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IJE Advance Access published online on February 2, 2006
International Journal of Epidemiology, doi:10.1093/ije/dyl012
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2006; all rights reserved.
Accepted January 11, 2006

Original paper

The incidence of coronary heart disease among Palestinians and Israelis in Jerusalem

Jeremy D. Kark 1 *, Rita Fink 1, Bella Adler 1, Nehama Goldberger 1, and Sylvie Goldman 1

1 Epidemiology Unit, Hadassah Medical Organization and Hebrew University-Hadassah School of Public Health and Community Medicine, Ein Kerem, Jerusalem 91120, Israel

* To whom correspondence should be addressed.
Jeremy D. Kark, E-mail: jeremy1{at}vms.huji.ac.il


  Abstract

Background Lifestyle factors relevant to coronary risk factors differ between Palestinians and Israelis. Both have been exposed, albeit differently, to the stressors of the long-term conflict. We determined the incidence of coronary heart disease, previously unreported in Palestinians, in these Mediterranean populations and made international comparisons with the MONICA Programme.

Methods We applied the rigorous World Health Organization MONICA protocol, which enables standardized international population-based comparisons, to determine all acute myocardial infarction events and coronary deaths among Palestinians and Israelis aged 25-74, residents of the Jerusalem district in 1997.

Results We confirmed a total of 265 coronary events among 76 200 Arabs and 698 among 226 500 Jews. Rates among Arabs were substantially higher than in Jews, particularly so in women. Age-adjusted rate ratios (RRs) for coronary events were 1.58 [95% confidence interval (95% CI) 1.34-1.87] among men and 2.37 (95% CI 1.81-3.10) among women. When restricted to coronary deaths, Arab: Jewish RRs were 2.79 (95% CI 2.09-3.73) in men and 2.66 (95% CI 1.77-4.00) in women. Compared with MONICA populations in 20 countries, Arabs ranked first in total coronary event rates and first in non-fatal myocardial infarction rates, exceeded populations in Finland, Scotland, and Northern Ireland, and showed striking differences from the participating Mediterranean centres.

Conclusions Coronary risk appears to be particularly high in Palestinian Arabs. Determinants of these unexpected findings should be sought and prevention programmes initiated.

Keywords: Arabs; coronary disease; incidence; Israel; Jews; myocardial infarction; Palestinians; registries; sudden cardiac death.
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