Deaths from coronary heart disease (cardiac infarcts) in Scotland, UK, fell between 1986 and 1995, probably due to a decrease of tobacco-smoking and a healthier diet, report Simon Capewell and colleagues from The Department of Public Health in Liverpool, UK, in this week’s issue of THE LANCET. Many people with heart attacks die before reaching hospital (83 365 in this study whereas 117 742 were admitted to hospital). Capewell and colleagues provide evidence that the reduction in out-of-hospital deaths from heart attacks is substantial, “Population-based out-of-hospital mortality rates fell by one third in women and one quarter in men” during the 10 years studied. Yet these figures disguise different outcomes for older people, “Yet even in 1995, only 40% of elderly people with infarcts survived to reach hospital, compared with 80% of men and women younger than 55 years.” Women and people from disadvantaged districts also had a lower decrease than expected in rates of heart attack.
Scotland, in common with many other European countries, has an accurate record-linkage system whereby deaths and the certified cause of deaths, district of residence (based in the UK on postcodes, typically encompassing 5000 people; postcode areas are assessed by a standard formula for an index of socio-economic deprivation), and hospital admissions and diagnosis can be assembled on a computer database. This allows comparisons in the incidence of many diseases over the years, and gives a measure of the effectiveness of prevention strategies. Such measures may give only an average estimate of what is happening within the population studied. Without a detailed breakdown of the information - as shown in this report - the fate of especially vulnerable groups may be missed.
The authors observe, “…at individual prevention levels, positive discrimination is needed, perhaps modelled on the interventions that have achieved impressive results in Finland and elsewhere.”
Contact : Dr Simon Capewell, Department of Public Health, University of Liverpool, Whelan building, Quadrangle, Liverpool L69 3GB, UK. T) +44 (0)151 794 5277; F) +44 (0)151 794 5588; E) capewell@liverpool.ac.uk
Journal
The Lancet