RC " 667 ' D5 1993 ' P‘UBL “ snvz 4r" 95:2 (I4. \ 0° 1 9 i7 "o ‘3 Whale . ISCHEMIC - HEflRT DISEASE 1980-1989 US. DEPARTMENT OF HEALTH 8- HUMAN SERVICES Public Health Service . Centers for Prseese Control ancl Prevention . ceannsFon DISEASECONTROL National Center for Chronic Disease Prevention and Health Promotion AND PREVENTION ,. 7 ii: a. 6w. Cardiovascular Disease Surveillance Ischemic Heart Disease, 1980-1989 Division of Chronic Disease Control and Community Intervention 1993 US. DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC HEALTH SERVICE Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion Atlanta, Georgia 30333 CAT. F0}; . - w A H T L A E H C 1 L B U P Foreword As the Nation’s prevention agency, the Centers for Disease Control and Prevention (CDC) is committed to reducing the major causes of preventable death and disability. Heart disease is the leading cause of death in the United States; ischemic heart disease (IHD) accounts for the major portion of these deaths. IHD kills nearly 500,000 Americans each year--more than all forms of cancer, the second leading cause of death. The major risk factors for IHD are known and preventable. Therefore, we could alleviate much of this heavy burden through concerted public health action. This surveillance report is the first in a series of reports on cardiovascular disease topics. It summarizes state-specific information on mortality, hospitalizations, and incidence and prevalence of IHD derived from nationally representative datasets from the National Center for Health Statistics, CDC. These data are an important resource for program planning at the state and national level. The compilation of these data in one publication will facilitate usage by state and local health departments and other organizations working to reduce the burden of IHD. I am pleased to share this report with you and encourage your use of these data to broaden the impact of public health efforts to prevent death and disability from IHD. William L. Roper, ., M.P.H. Director Centers for Disease Control and Prevention Acknowledgments Contributors Robert F. Anda Michele L. Casper Frank DeStefano Ralph S. Donehoo Barbara L. Dougherty Douglas E. Ferguson John R. Livengood Robert K. Merritt Russell H. Roegner Marjorie A. Speers Secretarial Support Rebecca J. Grimsley Donna D. Nicholson Requests for copies of this report should be forwarded to: Centers for Disease Control and Prevention Attn: Division of Chronic Disease Control and Community Intervention, K45 Center for Chronic Disease Prevention and Health Promotion Atlanta, Georgia 30333 Suggested Citation Centers for Disease Control and Prevention: Cardiovascular Disease Surveillance, Ischemic Heart Disease, 1980-1989 Issued 1993 Centers for Disease Control William L. Roper, M.D., MPH, and Prevention Director National Center for Jeffrey P. Koplan, M.D., M.P.H., Chronic Disease Prevention Director and Health Promotion Division of Chronic Disease Control Marjorie A. Speers, Ph.D., and Community Intervention Director Cardiovascular Health Studies John R. Livengood, M.D.,M.Phil., Branch Acting Chief Cardiovascular Epidemiology and Robert F. Anda, M.D., M.S., Surveillance Section Chief Statistics Branch Russell H. Roegner, Ph.D., Chief ”my ’ Table of Contents 1. Mortality ........................................................................................................ 1 Introduction ................................................................................................. 1 Data Sources and Methods .......................................................................... 2 Results ......................................................................................................... 3 Discussion ................................................................................................... 9 Mortality Tables ........................................................................................... 13 2. Hospitalizations ............................................................................................ 19 Introduction ................................................................................................ 19 Methods ...................................................................................................... 19 Results ........................................................................................................ 20 Discussion .................................................................................................. 27 Hospitalizations Tables ................................................................................. 31 3. Prevalence and Incidence of Nonfatal Ischemic Heart Disease ................... 39 Introduction ................................................................................................ 39 Methods ...................................................................................................... 39 Results ........................................................................................................ 40 Discussion .................................................................................................. 43 Prevalence and Incidence of Nonfatal Ischemic Heart Disease Tables ....... 49 Chapter 1. Introduction In the United States ischemic heart dis— ease (IHD) claims more lives per year than any other cause of death. In 1989, the most recent year for which mortality data have been pub— lished, 498,021 people died from IHD. Among 27 industrialized countries, in 1980 the United States ranked tenth for IHD mortality among men and ninth among women (Figure 1.1). Although the rates for IHD mortality are higher than the rates for other causes of death in the United States, substantial declines in IHD mortality have occurred at the national level Mortality since the mid—1960s. The decline was approxi- mately 2% per year from the mid—19608 to the mid-19708, 4% per year until 1979, and 3% per year from 1980 to 1988.2’3 Declines in IHD mortality rates have been observed for all race-sex groups; however, im— portant sociodemographic differences for IHD mortality and the rate of decline still exist. This chapter presents US. data on the trends in IHD mortality from 1980 to 1988 for men and women, blacks and whites, selected age groups, regions of the country, and states. Women Men Scotland N. Ireland N. Ireland Finland New Zealand Scotland Ireland Ireland England & Wales England & Wales Hungary New Zealand Australia Czechoslavakia Czechoslovakia Austrailia United States Hungary Israel United States Finland Denmark Canada Canada Denmark Norway Bulgaria Sweden Romania Netherlands Sweden Germany Norway Israel Austria Austria Netherlands Poland Germany Bulgaria Belgium Belgium Yugoslavia Switzerland Poland Italy Italy Romania Switzerland Yugoslavia France France I 1 1 Japan. . 1 . l . l I . 1 . l . l . l . l Japan 0 100 200 300 400 500 600 0 100 200 300 400 500 600 Rate per 100,000 Rate per 100,000 Figure 1.1 Age-adjusted IHD Mortality Rates, Ages 40-69, for Selected Industrialized Countries, by Sex, 1980 lschemic Heart Disease Surveillance Data Sources and Methods We abstracted the numbers of deaths at- tributed to IHD from the vital statistics files maintained by the National Center for Health Statistics, Centers for Disease Control and Pre- vention. IHD deaths were defined as those deaths for which the underlying cause of death on the death certificate was coded as 410—414 according to the International Classification of Diseases (1CD), 9th revision. The underlying cause, defined as the disease or injury that initi- ated the sequence of events leading directly to death, is selected from the conditions entered by a physician in the cause—of—death section of the death certificate. When more than one cause or condition is entered by the physician, the underlying cause is determined by the se— quence of conditions on the certificate, provi- sions of the ICD, and associated selection rules. We obtained 1980 census estimates of the population, and intercensal estimates for the subsequent years, from the Bureau of the Cen— sus. These population estimates were used to calculate annual IHD mortality rates. Crude IHD mortality rates were calculated for persons ages 35 and above, along with age— specific rates using 10 year age groups. We also calculated