Trends in the incidence and survival of patients with hospitalized myocardial infarction, Olmsted County, Minnesota, 1979 to 1994.
BACKGROUND
Evidence indicates that deaths from coronary disease are decreasing less in elderly persons and women. Understanding the determinants of these trends is important for prevention.


OBJECTIVE
To test the hypothesis that trends in incidence and survival of hospitalized myocardial infarction differ according to sex and age.


METHODS
Longitudinal observational study.


METHODS
Community-dwelling persons in Olmsted County, Minnesota.


METHODS
5117 patients who had an estimated 1820 incident myocardial infarctions from 1979 to 1994.


METHODS
Myocardial infarctions were validated by using epidemiologic criteria. Rates were directly adjusted to the age distribution of the 2000 U.S. population.


RESULTS
Of the 1820 incident infarctions, 44% occurred in women and 36% in persons 75 years of age or older. In 1979, the age-adjusted incidence of myocardial infarction was 205 per 100 000 persons (95% CI, 162 to 247 per 100 000 persons). Between 1979 and 1994, the age-adjusted incidence of myocardial infarction decreased by 8% (CI, -23% to 10%) in men but increased by 36% (CI, 9% to 70%) in women. A 31% decrease in the incidence of infarction over time was observed in men 40 years of age compared with a 49% increase in women 80 years of age. Survival improved predominantly in younger persons.


CONCLUSIONS
Over time, the incidence of hospitalized infarction decreased in men but increased in women and elderly persons. Survival benefits were clustered among younger persons. These results suggest that both incidence and survival contribute to the contrasting mortality trends by age and sex and that the burden of coronary disease has shifted toward elderly persons, a finding that has public health implications in an aging population.
Roger
Véronique L
VL
From the Mayo Clinic, Mayo Foundation, and Olmsted Medical Group, Rochester, Minnesota 55905, USA.
Jacobsen
Steven J
SJ
Weston
Susan A
SA
Goraya
Tauqir Y
TY
Killian
Jill
J
Reeder
Guy S
GS
Kottke
Thomas E
TE
Yawn
Barbara P
BP
Frye
Robert L
RL
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000401:mortality; D016012:Poisson Distribution; D017678:Sex Distribution