Geographic and socioeconomic variation in the onset of decline of coronary heart disease mortality in white women.
BACKGROUND
Regional, metropolitan, and socioeconomic factors related to the onset of decline of coronary heart disease (CHD) mortality among White women are reported. Such studies are important for planning population-level interventions.


METHODS
Mortality data for 1962 to 1978 were used, to estimate the year of onset of decline. Ecological analyses of socioeconomic data from the US census were used to emphasize structural and organizational aspects of changes in disease, rather than as a substitute for an individual-level design.


RESULTS
Onset of decline of CHD mortality among White women was estimated to have occurred by 1962 in 53% of 507 state economic areas (SEAs), ranging from 79% in the Northeast to 39% in the South. Metropolitan areas experienced earlier onset of decline than did nonmetropolitan areas. Average income, education, and occupational levels were highest in early onset areas and declined across onset categories.


CONCLUSIONS
The results provide additional evidence for previously observed geographic and social patterns of CHD decline. Emphasis on structural economic factors determining the shape of the CHD epidemic curve does not detract from the medical importance of risk factors, but underscores the importance of community development to public health improvements. The results are consistent with the idea that the course of the CHD epidemic in the United States has been strongly influenced by socioeconomic development.
Wing
S
S
Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill 27599-7400.
Barnett
E
E
Casper
M
M
Tyroler
H A
HA
D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000401:mortality* / Q000517:prevention & control; D004467:Economics / Q000639:trends; D004522:Educational Status; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007182:Income; D008875:Middle Aged; D009790:Occupations; D011634:Public Health / Q000592:standards; D012044:Regression Analysis; D012111:Residence Characteristics; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*