Decline In Heart Disease Death Began On Coasts
By DAVID WILLIAMSON
The strong decline in heart
disease death rates in the United
States, which has puzzled health
workers for the past decade,
began on the East and West
coasts and in the cities, scien
tists at the University of North
Carolina at Chapel Hill School of
Public Health have found.
Only after the declines in heart
disease mortality were well
established on the coasts and in
metropolitan area did they ex
tend to America's heartland, the
UNC research indicates.
"One thinks of fads and
fashions beginning in Northeast
ern states such as New York and
in Pacific states like California
and later spreading to more
isolated regions," said Dr. Steve
Wing, assistant research
professor of epidemiology.
"Apparently that's just what
happened when heart disease
death rates began to decline."
Wing is principal investigator
in a study that examined mor
tality records from 1968 to 1978
for 200 cities and 300 rural areas
across the country. The purpose
of the study, which will be
published in the American Jour
nal of Public Health this fall,
was to determine whether there
were geographic differences in
when heart disease mortality
began to fall.
Such information is important,
he said, because it may help
researchers pinpoint why the
nation's heart disease epidemic
is tapering off.
"Heart disease is still this
country's number one killer, ac
counting for more than half a
million deaths each year," Wing
said. "But for the nation as a
whole, rates have declined 30
percent since the early 1960's,
and in some areas, they have
dropped more than 50 percent."
Almost everyone who's in
terested in the topic, it
sometimes seems, has his own
theory about why deaths have
been reduced and wants to claim
credit, Wing said. And often, the
speculation reflects the in
terests of the people doing the
speculating.
"Exercise enthusiasts say it's
because people are jogging,
surgeons say it's heart surgery
and people who work on
coronary care units claim they
have had an impact," he said.
"Some epidemiologists say it's
because people are eating less
fat, while other say it's because
the percentage of smokers has
been reduced."
But the conclusions various
groups have reached aren't
necessarily correct, Wing said.
During the early part of the
20th century, for example, there
was a rapid drop in infectious
diseases that occurred at about
the time scientific medicine was
beginning to be practiced
widely. As a result, many people
attributed the drop in infectious
diseases to scientific medicine
with its germ theory, antibiotics
and other innovations.
"Subsequent research has
shown that the decline in infec
tious diseases preceded many of
the medical breakthroughs, and
can be attributed in large part to
general improvements in
housing, sanitation and nutri
tion," he said.
Wing and his colleagues
examined mortality data for
white men, ages 35 to 74, in 507
divisions of the continental U.S.
known as State Economic Areas.
That was because national
figures won't allow in-depth
examination of where trends
begin, and figures for smaller
area fluctuate too much each
year to be useful.
In addition, they could not look
at data before 1968 because of
major changes that year in how
heart disease mortality is re
corded.
The UNC researchers found
that two-thirds of the State
Economic Areas they examined
were experiencing a steady
decline in heart disease mor
tality for the entire 11-year
period. But in about a third,
chiefly the South, the South
Central, Mountain states and
rural areas, heart disease rates
tended to climb until the early
1970's before turning downward.
In 100 percent of New England
cities, where heart disease rates
traditionally have been high,
rates had begun falling by 1968.
By contrast, in the rural South,
where they also have been high,
only half of non-metropolitan
areas experienced the same
early decline.
"One of the things this paper
shows is that there turns out to
be a tremendous amount of
geographic variation in when the
drop in heart disease began,"
Wing said. "This is a piece of
evidence that will have to be ad
dressed by people who argue
that various treatments have
been responsible for the down
turn. Is it reasonable to assume,
for example, that there has been
so much variability by region in
what physicians do?"
The scientist said the pattern
appeared to him to resemble
patterns of cultural change
across the nation in such areas
as jobs, industry, education and
diet.
Co-authors of Wing's paper, all
members of the UNC School of
Public Health's epidemiology
department, are Dr. Carl Hayes,
Dr. Gerardo Heiss, Dr. Herman
A. Tyroler, Esther John and
Marilyn Knowles. Dr. Wilson
Riggan of the UNC Department
of Biostatistics also participated
in the research.
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