title: Population-based analysis of the effect of the Northridge Earthquake on cardiac death in Los Angeles County, California.
abstract: OBJECTIVE
  We sought to determine whether a natural disaster affected total cardiovascular mortality and coronary mortality in an entire population.
  
  
  BACKGROUND
  The effect of the January 17, 1994 Northridge Earthquake (NEQ) on all deaths and causes of deaths within the entire population of Los Angeles County is unknown. The purposes of our study were to analyze all deaths in this entire population before, during and after the NEQ and to determine whether the NEQ temporally and spatially altered death due to cardiovascular disease.
  
  
  METHODS
  We analyzed all death certificate data (n = 19,617) from Los Angeles County during January of 1992, 1993 (control periods) and 1994, using International Classification of Diseases, 9th Revision codes for ischemic heart disease (IHD) and atherosclerotic cardiovascular disease (ASCVD), as well as other causes of death.
  
  
  RESULTS
  There was an average of 73 deaths per day due to IHD and ASCVD during January 1 to 16, 1994; this increased to 125 on the day of the NEQ, and then decreased to 57 deaths per day from January 18 to 31 (p < 0.00001, before NEQ vs. day of NEQ; after NEQ vs. day of NEQ; and before NEQ vs. after NEQ). The NEQ was associated with an increase in deaths due to myocardial infarction and trauma but not cardiomyopathy, hypertensive heart disease, valvular heart disease, cerebrovascular disease or noncardiovascular causes. Based on plots of daily deaths due to IHD and ASCVD, the decrease in deaths during the 14 days after the NEQ (-144) overcompensated for the increase on the day of the NEQ (+55). Geographic analysis revealed a redistribution of deaths due to IHD and ASCVD toward the epicenter on the day of the NEQ.
  
  
  CONCLUSIONS
  When an entire population simultaneously experiences a major environmental stress, there is an increase in death due to coronary artery disease (but not other cardiac causes), followed by a decrease that overcompensates for the excess of death. The overcompensation may represent a residual population that is more resistant to stress or a possible preconditioning effect of the stress, or both. This study supports the concept that cardiovascular events within an entire population can be triggered by a shared stress.
authors.affiliation: Heart Institute, Good Samaritan Hospital, University of Southern California, Los Angeles 90017, USA. rkloner@goodsam.org
authors.forename: R A
authors.initials: RA
authors.lastname: Kloner
authors.forename: J
authors.initials: J
authors.lastname: Leor
authors.forename: W K
authors.initials: WK
authors.lastname: Poole
authors.forename: R
authors.initials: R
authors.lastname: Perritt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D009202:Cardiomyopathies / Q000401:mortality; D002318:Cardiovascular Diseases / Q000401:mortality*; D002561:Cerebrovascular Disorders / Q000401:mortality; D004190:Disasters; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality; D006801:Humans; D006973:Hypertension / Q000401:mortality; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality; D012189:Retrospective Studies; D013312:Stress, Physiological / Q000401:mortality