directly age-adjusted rates with the 1980 United States population as the standard. Age—adjusted mortality rates indicate what the level of mortality would be if there were no changes in the age distribution of the population from year to year. Therefore, they are better indicators than the unadjusted mortality death rates for showing trends in the risk of death over a period of time when the age distribution is changing. They are also more appropriate to use when comparing mortality rates among sub- groups of the population that have different age distributions. Unadjusted death rates (crude rates) on the other hand, reflect the actual public health burden from IHD in a community, and are appropriate to use for public health plan— ning, policy making, and resource allocation. We measured the temporal change in IHD mortality as both the absolute change and the percent change. We calculated the average an- nual absolute change in IHD mortality by sub— tracting the 1988 rate from the 1980 rate and dividing by eight. The average annual percent change was calculated by applying a log linear model to the rates for the years 1980—1988. The absolute change provides information on the changing public health burden of IHD mortality; however, its ability to compare groups with large differences in baseline (1980) IHD mortality rates is limited. The average annual percent change, on the other hand, indi- cates the rate at which IHD mortality is chang— ing, regardless of the starting level, and is useful for comparing change among groups with sub— stantial differences in baseline levels of IHD mortality. Our comparison of IHD mortality rates among sociodemographic groups provides valuable information for identifying and under- standing the secular trends in IHD mortality. However, the rates vary somewhat depending on both the accuracy of medical diagnosis and the accuracy in assigning cause of death.5' Systematic variation in the accuracy of death certificate data or the changing accuracy of such data among the sociodemographic groups could result in biased comparisons of trends in IHD mortality. To date, however, no studies have documented systematic variation among socio— demographic groups for either reason. lschemic Heart Disease Surveillance Results Variation in IHD Mortality Although IHD is the leading cause of death* (see endnote, page 10) for both blacks and whites, and for men and women, IHD mor— tality varies substantially among subgroups of the United States population. Therefore, we examined variations in IHD mortality by age group, race—sex group, region, and state. IHD mortality rates increased exponen— tially with each 10—year age group (Table 1.1). In 1988, the rate among the youngest age group (ages 35—44) was 19.4 per 100,000 whereas the rate among the oldest age group (ages 85 and older) was 4647.8 per 100,000 (Table 1.1, Sum- mary Table A). The pattern of increasing IHD mortality with increasing age occurred for blacks and whites, and for men and women (Tables 1.2—1.5). Men continued to have higher rates of IHD mortality than women (Figure 1.2). In 1988, the rate for black men (529.2 per 100,000) was 1.4 times higher than the rate for black women (365.8 per 100,000), and the rate for white men (612.7 per 100,000) was 1.8 times higher than the rate for white women (337.6 per 100,000) (Tables 1.2—1.5, Summary Table A). White men had higher IHD mortality rates than did black men. However, among women, there was very little racial variation in IHD mortality (Figure 1.2). A clear pattern of IHD mortality was evi- dent among the four regions of the United States (Figure 1.3). The Northeast consistently had the highest rates, followed by the Midwest and the South, and the lowest rates were in the West. Throughout the period 1980—1988, there was never any crossover in the ranking of the re— gions. In 1988, the rate in the Northeast (500.5 per 100,000) was 1.3 times higher than the rate in the West (391.6 per 100,000) (Summary Table A). The same regional patterns of IHD mortality were observed for men and women separately (Figures 1.4—1.5). Among the states, the crude IHD mortality rates in 1988 ranged from 170 per 100,000 (Alaska) to 614 per 100,000 (New York) (Table 1.6). Much of the variation in the crude mor— tality rates was due to the different age distribu- tions among the states. Because the rate of mortality increases with age, the states with 1,000. . . . 800 _ ‘\ , Figure 1.2 Trends in Age—adjusted o k \0- ‘ IHD Mortality, Ages 35 § 600_ ‘°~ ~ _ . ‘ ._ ‘K h , and Older, by Race and 9 —" Sex, United States, 1980— a White Men 1988 3 40°- _' E White Women E: o ----------------------- o 200 _ Black Men Black Women .——-——0 0 80 lschemic Heart Disease Surveillance 81 82 83 84 85 86 87 88 Year 1,000 . 800. . . . . é \IN Figure 1.3 Trends 1n Age-adjusted IHD Mortality o- 600. * --------- . ,,,,,,,,, . IIIIII T‘ ''' . N Rates, Ages 35 and Older, by Region, g '— T" w _ . 1:”1: ------ 7:? mm: Northeast Unlted States, 1980-1988 :1 400_ ‘0 — - — 0 mes: ., . ............. . g South *- —o 200- West H 0 80 81 82 83 84 85 86 87 88 Year 1,000. 800. O . . . . 8 600 Figure 1.4 Trends 1n Age-adjusted IHD Mortality g - Rates Among Women, Ages 35 and v- '\ ,_. . . B o ....... —° "°‘ Older, by Reglon, Umted States, 1980- o. 400. ._ : --------- o --------- w ........ . ,,,,, T: 1‘ . Northeast —- _ _ ............. h— ....... .__ _. 1988 :5; " ‘ “'- —-— - — 1 _: Midwest .— —0 West .——--0 0 80 81 82 83 84 85 86 87 88 Year 1.000l 800. O 8 Figure 1.5 Trends in Age-adjusted IHD Mortality 8“ 500_ Rates Among Men, Ages 35 and Older, I by Region, United States, 1980—1988 3 a) 400. °— ‘4 5 West m 0—. 200. O 80 81 82 83 84 85 86 87 88 Year lschemic Heart Disease Surveillance Figure 1.6 Quartiles of 1988 IHD Mortality by Figure 1.7 Quartiles of 1988 IHD Mortality by higher proportions of older people are more likely to have higher crude mortality rates. After we adjusted for the different age dis- tributions among the states, we found there was still substantial variation in IHD mortality rates (Table 1.7). In 1988, the average age-adjusted IHD mortality rate among states in the lowest quartile was 324.5 per 100,000 (with a range of 248.4 to 373.8 per 100,000), whereas the aver— age rate among the highest quartile was 500.4 per 100,000 (with a range of 468.6 to 584.0 per 100,000). A map of the state-specific mortality rates in 1988, by quartile, indicates that the highest rates occurred predominantly in the northeastern and midwestem states, with some State, Age-adjusted Rates, Ages 35 and Older, United States State, Age-adjusted Rates, Ages 35 and Older, Women, United States lschemic Heart Disease Surveillance high rate states in the South (Figure 1.6). The western states experienced lower rates than those found for the rest of the country. Separate maps of the geographic variation in IHD mortality for men and women indicate that states with the highest IHD mortality rates for women also tended to have the highest IHD mortality rates for men (Figures 1.7-1.8). The large Spearman correlation coefficient between state—specific rates for women and men (0.93) indicates that the rank order of states by IHD mortality was very similar for women and men. This suggests that similar factors may influence the state—to-state variation in IHD mortality for women and men. p ”D 248.4-373.8 4165-4682 {> 3743-4136 I 468.6-584.0 ., 4:. [31340-2533 I31o.2~341.1 " E 2703-3083 I 3453-4626 Figure 1.8 Quartiles of 1988 IHD Mortality by State, Age-adjusted Rates, Ages 35 and Older, Men, United States Variation in IHD Mortality Declines Deaths from IHD among people above the age of 35 decreased from 564,250 in 1980 to 508,195 in 1988. (Figure 1.9, Table 1.1). The age-adjusted IHD mortality rate declined 24% during this period from 588.3 per 100,000 in 1980 to 448.8 per 100,000 (Figure 1.10, Table 1.1). During the years 1980 through 1988, IHD mortality rates declined for each of the age groups, race—sex groups, regions, and states in— cluded in this report. However, some groups had faster declines than others. Among the age groups, the younger ages experienced the fastest rate of decline (as meas— ured in percent change) (Summary Table A). The largest absolute declines, on the other hand, occurred among the older age groups. Among the four race—sex groups, the