very low chd mortality among men aged 35-44 in several states in the united states akira sekikawa,...
TRANSCRIPT
![Page 1: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/1.jpg)
Very low CHD mortality among men aged 35-44 in several states in
the United States
Akira Sekikawa, MD, PhD, PhD
Lewis H Kuller, MD, DrPH
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, USA
![Page 2: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/2.jpg)
Learning objectives
• To learn the trends in risk factors for coronary heart disease in the US
• To learn some unique features of mortality from CHD among men aged 35-44
• To learn geographic variation in mortality from CHD by state and race in the US
• To learn possible reasons for this variation in CHD mortality in the US
![Page 3: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/3.jpg)
•Background•Methods•Results
Very low CHD mortality among men aged 35-44 in several states in
the United States
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, USA
![Page 4: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/4.jpg)
Important changes in lifestyle that have major effects on risk of CHD have occurred since the end of World War II
•decline in total serum cholesterol
•decline in prevalence of cigarette smoking
•improved treatment of high blood pressure
•increase in prevalence of obesity
Post World War II birth cohort aged 35-44 are most likely to be affected by these changes
![Page 5: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/5.jpg)
180
200
220
240
20-34 35-44 45-54 55-64 65-74 Age
Tot
al C
hole
ster
ol (
mg/
dl)
1960-621976-80 1988-94
Trends in the levels of total cholesterol
in men in the Unite States
![Page 6: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/6.jpg)
0
20
40
60
80
20-34 35-44 45-54 55-64 65-74Age
Pre
vale
nce
of h
yper
tens
ion
1960-621976-80 1988-94
Trends in the prevalence of hypertension
in men in the Unite States
![Page 7: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/7.jpg)
0
20
40
60
80
18-24 25-34 35-44 45-64 65-Age
Pre
vale
nce
of c
igar
ette
sm
okin
g
196519851995
Trends in the prevalence of cigarette smoking
in men in the Unite States
![Page 8: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/8.jpg)
Why young adult men (aged 35-44)?
Mortality rates from CHD among men aged 35-44 are
29/100,000 in the US
![Page 9: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/9.jpg)
Several unique features of mortality in this young age group (35-44 year old men)
• Cohort alternations in risk factors would emerge more rapidly in younger age groups
• Deaths from CHD in this age group are most likely to be incident, rather than from long-standing chronic clinical CHD
• Data on this age group would describe the difference between white and black better than older age groups and age-adjusted rates (cohort selection effect)
![Page 10: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/10.jpg)
•Background•Methods•Results
Very low CHD mortality among men aged 35-44 in several states in
the United States
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, USA
![Page 11: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/11.jpg)
Mortality data on CHDCDC Wonder
Age (35-44)-, sex (men)-, race (white and black)-, and state-specific data in 1994
for domestic comparisonCHD (ICD codes 410-414, 429.2)
for international comparisonCHD (ICD codes 410-414)
Mortality data which were not valid because of the small number were excluded from the analysis
![Page 12: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/12.jpg)
Mortality data - InternationalWHO Statistics Annuals
Country specific mortality among men aged 35-44 in 1994
CHD (ICD codes 410-414)
Australia, Canada, Chile, Finland, Greece, Mexico, Hong Kong, Hungary, Israel, Japan, Poland, Singapore, South Korea, Spain, Switzerland, Trinidad, and UK
![Page 13: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/13.jpg)
Ecological Analyses
• Sex-, state-, and race-specific mortality from cancer of lung and bronchus (age-adjusted data) - surrogate of cigarette smoking CDC Wonder
• State-, and race-specific data on percent of not-a-high-school graduate in the largest 25 states in 1992
Current Population Survey by Census Bureau
0
20
40
60
80
100
5.2 5.4 5.6 5.8 6 6.2 6.4
Total cholesterol (mmol/l)
Age
-sta
ndar
dize
d C
HD
mor
tali
ty i
n m
en
aged
35-
64 (
/100
,000
)
![Page 14: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/14.jpg)
•Background•Methods•Results
Very low CHD mortality among men aged 35-44 in several states in
the United States
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, USA
![Page 15: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/15.jpg)
CHD mortality (ICD 410-414, 429.2) among white men aged 35-44 in 1994 in the US by state (highest, middle, lowest)
0 10 20 30 40 50
KS
CO
TX
All
IL
KY
TN
![Page 16: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/16.jpg)
CHD mortality (/100,000)
>= 42 32 - 42 25 - 32 < 25
![Page 17: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/17.jpg)
CHD mortality (ICD 410-414, 429.2) among black men aged 35-44 in 1994 in the US by state (highest, middle, lowest)
0 20 40 60 80 100
NJ
CA
OH
All
TX
MO
MS
![Page 18: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/18.jpg)
CHD mortality (/100,000)
>= 42 32 - 42 25 - 32 < 25
![Page 19: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/19.jpg)
0 20 40 60 80 100
KS (W)
CO (W)
NJ (B)
CA (B)
KY (W)
TN (W)
MO (B)
MS (B)
![Page 20: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/20.jpg)
0 20 40 60 80 100
All
NJ
NY
PA
OH
IL
SC
MO
MS
WhiteBlack
![Page 21: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/21.jpg)
0 20 40 60 80 100
Japan
France
Australia
US white
Greece
Finland
US black
Poland
Hungary
![Page 22: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/22.jpg)
0 20 40 60 80 100
Japan
Whites in WA
France
Blacks in MD
Greece
Finland
Whites in TN
Poland
Blacks in MS
Hungary
![Page 23: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/23.jpg)
Why are there such differences in CHD mortality among men aged 35-44 in the
US by state and race?
Accuracy of diagnosis on death certificate
Quality of medical care
Differences in risk factors
![Page 24: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/24.jpg)
0
20
40
60
80
100
0 50 100 150 200 250 300
LC mortality
CH
D m
orta
lity
White
Black
![Page 25: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/25.jpg)
0
10
20
30
40
50
60
70
0 10 20 30 40 50
% of not high school graduate
CH
D m
orta
lity
White
Black
![Page 26: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/26.jpg)
Conclusions I
Differences in CHD mortality among black and white men aged 35-44 by state are as large as the differences observed between Poland and France,
one of the highest and the lowest in the mortality
from CHD around the world.Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, USA
![Page 27: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/27.jpg)
Conclusions II
The relatively strong correlation between CHD mortality and educational attainment as well as lung cancer mortality suggests that smoking and other CHD
risk factors are the potential candidates for the CHD mortality difference.
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, USA
![Page 28: Very low CHD mortality among men aged 35-44 in several states in the United States Akira Sekikawa, MD, PhD, PhD Lewis H Kuller, MD, DrPH Department of](https://reader036.vdocument.in/reader036/viewer/2022062805/5697bfe11a28abf838cb39a2/html5/thumbnails/28.jpg)
Conclusions III
If the differences are attributed to the variations in the distribution of traditional risk factors, the reduction of these risk factors could substantially reduce the mortality from CHD.
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, USA