title: Age, Period, and Cohort Effects on Mortality From Ischemic Heart Disease in Southern Spain.
abstract: OBJECTIVE
  Ischemic heart disease is the leading cause of death and one of the top 4 causes of burden of disease worldwide. The aim of this study was to evaluate age-period-cohort effects on mortality from ischemic heart disease in Andalusia (southern Spain) and in each of its 8 provinces during the period 1981-2008.
  
  
  METHODS
  A population-based ecological study was conducted. In all, 145 539 deaths from ischemic heart disease were analyzed for individuals aged between 30 and 84 years who died in Andalusia in the study period. A nonlinear regression model was estimated for each sex and geographical area using spline functions.
  
  
  RESULTS
  There was an upward trend in male and female mortality rate by age from the age of 30 years. The risk of death for men and women showed a downward trend for cohorts born after 1920, decreasing after 1960 with a steep slope among men. Analysis of the period effect showed that male and female death risk first remained steady from 1981 to 1990 and then increased between 1990 and 2000, only to decrease again until 2008.
  
  
  CONCLUSIONS
  There were similar age-period-cohort effects on mortality in all the provinces of Andalusia and for Andalusia as a whole. If the observed cohort and period effects persist, male and female mortality from ischemic heart disease will continue to decline.
authors.affiliation: Escuela Andaluza de Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria de Granada, Granada, Spain. Electronic address: ricardo.ocana.easp@juntadeandalucia.es.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Ocaña-Riola
authors.affiliation: Servicio de Epidemiología y Salud Laboral, Consejería de Salud de la Junta de Andalucía, Seville, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Mayoral-Cortés
authors.affiliation: Escuela Andaluza de Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria de Granada, Granada, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Fernández-Ajuria
authors.affiliation: Escuela Andaluza de Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria de Granada, Granada, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Sánchez-Cantalejo
authors.affiliation: Escuela Andaluza de Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria de Granada, Granada, Spain.
authors.forename: Piedad
authors.initials: P
authors.lastname: Martín-Olmedo
authors.affiliation: Departamento de Farmacología, Facultad de Medicina, Universidad de Málaga, Malaga, Spain.
authors.forename: Encarnación
authors.initials: E
authors.lastname: Blanco-Reina
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality*; D011159:Population Surveillance / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: Age-period-cohort models; Andalucía; Andalusia; Enfermedad isquémica del corazón; Funciones spline; Ischemic heart disease; Modelos edad-periodo-cohorte; Mortalidad; Mortality; Poisson regression; Regresión de Poisson; Spline functions