Circulation, Vol 89, 109-115, Copyright © 1994 by American Heart Association
S Baba, H Ozawa, Y Sakai, A Terao, M Konishi and K Tatara
BACKGROUND: By national statistics, Japanese ischemic heart disease (IHD)
mortality is one of the lowest of all industrialized countries, and the
proportion of deaths due to heart failure in heart disease is the highest.
There may be a difference in diagnostic preference between Japan and other
industrialized countries. METHODS AND RESULTS: IHD deaths according to the
death certificates were reevaluated with World Health Organization MONICA
criteria for those 25 to 74 years old by use of clinical and police records
in a Japanese city with a population of 347,000. Their cause of death was
given on the death certificates as IHD (International Classification of
Diseases [ICD], ninth revision, codes 410-414), heart failure (428), or
other heart diseases (393-405, 415-427, 429) in 1984 through 1986. Some
deaths in 1985 through 1986 from stroke (430-438) or other diseases (250,
272, 278, 440-448, 797- 799) were added. Of 409 subjects, 397 (97%) could
be examined. Reevaluation of the 106 deaths originally diagnosed as IHD
yielded 73 IHDs and 11 sudden deaths of unknown origin (SD), and
reevaluation of 160 deaths originally called heart failure yielded 26 IHDs
and 50 SDs. In total, reevaluation of all 397 deaths yielded 101 IHDs and
69 SDs. Some 88% of SD cases were originally certified as heart failure
(72%) or IHD (16%). Only two SDs were originally certified as stroke.
CONCLUSIONS: Assuming that 30% of SDs were due to IHD, the number of IHD
deaths would be 122, which is 11% larger than the number of IHD deaths
according to the death certificates. After reevaluation, the IHD mortality
in this study area still was the lowest in the industrialized countries.
ARTICLES
Heart disease deaths in a Japanese urban area evaluated by clinical and police records
Department of Preventive Medicine, Oita Medical College, Japan.
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