fastest rate of decline occurred among white men (av- erage 3.7% per year), and the slowest decline occurred among black women (average 2.2% per year) (Summary Table A). The average annual rates of decline for black men (3.1%) and for white women (2.9%) were very similar. Among the four regions, the fastest rate of decline was in the Northeast (an average 3.9% per year) (Summary Table A). The rates of decline per year for the other regions were 3.2% for the Midwest, 3.1% for the West, and 2.9% per year for the South. Despite the large variation in level of IHD mortality among the states, all states experi— ¥§ " ‘ El 3164-5026 35614-6306 {:5 5043-5669 I 6339-7551 enced declines in IHD mortality from 1980 to 1988 (Table 1.7). The average rate of decline among the states was 3.5% per year, with some states experiencing declines as large as 5% per year while other states experienced declines as small as 1.5% per year. The fastest rates of declining IHD mor— tality did not occur among states in the highest quartile of IHD mortality. As figure 1.11 indi— cates, when the states are grouped into quartiles based upon the level of IHD mortality in 1980, the rate of decline (3.9%) as measured by the average annual percent change among the states with the lowest level of IHD mortality was similar to the rate of decline (3.5%) in the states in the highest quartile The pattern for absolute change is different. States in the highest quar— tile of 1980 rates did experience larger absolute declines in IHD mortality than the other quar— tiles. This is partially to be expected since, mathematically, larger absolute declines can occur among states with higher 1980 baseline levels of IHD mortality than among states with lower baseline levels. Although the patterns in absolute change indicate that those states with the heaviest burden of IHD mortality have ex- perienced the largest decrease in numbers of death from IHD per 100,000, the patterns in percent change indicate that states with highest levels of IHD have not experienced a greater rate of decline than states with lower levels of IHD mortality. lschemic Heart Disease Surveillance Number of Deaths with Ischemic Heart Disease as Underlying Cause of Death, Ages 35 and Older, by Year, 1980-I988 Figure 1.9 Figure 1.10 Age—adjusted Mortality Rates per 100,000 Population for Ischemic Heart Disease, Ages 35 and Older, by Year, 1980-1988 Figure 1.11 Comparison of Absolute Change and Percent Change in IHD Mortality, 1980-1988, by Quartile of 1980 IHD Mortality Rate for States lschemic Heart Disease Surveillance Rate per 100,000 600. A500. 0 O O. 2400. (I) .C ‘u‘: 300. 0) o 3 200. CD .0 E 2100. 0. 80 81 82 83 84 85 86 87 88 Year 1,000. 800- 600- \N 400. 200. 0 80 81 82 83 84 85 86 87 88 Year Quartiles 0 1 2 3 4 a, '5 - -3.9 -3.7 "3‘2 '35 U) C m c l- O ‘3 -1o - C C < 0) U, S E '15 ' '13-8 44.3 “14-0 I Percent -20 1:] Absolute -18.3 Summary Table A IHD Mortality Rates per 100,000 and Change in IHD Mortality, by Sociodemographic Group, United States, 1980—1988 Average Annual Change in IHD Mortality Rates IHD Mortality Rate W Percent Absolute Group 1980 1988 Change Change Age 35-44 29.0 19.4 —4.8 -1.2 45-54 132.2 84.8 -5.4 —5.9 55-64 371.4 268.3 -4.1 -12.9 65-74 926.4 679.9 -3.9 -30.8 75-84 2240.0 1747.0 -3.1 -61.6 85+ 5578.9 4647.8 —2.3 -1 16.4 Race-Sex* Black Women 4388 365.8 -2.2 —9.1 Black Men 682.3 529.2 -3.1 -19.1 White Women 428.1 337.6 -2.9 -11.3 White Men 823.5 612.7 -3.7 -26.4 Regi0n* Northeast 690.5 500.5 -3.9 -23.8 Midwest 619.0 478.0 -3.2 —17.6 South 551.3 437.8 -2.9 -14.2 West 501.6 391.6 —3.1 -13.8 United States* 588.3 448.8 -3.4 -17.4 * Age—adjusted rates, ages 35+ lschemic Heart Disease Surveillance Discussion Although substantial declines in IHD mortality rates occurred from 1980 through 1988, IHD remains the number one cause of death in the United States. At the national level, the age—adjusted IHD mortality rate (ages 35+) declined 24% from 588 per 100,000 in 1980 to 449 per 100,000 in 1988. Declines in IHD mortality were observed among each sociodemographic group we exam- ined; however, some groups experienced faster declines than others. Younger age groups ex— perienced faster percent declines than older age groups. Among the race—sex groups, white men (3.7%) experienced the fastest annual declines and black women (2.2%) experienced the slow— est annual declines. The region with the fastest rate of decline was the Northeast (3.9% per year), while the rates of decline among the other regions varied from 2.9% to 3.2% per year. The declines in IHD mortality that oc- curred in all regions and states during the period 1980—1988 stand in contrast to the dramatic increases that occurred during the early part of this century.8 From 1920 to 1950 IHD mortal- ity rates increased approximately 50%. The decline in IHD mortality began in the late 19503 and early 1960s, with the earliest declines in lschemic Heart Disease Surveillance IHD mortality occurring among metropolitan areas, especially in the Northeast and Pacific West, and among communities with the most social and economic resources. Later, the de- clines in IHD mortality also spread to non- metropolitan areas, communities with fewer resources, and the southern states.9’10 By the mid 19703, declines in IHD mortal— ity were occurring throughout the United States. The declines in IHD mortality have continued into the 1980s, as reported herein, however, there has been a levelling off or slow— down in the rate of decline for several groups. From 1976 to 1985, black men, black women and white women all experienced slower rates of decline than the previous years 1968-1975. For white men, however, the rate of decline continued to increase slightly in the 19805. Other studies have reported variation in declining IHD mortality by socioeconomic status. Among US veterans and industrial em- ployees, the decline in IHD mortality was greater for professionals than non-profession- als.12’13 In addition, national trends in IHD mortality by educational status indicate that faster declines occurred among people with higher levels of education. References 1. The WHO MONICA Project Geographical Variation in the major risk factors of coronary heart disease in men and women, aged 35-64 years. World Health Statistics Quarterly 1988 (41) 115-140. 2. Higgins M, Thom T. Trends in coronary heart dis- ease in the United States. Int J of Epidemiol 1989;18:858- 866. 3. Cooper R, Stamler J, Dyer A, Garside D. The decline in mortality from coronary heart disease, USA, 1968-1975. J Chron Dis 1978;31:709-720. 4. Kleinman JC. State trends in infant mortality, 1968- 1983. Am J Public Health 1986;76:681-687. 5. Sorlie PD, Gold EB, The effect of physician termi- nology preference on coronary heart disease mortality: an artifact uncovered on the 9th version ICD. Am J Public Health 1987; 221067-1070. 6. Gittlesohn A. Royston P, Annotated bibliography of cause of death validation studies 1958-1980. Hyattsville, MD: National Center for Health Statisitcs, DHHS Publica- tion No. (PHS) 82-1363. Vital and Health Statistics; Series 2; No. 89. 7. Gittlesohn A, Senning J. Studies on the reliability of vital and health records: comparison of cause of death and hospital record diagnoses. Am J Public Health 1979;69:680-89. Endnote 8. Stallones RA. The rise and fall of ischemic heart disease, Sci Am 1980;243(5):53-59. 9. Wing SB, Casper ML, Riggan W, et al. Socioenvi- ronmental characteristics associated with the onset of decline of ischemic heart disease mortality in the United States. Am J Public Health 1988;78:923-926. ‘ 10. Wing SB, Barnett EM, Casper ML, Tyroler HA.‘ Geographic and socioeconomic variation in the onset of decline of coronary heart disease mortality in whitel women: empirical findings and theoretical development. Am J Public Health 1992; 82:204-209. 11. Sempos C, Cooper R, Kovar MG, McMillen M.