title: Trends in prevalence, incidence and mortality of diagnosed and silent coronary heart disease in Quebec.
abstract: BACKGROUND
  Of all cardiovascular causes of mortality, coronary heart disease (CHD) remains the leading cause of death. Our objectives were to establish trends in the prevalence and incidence of CHD in the province of Quebec, and to determine the proportion of CHD mortality that had no previous CHD diagnosis.
  
  
  METHODS
  Trends in prevalence, incidence and mortality were examined with a population-based study using the Quebec Integrated Chronic Disease Surveillance System, which links several health administrative databases. Data are presented using two case definitions for Quebecers aged 20 years and over: 1) a validated definition, and 2) CHD causes of death codes added to estimate the proportion of deaths that occurred without any previous CHD diagnosis as a proxy for sudden cardiac death (SCD).
  
  
  RESULTS
  In 2012/2013, the crude prevalence of CHD was 9.4% with the first definition (593 000 people). Between 2000/2001 and 2012/2013, the age-standardized prevalence increased by 14%, although it has been decreasing slightly since 2009/2010. Age-standardized incidence and mortality rates decreased by 46% and 26% respectively, and represented a crude rate of 6.9 per 1000 and 5.2% in 2012/2013. The proportion identified only by CHD mortality, our SCD proxy, was only significant for the incident cases (0.38 per 1000 in 2009/2010) and declined over the study period.
  
  
  CONCLUSIONS
  The prevalence of CHD has tended to decrease in recent years, and incidence and mortality have been declining in Quebec. Most CHD mortality occurs in previously diagnosed patients and only a small proportion of incident cases were not previously identified.
authors.affiliation: Institut national de santé publique du Québec, Québec, Quebec, Canada.|Faculté de pharmacie, Université Laval, Québec, Quebec, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Blais
authors.affiliation: Institut national de santé publique du Québec, Québec, Quebec, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Rochette
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000453:epidemiology; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002423:Cause of Death; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D011792:Quebec / Q000453:epidemiology; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis
keywords: coronary heart disease; epidemiology; incidence; sudden cardiac death; trends