Trends in age-specific and age-standardized death certification rates from all ischaemic heart disease and cerebrovascular disease in Switzerland have been analysed for the period 1969-87, i.e. since the introduction of the Eighth Revision of the International Classification of Diseases for coding causes of death. For coronary heart disease, overall age-standardized rates of males in the mid-late 1980's were similar to those in the late 1960's, although some upward trend was evident up to the mid 1970's (with a peak rate of 120.4/100 00, World standard, in 1978) followed by steady declines in more recent years (103.8/100 000 in 1987). These falls were larger in truncated (35 to 64 years) rates. For females, overall age-standardized rates were stable around a value of 40/100 000, while truncated rates tended to decrease, particularly over most recent years, with an overall decline of over 25%. Examination of age-specific trends showed that in both sexes declines at younger ages were already evident in the earlier calendar period, while above age 50 some fall became evident only in most recent years. Thus, in a formal log-linear age/period/cohort model, both a period and a cohort component emerged. In relation to cerebrovascular diseases, the overall declines were around 40% in males (from 67.4 to 41.2/ 100 000, World standard) and 45% for females (from 56.6 to 31.7/100 000), and were proportionally comparable across subsequent age groups above age 45. The estimates for the age/period/cohort model were thus downwards both for the period and the cohort component although, in such a situation, it is difficult to disentangle the major underlying component. These persistent declines in stroke mortality are remarkable, since certified mortality is now lower in Switzerland than in any other industrialized country, and correspond to the avoidance of over 4000 deaths per year, as compared with the rates of the late 1960's or early 1970's. The recent falls in ischaemic heart disease mortality are similar to those observed in several other western European countries with a 10 to 15 year delay in comparison with the USA, and are of major public health relevance, too, since they correspond to the avoidance of about 1300 deaths per year.
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health