‘ Divergence of the recent trends in coronary mortality for, the four major race-sex groups in the United States. Am J Public_Health 1988; 78:1422-1427. ‘ 12. Pell S, FayerweatherWE. Incidence of myocardial l infarction and associated mortality and morbidity in a large employed population, 1957-1983. N Engl J Med l 1985;312:1005-11. l 13. Rogot E, Hrubee Z. Trends in mortality from coro- nary heart disease and stroke among US veterans:1954— 1979. J Clin Epidemiol 1989;42:245—56. ‘ 14. Feldman JJ, Makuc DM, Kleinman JC, Cornoni- Huntley J. National trends in educational differentials in mortality. Am J Epidemiol 1989;129:919-33. *The ranking of IHD (ICD9 410-414) as the leading cause of death differs from National Center for Health Statistics publications which rank the broader category, Diseases of the Heart (ICD9 390-398, 402, 404-429), as the leading cause of death. We chose to present the data for IHD separately for the following reasons: a) it accounts for approximately two thirds of all deaths within the category ’Diseases of the Heart', b) it stands alone as the number one cause of death in the United States and c) the risk factor profile for IHD differs somewhat from the risk factor profiles for other causes of death included within the category ’Diseases of the Heart’. 10 lschemic Heart Disease Surveillance Chapter 1 Tables Table 1.1 Number of Deaths with lschemic Heart Disease as Under|ying Cause and Mortality Rate per 100,000 Population, by Age Group, United States, 1980-1988 Age 1980 1981 1982 1983 1984 1985 1986 1987 1988 35-44 Number 7472 7462 7456 7302 7318 7413 7418 7124 6793 Rate 29.0 28.3 26.6 25.0 24.0 23.4 22.5 20.9 19.4 45-54 Number 30074 28948 27497 26034 24625 23652 21886 21406 20380 Rate 132.2 128.1 ‘ 122.5 116.3 109.8 105.1 96.3 92.4 84.8 55-64 Number 80827 78950 77004 74812 72116 69163 65036 61349 58267 Rate 371.4 359.9 348.8 337.2 324.1 310.7 293.7 279.8 2683 65-74 Number 144998 141845 140770 139045 134396 131995 127111 123611 121112 Rate 926.4 892.1 870.5 844.9 805.2 778.7 736.2 702.7 679.9 75-84 Number 174268 170059 171001 172226 170562 169421 165799 164063 165537 Rate 2240.0 2135.6 2094.0 2056.5 1986.6 1924.2 1837.4 1772.4 1747.0 85+ Number 126611 126330 127419 131540 130801 133534 131821 133134 136106 Rere 5578.9 5373.4 5208.8 5192.3 4999.1 4972.2 4765.9 4669.7 4647.8 Total Number 564250 553594 551147 550959 539818 535178 519071 510687 508195 Rate 587.7 570.0 554.9 544.5 523.9 510.3 485.7 468.8 457.6 Age-adjusted Rate 588.3 565.6 550.5 538.4 516.9 502.5 477.5 460.0 448.8 Table 1.2 Number of Deaths with lschemic Heart Disease as Underlying Cause and Mortality Rate per 100,000 Population, by Age Group, Black Women, United States, 1980-1988 Age 1980 1981 1982 1983 1984 1985 1986 1987 1988 35-44 Number 370 326 360 364 363 334 336 320 349 Rate 24.7 21.4 22.6 22.0 20.9 18.5 17.7 16.1 16.9 45-54 Number 1333 1254 1313 1179 1151 1119 1083 1056 1080 Rate 105.8 99.1 103.1 91.5 88.3 84.7 80.7 77.2 76.9 55-64 Number 3347 3272 3246 3253 3138 3129 2914 2873 2849 Rate 314.4 302.7 295.6 291.9 278.3 274.5 253.1 248.0 244.6 65—74 Number 5662 5605 5405 5619 5436 5458 5299 5187 5076 Rate 725.5 705.9 670.2 686.1 654.5 648.3 620.2 597.7 576.0 75-84 Number 6031 5870 5865 6308 6249 6257 6342 6235 6645 Rate 1660.4 1571.8 1522.7 1593.4 1536.8 1499.3 1478.1 1417.8 1475.2 85+ Number 3767 3870 3825 4015 4067 4334 4621 4788 4907 Rate 3494.3 3431.5 3196.4 3197.3 3069.5 3154.9 3202.2 3187.6 3123.2 Total Number 20510 20197 20014 20738 20404 20631 20595 20459 20906 Rate 404.2 392.0 379.3 384.0 368.8 364.0 354.0 342.9 341.5 Age-adjusted Rate 438.8 421.8 406.1 410.7 393.8 389.4 378.2 366.9 365.8 lschemic Heart Disease Surveillance 13 Table 1.3 Number of Deaths with lschemic Heart Disease as Underlying Cause and Mortality Rate per 100,000 Population, by Age Group, Black Men, United States, 1980-1988 Age 1980 1 981 1982 1983 1 984 1985 1986 1987 1988 35-44 Number 844 858 814 766 819 883 893 850 823 Rate 67.9 67.8 61.5 55.6 56.7 58.5 56.3 51.4 47.7 45-54 Number 2617 2506 2392 2374 2280 2161 2004 2039 1953 Rate 254.9 243.1 230.8 226.6 215.1 201.4 184.3 183.4 171.6 55-64 Number 5024 5106 4929 4838 4732 4604 4346 4144 4131 Rate 584.9 583.5 552.3 531.8 512.0 491.6 459.0 433.3 428.6 65-74 Number 6561 6462 6274 6342 6107 6142 5820 5953 5789 Rate 1151.7 1117.5 1069.1 1063.2 1007.6 994.4 924.9 927.5 883.2 75-84 Number 5172 4890 4897 5109 4999 5116 4867 5026 5156 Rate 2253.9 2084.8 2037.5 2083.9 1991.5 2007.3 1866.5 1885.5 1906.8 85+ Number 2273 2106 2238 2264 2195 2272 2342 2285 2341 Rate 4237.4 3772.3 3871 .8 3728.5 3501 .3 3514.9 3569.6 3382.5 3368.0 Total Number 22491 21928 21544 21693 21 132 21178 20272 20297 20193 Rate 564.8 542.7 520.8 51 1.9 486.1 475.2 443.0 432.0 418.8 Age-adjusted Rate 682.3 648.8 627.8 620.0 591.1 583.2 549.7 539.9 529.2 Table 1.4 Number of Deaths with lschemic Heart Disease as Underlying Cause and Mortality Rate per 100,000 Population, by Age Group, White Women, United States, 1980-1988 Age 1980 1981 1982 1983 1984 1985 1986 1987 1988 35-44 Number 966 990 1029 948 975 1005 1010 983 922 Rate 8.6 8.6 8.4 7.4 7.4 7.3 7.1 6.7 6.1 4554 Number 4769 4762 4349 4286 3982 3851 3567 3612 3428 Flate 46.5 47.0 43.4 43.1 40.1 38.7 35.7 35.5 32.5 5564 Number 18365 18148 17691 17467 16825 15999 15301 14565 13900 Rate 177.5 174.5 169.5 167.1 161.1 153.8 148.4 143.4 138.8 6574 Number 47495 46316 46197 45390 44694 43163 41889 40697 39617 Rate 595.1 572.8 563.4 545.8 531.6 507.5 485.7 465.0 448.8 75-84 Number 83194 80443 81079 81156 80065 78967 77644 76629 76732 Rate 1855.2 1754.8 1726.8 1687.9 1627.4 1568.6 1508.6 1456.2 1429.6 85+ Number 78265 78830 79973 83192 83069 85054 84506 85478 87534 Rate 5355.8 5176.3 5024.1 5031.0 4848.2 4823.8 4647.1 4555.8 4542.3 Total Number 233054 229489 230318 232439 229610 228039 223917 221964 222133 Rate 508.7 496.2 488.2 484.9 471 .7 461 .8 446.6 435.8 429.3 Age-adjusted Rate 428.1 41 1.5 402.0 395.3 381.6 370.4 355.7 344.7 337.6 14 lschemic Heart Disease Surveillance Table 1.5 Number of Deaths with lschemic Heart Disease as Underlying Cause and Mortality Rate per 100,000 Population, by Age Group, White Men, United States, 1980-1988 Age 1980 1981 1982 1983 1984 1985 1986 1987 1988 35-44 Number 5189 5191 5157 5108 5065 5074 5075 4846 4607 Rate 46.8 45.9 42.8 40.6 38.7 37.3 35.9 33.1 30.7 45-54 Number 21066 20149 19149 17911 16919 16224 14911 14380 13614 Rate 216.1 208.4 199.7 187.6 177.3 169.9 154.9 146.7 133.6 55-64 Number 53576 51877 50553 48617 46767 44752 41810 39084 36660 Rate 584.2 562.0 545.0 522.3 501.3 479.9 451.9 427.6 405.4 65-74 Number 84400 82602 81888 80700 77140 76155 73078 70668 69471 Rate 1377.9 1325.6 1290.1 1245.6 1171.7 1136.0 1066.5 1009.4 979.3 75-84 Number 78931 77933 78123 78570 78090 77863 75715 74926 75669 Rate 3015.2 2910.1 2845.4 2789.3 2701.5 2623.8 2484.1 2388.5 2348.3 85+ Number 41727 40941 40758 41407 40753 41 157 39606 39719 40471 Rate 6666.0 6421.2 6240.9 6211.5 5993.0 5969.0 5627.4 5514.0 5513.2 Total Number 284889 278693 275628 272313 264734 261225 250195 243623 240492 Rate 723.7 700.9 677.9 657.9 628.6 610.0 573.9 548.3 531.3 Age-adjusted Rate 823.5 793.5 771.5 750.4 718.3 698.6 657.6 629.6 612.7 lschemic Heart Disease Surveillance 15 Table 1.6 Number and Crude Rate of Ischemic Heart Disease Mortality per 100,000, Ages 35+, by State, United States, 1980-1988 1980 1981 1982 1983 1984 State Number Rate Number Rate Number Rate Number Rate Number Hate Alabama 8189 505.0 8391 513.1 8239 495.8 8233 488.8 8220 480.3 Alaska 260 213.8 248 200.2 286 212.0 263 178.6 263 169.5 Arizona 5491 489.2 5457 470.6 5591 461.4 5764 457.7 5790 440.7 Arkansas 5950 593.0 5679 561.4 5620 546.7 5515 527.4 5439 511.1 California 47012 477.6 46463 463.7 47806 461.8 46978 441.2 47583 435.5 Colorado 4500 408.8 4631 411.6 4753 406.0 4502 372.2 4567 370.0 Connecticut 8028 569.3 7969 559.9 8018 553.5 7638 519.1 7453 498.8 Delaware 1103 441.9 1095 435.8 1061 413.7 1081 412.8 1040 388.4 District of Columbia 1414 513.1 1328 484.5 1244 451.9 1012 383.6 815 288.3 Florida 29985 61 1.4 30688 604.1 30448 575.2 31352 570.7 31 150 546.5 Georgia 10669 493.1 10578 480.1 10298 454.2 10636 457.9 10435 436.7 Hawaii 1121 300.8 1163 308.6 1134 289.7 1200 295.9 1133 270.1 Idaho 1771 491.5 1693 459.1 1678 440.9 1711 439.2 1713 429.5 Illinois 31252 647.5 30383 628.4 29582 605.4 29404 597.3 28107 565.7 Indiana 13562 599.8 13470 593.4 13760 597.7 13632 586.6 13416 569.4 Iowa 8289 662.4 8191 653.1 8273 654.8 8349 656.3 7823 610.6 Kansas 6422 632.3 6199 607.1 6190 596.7 6145 585.0 5975 563.1 Kentucky 9794 652.0 9074 599.2 8889 574.8 911 1 579.1 8685 544.2 Louisiana 8998 559.8 8906 548.8 8702 524.1 8558 506.8 8328 488.9 Maine 3245 670.4 3099 632.0 3184 636.1 3173 622.5 3228 621.0 Maryland 6946 391.0 6771 377.2 6873 375.6 6919 371.6 6775 355.7 Massachusetts 18177 