 100,000 population) attributed to HF were observed from 1992 (death rate 82) to 2001 (death rate 102). Adjustment for age attenuated the increase in community death rates due to HF. Slight increases in age-adjusted death rates from HF were noted in men, whereas age-adjusted mortality from HF in women decreased by 22% between our initial study year and the most recent study year. The elderly were at greatest risk for dying of HF and increases in HF death rates were observed in the oldest subjects (>/=85 years of age) over time. There was an increasing proportion of all deaths due to HF that occurred in the out-of-hospital setting in 2001 (61%) compared with 1992 (52%). The results of this study suggest changing patterns in death rates due to HF in a large northeastern community.