International Journal of Epidemiology, Vol 28, 1050-1058, Copyright © 1999 by International Epidemiological Association
T Lang, P Ducimetiere, D Arveiler, P Amouyel, J Ferrieres, JB Ruidavets, M Montaye, B Haas and A Bingham
OBJECTIVES: To assess whether different definitions of acute coronary
events yielded concordant results concerning trends and geographical
disparities in coronary heart disease (CHD) mortality and morbidity in
France. STUDY DESIGN: Data from three French CHD registries participating
in the WHO MONICA Project during the period 1985-1992. SETTING: Three areas
of about one million inhabitants each in the North, South and East of
France. SUBJECTS: About 2,000 acute coronary events each year. MAIN OUTCOME
MEASURES: Mortality, annual rate of fatal and non-fatal events, incidence
of first and recurrent events, case-fatality rates. RESULTS: For incidence
and mortality, the broader the broader the definition of the acute event,
the higher the reported rates. The same tendency was not observed for
case-fatality rates. Comparing between-registry rates for mortality, 28-day
case-fatality and hospital case fatality yielded relatively concordant
results whatever the definition of event. As a whole, the higher mortality
rate in Lille and its intermediate rank in Strasbourg were related more to
disparities in case-fatality rates, with only small variations in incidence
rates, independently of the definition used. Comparing temporal trends in
rates within and between regions, a consistent decrease in annual mortality
rates and case-fatality rates was observed, whatever the definition. In
contrast, the incidence of non- fatal probable myocardial infarction did
not change during the period in any register. CONCLUSIONS: Although the
absolute estimates of rates were variable with the definition of the event,
major findings in relation to trends and geographical disparities were
fairly consistent across the definitions: the North-South gradient in
mortality observed in France was found to be much more pronounced for case
fatality than for incidence. The proportion of milder acute myocardial
infarction is currently increasing and this element should be taken into
account when analysing CHD rates.
Trends and geographical disparities in coronary heart disease in France: are results concordant when different definitions of events are used?
INSERM U258, Hopital P Brousse, Villejuif, France. lang@biomath.jussieu.fr
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