718.6 17189 675.0 17100 662.3 16768 640.8 16357 615.4 Michigan 22376 599.2 22265 594.6 22329 591.1 22143 581.7 21689 561.1 Minnesota 9735 582.0 9258 548.5 9314 541.5 9377 537.8 8846 500.0 Mississippi 5423 542.0 5500 545.0 5355 520.3 5333 510.6 5378 507.3 Missouri 14607 673.7 13946 640.1 13857 628.2 13810 618.7 13322 588.0 Montana 1635 513.1 1563 484.0 1503 453.3 1533 451.0 1542 444.7 Nebraska 4205 633.3 4315 646.9 4272 632.5 4109 602.8 4106 596.6 Nevada 1228 363.3 1244 348.8 1330 351.1 1271 321.7 1326 321.8 New Hampshire 2332 604.2 2233 568.1 2174 538.0 2141 518.8 2236 526.1 New Jersey 22906 679.9 21910 646.4 21840 634.3 21572 618.5 20975 592.7 New Mexico 1647 334.2 1511 300.1 1628 310.7 1526 281.6 1585 284.8 New York 63935 805.5 61939 780.8 62326 776.7 62261 767.2 60706 741.0 North Carolina 12730 520.5 13052 524.9 12630 494.1 13029 498.1 13029 484.5 North Dakota 1653 633.4 1549 591.0 1511 564.5 1571 577.6 1516 551.8 Ohio 29539 646.7 29124 635.1 28394 611.6 28638 611.9 27638 583.7 Oklahoma 8133 625.1 8030 610.2 8086 589.7 7973 565.5 7624 539.6 Oregon 6108 554.3 5998 535.9 5891 517.4 6080 528.1 6020 512.3 Pennsylvania 35676 654.8 34172 625.7 33535 607.0 33698 604.7 32819 584.6 Rhode Island 3240 754.6 3106 718.2 3055 696.7 3089 696.5 3081 684.7 South Carolina 6028 493.6 5950 476.6 5895 459.4 6401 487.3 6134 454.9 South Dakota 1981 689.6 1912 664.1 2023 692.2 1999 675.3 1847 615.4 Tennessee 11043 565.9 11094 561.9 10937 542.8 11150 544.6 10666 511.2 Texas 24496 441.2 24595 432.8 23999 403.1 24436 397.0 23977 381.2 Utah 1842 394.1 1938 402.9 1821 363.5 1793 346.3 1837 345.6 Vermont 1213 582.4 1145 544.3 1180 548.0 1126 512.7 1096 490.3 Virginia 11028 498.7 10819 482.5 10581 462.5 10865 465.1 10441 436.9 Washington 7978 468.3 7976 457.4 8267 461.7 8073 441.8 8012 427.7 West Virginia 5659 671.9 5583 658.6 5513 642.7 5355 617.9 5355 616.0 Wisconsin 12919 659.7 12492 631.9 12441 618.4 12017 590.0 12048 582.9 Wyoming 777 462.9 710 411.8 731 410.3 646 356.8 672 371.9 16 Ischemic Heart Disease Surveillance Table 1.6 Number and Crude Rate of lschemic Heart Disease Mortality per 100,000, Ages 35+, by State, United States, 1980—1988 (continued) 1985 1986 1987 1988 State Number Rate Number Rate Number Rate Number Rate Alabama 8167 469.9 7610 431.9 7521 420.4 7538 416.4 Alaska 288 179.6 330 198.4 305 181.8 291 1704 Arizona 5712 414.8 5766 398.7 6117 403.7 6335 402.5 Arkansas 5409 501.1 5164 473.5 5537 501.2 5548 497.7 California 48303 430.0 47573 409.3 47893 397.9 48181 386.1 Colorado 4530 359.6 4631 360.3 4445 339.0 4665 351.5 Connecticut 7439 490.3 7061 457.8 6900 440.5 6750 423.8 Delaware 1151 420.8 1123 398.1 1072 370.5 1068 359.3 District of Columbia 844 294.7 793 274.2 804 276.9 811 278.2 Florida 32218 545.5 31834 519.8 32957 519.1 32898 500.5 Georgia 10519 427.8 10305 407.0 10140 389.1 10255 383.1 Hawaii 1116 257.6 1158 260.2 1149 250.3 1037 219.2 Idaho 1617 397.8 1568 381.9 1578 381.2 1579 376.8 Illinois 28174 563.0 27326 541.6 26658 522.9 26502 514.7 lndiana 12993 545.0 13016 540.7 12523 512.9 12578 508.1 lowa 7652 595.4 6627 518.4 6946 542.1 6638 512.3 Kansas 5875 548.6 5533 510.9 5472 498.6 5324 477.7 Kentucky 8720 539.2 8481 520.0 8130 493.6 8515 511.9 Louisiana 8199 475.6 7798 446.6 7888 451.2 7958 457.1 Maine 3147 595.2 3040 566.6 2893 528.3 2822 501.9 Maryland 6500 334.3 6591 330.5 6420 313.4 6102 2894 Massachusetts 15637 580.6 14950 548.2 14128 507.1 13950 492.1 Michigan 21911 558.4 21854 548.6 21102 520.9 20806 506.7 Minnesota 8718 485.6 8423 463.1 8210 444.4 8156 431.4 Mississippi 5362 498.3 4670 429.8 4614 421.7 5017 456.5 Missouri 13114 571.9 12756 549.4 12871 546.1 12621 527.9 Montana 1447 411.0 1403 397.9 1339 379.0 1324 373.6 Nebraska 3926 567.2 3642 524.7 3702 531.0 3436 487.1 Nevada 1508 350.9 1236 273.7 1248 260.7 1296 254.1 New Hampshire 2145 491.6 2145 476.0 1989 426.4 2067 427.3 New Jersey 20785 579.3 20034 549.8 19357 523.6 19352 516.3 New Mexico 1576 275.9 1470 250.4 1453 241.5 1402 229.7 New York 58539 709.0 55120 660.3 52778 625.5 52509 614.0 North Carolina 12972 470.3 13207 468.7 13480 467.2 13606 461.1 North Dakota 1546 560.2 1312 476.0 1353 491.7 1340 487.4 Ohio 27111 566.7 26731 552.2 25623 522.4 25186 507.0 Oklahoma 7879 554.2 7635 534.1 7413 520.2 7625 534.3 Oregon 6243 521.8 5821 478.0 5915 476.5 5751 451.5 Pennsylvania 32246 570.8 31171 545.9 30063 520.0 29312 500.6 Rhode Island 2963 649.5 3056 658.7 2715 573.9 2538 521.4 South Carolina 6253 452.2 6392 451.8 6390 441.3 6505 439.5 South Dakota 1761 580.3 1733 568.1 1727 561.8 1709 550.3 Tennessee 10596 498.9 10246 475.4 10308 469.4 10414 466.7 Texas 23636 367.1 23046 348.5 22611 336.2 22461 329.7 Utah 1807 332.7 1673 300.6 1656 290.9 1639 282.7 Vermont 1111 488.4 1071 463.2 1077 456.3 985 405.9 Virginia 10287 421.4 9908 396.1 9706 377.2 9780 369.8 Washington 7720 401.5 7564 383.8 7287 359.0 7414 352.7 West Virginia 4970 569.3 4853 557.1 4935 567.4 4555 526.2 Wisconsin 12120 578.7 11998 566.7 11706 545.1 11497 524.9 Wyoming 716 395.6 623 342.8 583 327.1 547 311.3 lschemic Heart Disease Surveillance 17 Table 1.7 Age—adjusted lschemic Heart Disease Mortality Rates per 100,000 and Change in lschemic Heart Disease Mortality, Ages 35+ by State, United States, 1980-1988 Average Average Annual Annual Percent Absolute State 1980 1981 1982 1983 1984 1985 1986 1987 1988 Change Change Alabama 513.3 514.9 495.6 486.2 476.8 465.6 428.0 416.5 412.5 -3.0 -12.6 Alaska 463.4 439.6 457.7 381.9 364.2 388.0 418.7 383.5 359.0 -2.6 -13.1 Arizona 510.0 482.3 472.1 464.9 445.4 419.0 402.9 410.2 408.5 -2.9 -12.7 Arkansas 534.5 501.1 488.2 470.8 458.1 448.2 423.6 449.9 446.2 23 -11,0 California 507.0 490.2 490.1 467.5 461.3 456.6 435.6 423.5 410.4 -2.5 421 Colorado 459.6 463.3 463.2 425.1 423.0 411.4 409.8 384.1 399.3 -2.3 -7.5 Connecticut 566.5 549.3 541.4 503.9 481.1 472.8 439.0 420.6 403.7 —4.3 .204 Delaware 479.0 465.7 439.3 436.1 408.1 440.9 416.9 387.0 374.8 -2.7 -13_0 District of Columbia 513.8 480.5 446.5 356.6 280.8 288.1 270.0 272.7 274.3 -8.7 -29.9 Florida 521.2 511.4 486.0 479.9 457.8 455.5 432.4 432.1 416.5 -2.8 431 Georgia 551.3 533.1 505.7 510.1 487.8 479.8 459.5 442.6 438.3 -2.8 -14.1 Hawaii 379.2 379.1 349.9 348.7 319.2 300.2 301.1 284.6 248.3 -4.9 -16.4 Idaho 504.9 469.0 451.1 450.2 441.4 406.8 385.1 380.9 373.8 -3.7 -16.4 Illinois 650.9 624.2 599.3 587.8 554.2 549.0 526.6 507.6 499.1 -3.3 -19.0 Indiana 605.3 591.8 594.3 580.0 560.8 535.3 528.2 499.6 493.8 -2.7 -13.9 Iowa 551.5 536.0 534.5 533.6 494.7 480.4 412.3 427.8 401.6 4.2 .18] Kansas 541.7 515.3 509.7 499.6 480.1 467.5 432.9 422.0 404.9 —3.5 —17.1 Kentucky 645.4 588.5 566.4 570.0 537.6 532.0 511.1 482.8 501.4 -3.1 -19,1 Louisiana 598.4 585.7 563.4 543.7 523.0 506.9 470.0 465.3 472.4 -3.4 -15.8 Maine 607.7 571.1 573.6 560.5 558.6 538.5 510.1 478.0 453.6 -3.2 -19.3 Maryland 454.1 429.6 426.0 418.8 399.3 373.7 369.7 350.6 325.8 -3.8 -16.0 Massachusetts 650.8 607.3 595.6 574.4 552.0 519.6 489.6 456.5 442.1 -4.7 .261 Michigan 638.3 622.1 612.7 599.0 574.5 571.4 559.8 531.2 516.2 -2.6 -15.3 Minnesota 523.8 490.7 483.2 476.5 443.2 430.9 410.0 395.4 384.1 -3.8 -17.5 Mississippi 522.6 521.0 497.3 487.8 484.9 476.5 410.2 403.4 435.9 -3.1 —10.8 Missouri 6037 567.8 555.4 547.1 519.1 505.5 485.7 483.9 468.6 -3.0 -16.9 Montana 505.2 474.3 443.4 442.8 436.8 402.3 388.3 363.2 355.5 -4.2 .18] Nebraska 527.3 531.5 526.2 497.6 492.3 464.8 429.4 431.6 396.3 -3.7 -16.4 Nevada 499.9 467.1 470.9 426.5 427.3 450.1 346.9 329.8 318.2 -5.5 -22,7 New Hampshire 598.2 559.4 532.1 512.2 521.2 490.2 476.9 431.7 433.6 -3.8 -20.6 New Jersey 706.4 663.1 648.2 629.0 600.5 584.5 553.6 525.9 518.3 -3.8 -23.5 New Mexico 386.0 339.5 354.5 321.2 323.9 310.7 280.0 265.0 251.7 -4.8 -16,8 New York 783.8 752.4 746.2 735.5 709.3 676.4 629.6 595.9 584.0 -3.8 -25.0 North Carolina 565.7 563.0 528.8 530.7 515.4 498.9 495.2 492.0 486.5 -2.0 .99 North Dakota 548.9 508.4 484.0 493.5 473.9 475.4 400.1 411.3 406.1 -3.7 -17.9 Ohio 657.4 637.0 610.3 606.3 575.6 557.3 540.1 509.3 494.0 -3.5 -20.4 Oklahoma 583.4 572.5 560.8 537.3 513.1 525.0 503.9 486.5 498.1 -2.2 .10] Oregon 537.7 512.5 492.6 496.9 477.3 482.6 439.7 435.3 413.6 -2.9 .155 Pennsylvania 627.3 591.2 569.2 562.0 539.7 522.2 496.3 470.6 452.5 -3.8 -21.9 Rhode Island 675.4 635.2 614.9 609.8 596.0 567.1 573.0 497.5 449.2 -4.2 .233 South Carolina 560.5 536.7 514.0 542.8 506.7 501.9 