Why heart disease mortality is low in France. Authors' hypothesis is wrong.
Year: 1999
Type: article
Abstract: Editor—We agree with Law and Wald that one must consider the cohort effect—the time lag—in investigating the association of levels of risk factors with mortality from coronary heart disease.1 Analysis of mortality from coronary heart disease in birth cohorts since the second world war is therefore important.
We evaluated mortality from coronary heart disease in the United States, Japan, South Korea, and other countries, as well as within the United States by state, for men aged 35-44. We found that the very low mortality from coronary heart disease in Japan (5.5/100 000, compared with 11.4/100 000 in South Korea and 26.4/100 000 among American white men in 1992) might be an artefact.
A substantial proportion of mortality from coronary heart disease among men aged 35-44 may be miscoded as heart failure (ICD-9, code 428) because in Japan more than 60%of mortality from diseases of the heart (codes 390-429) was coded as heart failure. This proportion is usually very low in this age group—1% among American white men. If half the mortality from heart disease was due to coronary heart disease in Japan there would be only a twofold difference in mortality from coronary heart disease between the United States and Japan: 26.4/100 000 among American white men versus 13.5/100 000 among Japanese men in 1992.
In some states in the United States we found that mortality from coronary heart disease among white men aged 35-44 is similar to that in France (14.7/100 000): 13.8/100 000 in Washington, 14.7/100 000 in Connecticut, 15.4/100 000 in Kansas, 16.4/100 000 in Colorado, and 17.1/100 000 in California. The low rates in these states are not due to heavy alcohol consumption compared with that in other states; rather, they are strongly related to educational attainments of the population and the prevalence of cigarette smoking and perhaps other risk factors.
Studies of recent birth cohorts by country provide better evaluation of causes of death and measurements of atherosclerosis. Focusing on smaller geographic areas as opposed to whole countries may improve understanding of geographic variation in mortality from coronary heart disease. Alcohol may be an important attribute for a lower rate of coronary heart disease in France but is not necessarily the only key factor.
Atherosclerosis has a long incubation period. Diet measured 30 years before reported death may better predict the extent of atherosclerosis and mortality from coronary heart disease.
Source: PubMed Central
Authors: A Sekikawa, L H Kuller
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W135770951