LETTERS TO THE EDITOR DC: US Department of Transportation, October 1989. 5. Solomon D: Accidents on Main Rural Highways Related to Speed, Driver, and Vehicle. Washington, DC: Govt Printing Office, 1964. 6. Baum HM, Wells JK, Lund AK: Motor vehicle crash fatalities in the second year of 55 mph speed limits. J Safety Research, (in press). Herbert M. Baum, PhD Adrian K. Lund, PhD JoAnn K. Wells, BS Insurance Institute for Highway Safety, 1005 N. Glebe Road, Arlington, VA 22201

C) 1990 American Journal of Public Health

The Onset of Decline in Ischemic Heart Disease in Italy A previous study of ischemic heart disease (IHD) in Italy from 1968 to 1978 showed an 8 percent decline among females as against a 17 percent rise among males. ' The period 1972-81 showed heart disease mortality beginning to fall-down 7% in males, 5% in females between 1978 and 1980.2 We have now updated these trends to 1984; as in previous work, analyses are based on ICD-8 Nos. 410-413 and ICD 9 Nos. 410-414, and on estimates of the resident population, published by the Central Institute of Statistics (ISTAT).3,4 Peak rates were reached in 1978 for males (131.2/100,000, world standard) and in 1977 for females (65.1/100,000). Since then, steady and substantial declines have been observed, to levels of 100.2 for males and 42.7 for females in 1984. The trends for truncated rates (limited to 35-64 years) were proportionally similar to the overall trends for both sexes (data not shown).

Table 1 gives the pattern of agespecific rates. In males, the percentage change was somewhat greater below age 59 than between 60 and 79 years, particularly in the 60-64 age group. Among females, declines were larger in absolute terms and relatively more consistent across subsequent age groups, although the smallest proportional fall was again observed in the 60 to 64 age group. This would indicate the importance of cohort effects in IHD mortality, since the age group showing the most unfavorable trends in the previous decade was between 50 and 59 years.' In absolute terms, the decline in cardiovascular disease mortality in Italy between 1978 and 1984 reflects the avoidance of about 20,000 deaths per year; 72,500 deaths were observed in 1984 as against about 95,000 expected on the basis of 1978 rates. These substantial changes in IHD mortality can be accounted for in part by changes in classification and coding of causes of deaths,5 since there was no modification of the ICD codes for ischemic heart disease between the 8th and the 9th Revisions of the ICD, and changes in rates were not restricted to the years around the change of ICD Revision (1979). Part of the trends, however, are probably artefactual, and due to the separation of cardiovascular disease, unspecified (9th ICD-No. 429.2), which accounted for 9,800 deaths in 1984 vs 7600 for all undefined heart disease (8th ICD, 429) in 1978. Further, coding procedures have been modified, since death certificates including myocardial infarction plus cancer, asthma or diabetes should now not preferentially be attributed to infarc-

tion. Even restricting the inference to acute myocardial infarction, however, the decline for males between 1978 and 1984 was still appreciable (from 75.0 to 66.2/100,000, world standard). The pattern of trends in cardiovascular disease in Italy thus appears similar to that observed in the United States,6 with a delay of 10 to 15 years,7 and its determinants should be sought, as in other industralized countries, in a complex of factors affecting incidence of the disease and its prognosis.2,6 REFERENCES 1. La Vecchia C, Decarli A: Trends in ischemic heart disease mortality in Italy, 1968-78. Am J Public Health 1986; 76:454-456. 2. Nicolosi A, Casati S, Taioli E, Polli E: Death from cardiovascular disease in Italy, 1972-81: Decline in mortality rates and possible causes. Int J Epidemiol 1988; 17:766-772. 3. ISTAT: Annuario di Statistiche Sanitarie. (various issues). Roma 196-1989. 4. ISTAT: Popolazione residente per sesso, eta e regione. Boll Mensile Statistica 1976; 10 (Suppl); 1978;29 (Suppl). 5. Klebba A, Scott JH: Estimates of selected comparability ratios based on dual coding of 1976 death certificates by the Eight and Ninth Revisions of the International Classification of Diseases. Mo Vital Stat Rep 1980; 28 (Suppl): 118. 6. Ragland KE, Selvin S, Merill DW: The onset of decline in ischemic heart disease mortality in the United States. Am J Epidemiol 1988; 127:516531. 7. Uemura K, Pisa Z: Trends in cardiovascular disease mortality in industrialized countries since 1950. WHO Stat Q 1988; 41:155-178. Carlo La Vecchia' 2 Eva Negri' Adriano Decarli3 1) Istituto di Ricerche Farmacologiche "Mario Negri," Via Eritrea, 62-20157 Milan, Italy. 2) Institute of Social and Preventive Medicine, Bugnon 17-1005 Lausanne, Switzerland. 3) Istituto di Biometria e Statistica Medica, Universita di Milano, 20133-Milan, Italy.

© 1990 American Journal of Public Health

TABLE 1-Age-specific Death Certification Rates per 100,000 Males and Females from all lschemic Heart Disease, Italy, 1977-84

Females

Males Percent

Age Group

Percent

(years)

1977-78

1979-80

1981-82

1983-84

change

1977-78

30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 280

9.9 19.1 43.8 91.9 173.8 285.0 410.2 624.9 963.2 1527.9 3068.8

7.8 18.3 38.3 80.1 159.8 263.8 397.9 591.3 877.8 1318.8 2640.1

6.8 16.5 37.1 72.7 142.5 244.8 373.2 549.1 820.3 1220.5 2261.1

7.1 15.7 33.9 67.8 131.2 227.2 375.6 518.0 818.3 1249.1 2251.1

-28.3 -17.8 -22.6 -26.2 -24.5 -20.3 -8.4 -17.1 -15.0 -18.2 -26.6

2.2 3.3 7.0 14.1 28.2 59.7 118.4 244.3 499.1 993.6 2695.1

130.9

118.4

107.9

105.4

-19.5

64.5

Age-adjusted, all ages (World Standard)

502

1981-82

1983-84

change

24.4 50.7 107.4 207.2 431.8 836.6 2270.4

1.2 2.4 5.5 11.3 22.8 45.1 93.4 187.0 379.6 740.1 1862.8

1.1 1.9 4.5 10.6 21.0 43.5 94.0 176.9 361.5 709.7 1865.3

-50.0 -42.4 -35.7 -24.8 -25.5 -27.1 -20.6 -27.6 -27.6 -28.6 -30.8

55.0

47.2

46.0

-28.7

1979-80 1.5 2.5 6.3 13.6

AJPH April 1990, Vol. 80, No.4

The onset of decline in ischemic heart disease in Italy.

LETTERS TO THE EDITOR DC: US Department of Transportation, October 1989. 5. Solomon D: Accidents on Main Rural Highways Related to Speed, Driver, and...
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