499.6 486.4 485.0 -1.7 -9.4 South Dakota 565.7 539.8 556.9 541.7 497.7 468.6 458.8 446.9 436.4 -3.5 -16.2 Tennessee 580.8 570.4 551.0 550.7 515.2 502.1 476.9 470.3 468.2 —3.0 -14.1 Texas 475.5 468.5 442.2 436.9 420.8 405.3 386.0 370.6 364.3 -3.5 -13.9 Utah 445.7 455.0 413.3 392.1 391.7 376.6 338.5 325.7 316.9 -4.6 -16.1 Vermont 549.0 511.1 516.8 487.3 465.2 466.8 445.7 440.9 390.4 -3.5 -19.8 Virginia 568.5 546.2 525.6 529.0 496.5 479.6 453.7 434.0 428.2 -3.6 -17.5 Washington 481.3 466.5 472.4 450.2 434.0 407.0 388.4 362.0 355.7 -4.0 -15,7 West Virginia 649.0 631.0 615.9 588.5 584.9 538.5 522.5 527.1 487.4 -3.4 .202 Wisconsin 601.8 569.6 555.6 526.5 519.0 513.4 501.0 482.0 460.8 -3.0 -17.6 Wyoming 531.7 477.0 488.0 420.2 433.2 456.4 393.6 370.4 350.2 -4.5 -22.7 13 lschemic Heart Disease Surveillance Chapter 2. Hospitalizations Introduction Hospitalization for ischemic heart dis— ease (IHD) is one indicator of the morbidity and health care burden associated with this disease. In this chapter, we examine trends in hospitali— zations for IHD in the United States during 1980-1989. We evaluate the numbers and rates of hospitalizations by calendar year, age, sex, race, and geographic region. We present data for hospitalizations with IHD listed as the pri- mary (i.e. first listed or principal) diagnosis separately from hospitalizations for which IHD is any listed diagnosis. Methods We used data from the National Hospital Discharge Survey (N HDS) to estimate the num- ber of IHD-related hospitalizations in US. non— institutional, nonfederal hospitals. Conducted by the National Center for Health Statistics (NCHS), the NHDS continuously collects hos— pital discharge data on the characteristics of patients, their diagnoses and surgical proce— dures, and the characteristics of the hospitals from which they are discharged. NCHS Vital and Health Statistics Reports provide details on specific yearly surveys, and approximations to standard errors of estimates. The NHDS was originally based on a two- stage, stratified design, but in 1988 it was redes— igned around a three—stage sampling design. NCHS changed the design to make the survey geographically comparable with other NCHS surveys, to use a different source listing to establish the universe of hospitals sampled for the survey, and to revise several data collection and estimation procedures. NCHS compared estimates generated from the respective sam- ples of hospitals under the old and new survey methodologies using discharge data for the first 3 months of 1988. In general, most of the differences were not statistically significant. Changes in methodology or design may ac- lschemic Heart Disease Surveillance count, however, in part for differences observed when one compares current estimates with those based on data before 1988. Hospitaliza— tion discharge rates may also have been affected by the institution of diagnosis-related groups (DRGs) in late 1983 and greater use of outpa— tient surgery during the decade. To estimate numbers and rates of IHD-re— lated discharges, we selected all discharges for which any of the seven discharge diagnoses which were coded to the International Classifi— cation of Diseases, Ninth Revision, Clinical Modification (lCD—9—CM) rubric 410—414. SAS statistical software was used to compute the survey-design-weighted number of dis— charges and associated hospital discharge rates. Denominators for age—specific and crude rates were based on US. resident population esti- mates provided by the U.S. Bureau of the Cen— sus. Age-specific rates were combined and standardized using the direct method. The 1980 US. resident population was used as the standard for weighting individual age-specific rates of each year. Using the adjusted rates for each year, we estimated the percent change in rates for 1980— 1987 (data collected using the earlier NHDS sampling design) and for 1988-1989 (data col— lected using the revised NHDS sampling de- sign). Percent change was determined separately for these two time periods because, in general, numbers of discharges and rates appeared to decrease in the latter period. We estimated the percent change over the period 1980—87 by subtracting the average of the 1980— 1983 rates from the average of the 1984—1987 rates, dividing the difference by the average of the 1980—1983 rates, and multiplying the result by 100 to convert the number to a percent. We determined the total percent change for 1988— 1989 by comparing the adjusted rate for 1989 with the adjusted rate for 1988. 19 Results Between 1980 and 1989, the estimated number of hospital discharges with IHD listed as any discharge diagnosis ranged from about 3.7 million in 1980 to about 4.3 million in 1984 (Figure 2.1). Under the revised survey design, the estimated number of hospital discharges with IHD as any listed diagnosis was approxi- mately 4 million in both 1988 and 1989. About half of these hospital discharges for 1989 had IHD listed as the primary discharge diagnosis (Table 2.1). In all tables, total numbers of hospital dis- charges, total rates, and age-adjusted rates are presented by individual year. For specified demographic groups (all races and sexes com- bined; men only; women only; white men; white women), Tables 2.2 through 2.6 also present age—specific statistics for hospital dis- charges with IHD listed as the primary diagno— sis* (see endnote, page 28). Because of smaller sample sizes, discharge rates for black men and black women are less reliable than those re— Figure 2.1 Number of Hospital Discharges with E" Ischemic Heart Disease as Any Listed 5? Discharge Diagnosis. by Year, United 1% States, 1980-1989 5, g 8 .5 20 ported for whites. Estimated numbers of hos- pital discharges have been rounded to thou- sands in the tables. For an individual year and demographic group, age—specific rates were calculated based on the sum of the survey- weighted numbers of hospital discharges for the specified age category divided by the corre- sponding age—specific population estimate. Also, for each specified year and demographic group, total rates (sometimes called crude rates) were calculated by summing the survey- weighted numbers of hospital discharges across age category and dividing by the appropriate total annual population estimate. All rates pre— sented in the tables (i.e., age—specific, total, and age—adjusted) are expressed per 10,000 popula— tion. Tables 2.8 through 2.13 present the same set of statistics using hospital discharges with IHD as any of the listed diagnoses. Tables 2.14 and 2.15 present numbers, total rates, and ad- justed discharge rates by US region and year for primary and any listed IHD diagnosis, re- spectively. 80 81 82 83 84 85 86 87 88 89 Year lschemic Heart Disease Surveillance IHD as Primary Diagnosis IHD was the primary diagnosis for roughly 2 million hospital discharges per year (Table 2.2). Under the earlier NCHS sampling design, the age—adjusted rate of hospital dis- charges having IHD as the primary diagnosis was about 80 discharges per 10,000 for 1980 and 1981, and ranged from approximately 84 to 88 discharges per 10,000 between 1982 and 1987 (Figure 2.2). Under the revised design, the age—adjusted rate was about 80 per 10,000 for 1988 and 1989. The average age—adjusted rate increased by about 2.9% between 1980— 1983 and 1984-1987. Between 1988 and 1989 the rate declined by 3.8%. Each year, the discharge rate for IHD listed as the primary diagnosis generally increased with increasing age (Table 2.2). In 1989, the rate ranged from 1.3 per 10,000 among persons less than 35 years old to 400.9 per 10,000 among persons 75 to 84 years old. Among men, an estimated 1.1 million hos‘- pital discharges had IHD listed as the primary discharge‘diagnosis in both 1980 and 1981 (Ta— ble 2.3). During 1982—1985 around 1.2 million discharges occurred each year and increased to around 1.3 million annually during 1986—1987. The number of men with IHD as a primary discharge diagnosis was around 1.2 million dur- ing 1988 and 1989. The corresponding age—ad— justed hospital discharge rate in both 1980 and 1981 was around 105 discharges per 10,000 and increased to 113-118 discharges per 10,000 for the years 1982-87 (Figure 2.3). Under the re- vised survey design, the age-adjusted discharge rates for men were about 109 per 10,000 in 1988 and 104 per 10,000 