Declining coronary heart disease mortality in Iceland: contribution by incidence, recurrence and case fatality rate.
OBJECTIVE
To analyse to what extent the recent decline in coronary heart disease mortality in Iceland is due to changes in incidence, recurrence and case fatality rates.


METHODS
A countrywide registration of myocardial infarction (MI) in people aged 25-74 was performed in Iceland during 1981-1999 according to the MONICA protocol. Possible cases were found by review of all hospital discharge records, autopsy records and death certificates.


RESULTS
MI death rate declined by 63% in males and 51% in females, most in the youngest age groups in men (86%) and least in the oldest (49%). In women there was not a significant difference in age groups. Overall the age-adjusted reduction in MI death rate was 55.4% in both sexes combined; of this 23.1% was due to incidence reduction, 22.8% to recurrence reduction and 11.6% to case fatality reduction. In the youngest age groups the decline in incidence contributed most to the decline in MI death rate (62% in men and 71% in women), but thereafter the decline in case fatality in men. In the older age groups decline in recurrence rate has greater weight.


CONCLUSIONS
The recent decline in MI mortality under the age of 75 years in Iceland is due to reduction in incidence and recurrence rate by about 40% each and to reduction in case fatality by 20%.
Sigfusson
Nikulas
N
Icelandic Heart Association, Reykjavik, Iceland.
Sigurdsson
Gunnar
G
Agnarsson
Uggi
U
Gudmundsdottir
Inga Ingibjörg
II
Stefansdottir
Ingibjörg
I
Sigvaldason
Helgi
H
Gudnason
Vilmundur
V
D000328:Adult; D000368:Aged; D003196:Computer Graphics; D003327:Coronary Disease / Q000401:mortality*; D005260:Female; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D010865:Pilot Projects; D012008:Recurrence; D012044:Regression Analysis; D012189:Retrospective Studies; D015996:Survival Rate