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. 2011 Sep 6:343:d5170.
doi: 10.1136/bmj.d5170.

Ageing, menopause, and ischaemic heart disease mortality in England, Wales, and the United States: modelling study of national mortality data

Dhananjay Vaidya  1 , Diane M Becker, Vera Bittner, Rasika A Mathias, Pamela Ouyang
Affiliations

Ageing, menopause, and ischaemic heart disease mortality in England, Wales, and the United States: modelling study of national mortality data

Dhananjay Vaidya et al. BMJ. .

Abstract

Objectives: To use changes in heart disease mortality rates with age to investigate the plausibility of attributing women's lower heart disease mortality than men to the protective effects of premenopausal sex hormones.

Design: Modelling study of longitudinal mortality data with models assuming (i) a linear association between mortality rates and age (absolute mortality) or (ii) a logarithmic association (proportional mortality). We fitted models to age and sex specific mortality rates in the census years 1950 to 2000 for three birth cohorts (1916-25, 1926-35, and 1936-45).

Data sources: UK Office for National Statistics and the US National Center for Health Statistics. Main outcome measure(s) Fit of models to data for England and Wales and for the US.

Results: For England-Wales data, proportional increases in ischaemic heart disease mortality fitted the data better than absolute increases (improvement in deviance statistics: women, 58 logarithmic units; men, 37). We identified a deceleration in male mortality after age 45 years (decreasing from 30.3% to 5.2% per age-year, P = 0.042), although the corresponding difference in women was non-significant (P = 0.43, overall trend 7.9% per age-year, P<0.001). By contrast, female breast cancer mortality decelerated significantly after age 45 years (decreasing from 19.3% to 2.6% per age-year, P<0.001). We found similar results in US data.

Conclusions: Proportional age related changes in ischaemic heart disease mortality, suggesting a loss of reparative reserve, fit longitudinal mortality data from England, Wales, and the United States better than absolute age related changes in mortality. Acceleration in male heart disease mortality at younger ages could explain sex differences rather than any menopausal changes in women.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Ischaemic heart disease mortality in England and Wales by age plotted on absolute scale (top panels) and on logarithmic scale (bottom panels)
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Fig 2 Total heart disease mortality in the United States by age plotted on absolute scale (top panels) and on logarithmic scale (bottom panels)
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Fig 3 Female breast cancer mortality in England and Wales and the United States plotted on absolute scale (top panels) and on logarithmic scale (bottom panels)
See this image and copyright information in PMC

Comment in

References

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