in 1989. The average age— adjusted rate increased by about 2.5% between 1980-1983 and 1984-1987. Between 1988 and 1989, the rate declined 5.3%. lschemic Heart Disease Surveillance Among women, the estimated number of hospital discharges with IHD recorded as the primary discharge diagnosis increased from a low of 737,000 in 1980 to a high of 901,000 in 1987 (Table 2.4). For 1988 and 1989, about 825,000 discharges occurred each year. The estimated age-adjusted rates for women were roughly half those for men, ranging from ap— proximately 56 to 63 discharges per 10,000 population between 1980 and 1987 (Figure 2.3). For the years 1988 and 1989, the age—ad— justed rate among all women was about 55 discharges per 10,000. The average age—ad— justed rate increased by about 3.1% between 1980-1983 and 1984—87. Between 1988 and 1989, the rate declined 2.1%. For each year between 1980—1987, the age- adjusted rate for white men was highest in comparison to the rates of the other three demo- graphic groups (Figure 2.4). In general, the age-adjusted rates for black men tended to be next highest with the rates for white women following and those for black women being the lowest among the four groups. Under the re— vised survey design in 1988 and 1989, the age- adjusted rates for white men continued to be the highest among the four groups, with black and white women having the lowest rates. Among white men, the estimated number of hospital discharges with IHD as the primary discharge diagnosis was about 900,000 for 1980; this number rose and remained at about 1 million discharges for each subsequent year (Table 2.5). The corresponding age—adjusted hospital discharge rate for 1980 was about 98 discharges per 10,000 population. This rate in— creased to about 1 10-1 14 discharges per 10,000 for the years 1981—1983 and decreased to around 108—1 10 discharges between 1984—1987 21 (Figure 2.4). For 1988, the age-adjusted rate under the revised survey design was about 103 discharges per 10,000 and for 1989, the rate was 99 discharges per 10,000. Between 1980—1983 and 1984—1987 the average age-adjusted rate decreased by 0.4%. Between 1988 and 1989, the rate decreased by 4.6%. Among white women, the estimated num- ber of hospital discharges with IHD recorded as the primary discharge diagnosis was about 615,000 for 1980 (Table 2.6). Relative to 1980, the estimates of hospital discharges among white women were higher for each of the years 1981 to 1987, ranging in the neighborhood of 700,000 to 735,000 hospital discharges. For 1988 and 1989, the corresponding numbers were estimated at around 665,000 discharges for white women. The estimated age-adjusted rates for white women were roughly half those for the white men, ranging from about 52 to 59 discharges per 10,000 population for the period 1980 to 1987 (Figure 2.4). For the years 1988 and 1989, the age—adjusted rate among white women was about 50 discharges per 10,000 population. The average age—adjusted rate for 1980-1983 and for 1984—1987 declined by 0.4% for the years 1980—1987. Relative to the 1988 rate, the 1989 rate declined by 2.0%. The estimated number of hospital dis— charges for black men having IHD as the pri- mary discharge diagnosis was around 48,000 per year for 1980—1982, rose to around 60,000 22 per year for 1983-85, and increased to around 70,000 discharges per year for 1986-87. The number of hospital discharges among black men was estimated at approximately 62,000 in 1988 and 50,000 in 1989. (Table 2.7). The age-adjusted hospital discharge rates for 1980- 1982 were around 54 per 10,000 population and ranged from approximately 61 to 72 between 1983 and 1987 (Figure 2.4). The age—adjusted hospital discharge rates were estimated to be 62 per 10,000 in 1988 and 47 per 10,000 in 1989. Between 1980-1983 and 1984-1987 the rate per 10,000 increased 18.0%. Between 1988 and 1989, the rate decreased by 23.6%. Among black women, the estimated number of hospital discharges with IHD recorded as the primary discharge diagnosis ranged from 49,000 to 58,000 between 1980 and 1983 (Ta— ble 2.7). For 1984-1987, the number of hospital discharges among black women was 63,000 to 69,000 discharges. The number of discharges were estimated to be 70,000 in 1988 and 67,000 in 1989. Except for 1989, the estimated age—ad- justed rates for black women were lower than those for the black men, ranging from about 44 to 54 discharges per 10,000 population between 1980 to 1987 (Figure 2.4). For the years 1988 and 1989, the age-adjusted rates among black women were about 50 discharges per 10,000 population. Between 1980—1983 and 1984- 1987 the average age-adjusted rate increased by 12.1%. Relative to the 1988 rate, the 1989 rate declined by 5.4%. lschemic Heart Disease Surveillance Figure 2.2 Age—adjusted Rate of Hospital Dis- Figure 2.3 Figure 2.4 charges with Ischemic Heart Disease as Primary Diagnosis per 10,000 Popula- tion, by Year, United States, 1980-1989 Age-adjusted Rate of Hospital Discharges with Ischemic Heart Disease as Primary Diagnosis per 10,000 Population, by Sex and Year, United States, 1980-1989 Age-adjusted Rate of Hospital Discharges with Ischemic Heart Disease as Primary Diagnosis per 10,000 Population, by Race- Sex Group and Year, United States, 1980- 1989 Ischemic Heart Disease Surveillance 100. 80. so, 40. Rate per 10,000 20, 150 Rate per 10,000 ‘1 5" 80 81 82 83 84 85 86 87 88 89 Year o—o-.._._.o—o. 50 " "’ \" ‘ Men 25' Women .- — o 0 BO 81 82 83 84 85 86 87 88 89 Year 150. 125. o 100, o 0. o C 751 8 9 White Mgr; «I 50. I .wnésawgmm 25i fiJaGLMi'L filagg nggn 0 80 81 82 83 84 85 86 87 88 89 Year 23 IHD as Any Listed Diagnosis Approximately 4 million hospital dis— charges per year had IHD as one of the seven diagnoses reported on the NHDS (Table 2.8). Between 1980—1987, the age-adjusted rate of hospital discharges for IHD as any listed diag- nosis ranged from approximately 164 to 179 discharges per 10,000 population (Figure 2.5). Under the revised design, the age—adjusted rates were estimated to be slightly lower at about 158 per 10,000 in 1988 and 152 per 10,000 in 1989. Between 1980—1983 and 1984—1987 the aver- aged age-adjusted rate increased by 0.4%. Relative to the 1988 rate, the 1989 rate de- creased by 3.6% In all years, the discharge rate for IHD as any listed diagnosis also increased exponen- tially with increasing age (Table 2.8). In 1989, the rate for IHD as any listed discharge diagno- sis ranged from 1.9 per 10,000 among persons less than 35 years old to 1,398.5 per 10,000 among persons at least 85 years old. Among men only, an estimated 2.0 million hospital discharges had IHD as any listed dis— charge diagnosis in both 1980 and 1981 (Table 2.9). The number ranged from approximately 2.1 to 2.3 million discharges annually for 1982— 1987. For 1988 and 1989, the total number of men with IHD as any listed discharge diagnosis was estimated to be around 2.2 million per year. The corresponding age—adjusted hospital dis- charge rate in both 1980 and 1981 was around 205 discharges per 10,000 and ranged from 214—224 discharges per 10,000 for the years 1982—1987 (Figure 2.6). Under the revised sur— vey design, the age-adjusted rates for men were about 204 discharges per 10,000 in 1988 and 196 discharges per 10,000 in 1989. Between 1980—1983 and 1984-1987 the average age-ad— justed rate increased by 2.2%. Relative to the 1988 rate, the 1989 rate declined by 3.7%. Among women only, the estimated number 24 of hospital discharges with IHD recorded as any listed discharge diagnosis increased between 1980 and 1987 ranging from 1.8 million to 2.1 million discharges per year (Table 2.10). For both 1988 and 1989, the corresponding esti- mates were around 1.8 million discharges for all women. The estimated age-adjusted rates for women were about 40% lower those of the men, ranging from approximately 130 to 144 discharges per 10,000 during the period 1980 to 1987 (Figure 2.6). For the years 1988 and 1989, the age—adjusted rate among all women was about 120 discharges per 10,000. Between 1980—1983 and 1984-1987 the average age—ad— justed rate decreased by 1.8%. Relative to the 1988 rate, the 1989 rate decreased by 3.5%. For each year from 1980-1987, the age-ad- justed rate for white men was highest compared with the rates for the other three race—sex groups; black women had the lowest rate (Fig— ure 2.7). This pattern was similar to that seen with the rates among the four groups for pri- mary discharges of IHD. From 1980—1982, the rates for white women exceeded those for black men but from 1984—1987, black men had higher rates. Under the revised survey design in 1988 and 1989, the age—adjusted rates for white men continued to be the highest, with black and white women having the lowest rates. Among white men, the estimated number of hospital discharges with IHD as any listed diagnosis was estimated to be approximately 1.6 million for 1980 and ranged from about 1.8 to 2.0 million for each subsequent year (Table 2.11). The corresponding age-adjusted hospi- tal discharge rate for 1980 was approximately 188 per 10,000 and varied from about 203 to 216 discharges per 10,000 for 1981—1987 (Fig— ure 2.7). Under the revised survey design, the age-adjusted rates were estimated to be slightly lower at 195 discharges per 10,000 in 1988 and 188 discharges per 10,000 population in 1989. Ischemic Heart Disease Surveillance Between 1980—1983 and 1984—1987 the aver- age age-adjusted rate decreased by only 0.1%. Relative to the 1988 rate, the 1989 rate de- creased 3.8%. Among white women, the estimated num— ber of hospital discharges with IHD recorded as any listed discharge diagnosis was about 1.4 million for 1980 (Table 2.12). Relative to 1980, the estimates of hospital discharges among white women for IHD were higher for each of the years from 1981 to 1987, ranging from 1.6 to 1.7 million. For 1988 and 1989, there were approximately 1.5 million discharges among white women. The estimated age—adjusted rates for white women were about 40% lower than those for white men, ranging from around 118 to 136 discharges per 10,000 population Figure 2.6 Ischemic Heart Disease Surveillance between 1980 and 1987 (Figure 2.7). In 1988 and 1989, the age-adjusted rate among white women was about 110 per 10,000 population. Between 1980—1983 and 1984-1987 the aver- age age-adjusted rate decreased by 3.8%. Rela- tive to the 1988 rate, the 1989 rate decreased 2.6%. The estimated number of hospital dis— charges for black men having IHD as any listed discharge diagnosis was around 100,000 per year for 1980-1982; this number ranged from 117,000 to 138,000 between 1983 and 1987. The number of hospital discharges among black men was approximately 120,000 in 1988 and 110,000 in 1989 (Table 2.13). The correspond— ing age-adjusted hospital discharge rates for 1980—1982 were approximately 118 per 10,000 200 . . . . . 150_ m 1 Figure 2.5 Age—adjusted Rate of Hospital D1scharges with Ischemic Heart Disease as Any Listed 8 Diagnosis per 10,000 Population, by Year, 8. United States, 1980-1989 ‘: 100- g g g 50 _, 0 80 81 82 83 84 85 86 87 88 89 Year 250. Age-adjusted Rate of Hospital Discharges 200- M with Ischemic Heart Disease as Any Listed Diagnosis per 10,000 Population, by Sex g 1501 and Year, United States, 1980—1989 Sf __... —o - " - k \ __ _. L .- . ~ .‘ m ‘ o. g 100. T 03 u: Men 50. .V_Vomen. 0 80 81 82 83 84 85 86 87 88 89 Year 25 200. Figure 2.7 Age-adjusted Rates of Hospital Dis- 0 charges with Ischemic Heart Disease as 8 150_ Any Listed Diagnosis per 10,000 Popu- .9 lation, by Race—Sex Group and Year, a; United States, 1980-1989 g ‘00- White Mgr; E .WD!!§.Y‘.’R'P.‘?R 50. .BJact Man. Black Women 0 and ranged from approximately 132 to 145 between 1983 and 1987 (Figure 2.7). For 1988 and 1989, the age—adjusted hospital discharge rates were estimated to be about 124.0 and 109.0 per 10,000 respectively. Between 1980— 1983 and 1984-1987 the average age—adjusted rate increased 15.9%. Between 1988 and 1989, the rate decreased by 12.1%. Among black women, the estimated num— ber of hospital discharges with IHD recorded as any listed diagnosis ranged from 126,000 to 137,000 over the years 1980—82 (Table 2.13). For 1983-1987, the estimates of hospital dis- charges among black women were in the neigh— borhood of 146,000 to 154,000 discharges. For 1988 and 1989, the corresponding numbers of hospital discharges were estimated at 154,000 and 138,000 respectively. For each year, the estimated age—adjusted rates for black women were lower than those for black men (Figure 2.7). The rates ranged from approximately 1 12 to 125 discharges per 10,000 over the period 1980 to 1987. For the years 1988 and 1989, the age-adjusted rates among black women were estimated to be 116 and 102 per 10,000 popu- lation. The average age—adjusted rate for 1984- 1987 was 2.4% higher than the averaged rate for 1980—1983. Between 1988 and 1989 the rate declined 11.6%. 26 80 81 82 83 84 85 86 87 88 89 Year Rates by Region Age- and race-adjusted rates of hospital discharges with IHD as the primary diagnosis were, for most years, highest in the North Cen— tral part of the nation and lowest in the West (Table 2.14). For IHD as any listed diagnosis, the West had the lowest rates of hospital dis- charges for all years but 1987 (Table 2.15). The rates were highest in the North Central and Northeast regions of the United States. Between 1980—83 and 1984—87, the aver— age age—adjusted rates of IHD as a primary diagnosis increased 1.4%, 7.6%, and 1.1% within the Northeast, North Central, and West- ern regions respectively and decreased 0.1% within the South. Between 1988 and 1989, the rates decreased 3.5%, 8.3% and 6.1% within the Northeast, South, and West respectively, and increased 0.8% within the North Central re- gion. For IHD as any listed diagnosis, the average age-adjusted rates between 1980—83 and 1984- 87 increased 4.1%, 0.4% and 2.1% within the Northeast, North Central, and Western regions respectively and decreased 4.3% within the South. Between 1988 and 1989, the rates de- creased 7.6%, 5.5%, and 3.3% within the Northeast, South, and West respectively and increased 1.5% within the North Central region. lschemic Heart Disease Surveillance Discussion The health care burden for persons with IHD is enormous. Between 1980 and 1989 approximately 2 million hospital discharges per year had IHD listed as the primary diagnosis, and 3.7 to 4.3 million discharges per year had IHD as any listed diagnosis. Of the hospital discharges with IHD listed as any diagnosis, about half had IHD as the primary diagnosis. Of the four race-sex groups studied, white men had the highest rates of discharges with IHD as the primary diagnosis, followed in order by black men, white women, and black women. For IHD as any listed diagnosis, the same pat- tern was observed among the four race-sex groups. Among white men and white women, dis- charge rates were generally stable between the periods 1980—83 and 1984-87. In contrast, the rates among black men and black women in- creased between the two periods. Between 1988 and 1989, however, the discharge rates showed a consistent pattern of decline for all demographic groups. These changes need to be interpreted cautiously because of the change in survey methodology after 1987 and the short period of time to measure any change. An earlier study5 used the NHDS data to assess the changes in the rates of hospital discharge with IHD as the primary diagnosis. In that study, a significant increase in hospital discharges be— tween 1984 and 1986 was reported; a detailed analysis indicated that the increase was primar- lschemic Heart Disease Surveillance ily due to an increase in the number of dis- charges for angina pectoris (ICD-9—CM Code 411.1). We found substantial regional variation in discharge rates for IHD. For IHD as the pri— mary discharge diagnosis, the rates were high— est in the North Central region and lowest in the West. A similar pattern was found for IHD as any listed diagnosis, with rates highest in the North Central and Northeastern regions and lowest in the West. These patterns are similar to the regional patterns for IHD mortality (Chapter 1). Our methods have some limitations. First, the NHDS is limited to the civilian non-institu— tionalized population of the United States and thus may underestimate IHD hospital discharge rates. This limitation, however, should not af- fect the temporal patterns in discharges for IHD. In addition, the NHDS sample represents hos— pital discharges and not individual persons. Thus, some people who were hospitalized on more than one occasion for the same condition may have been counted more than once. Be- cause we are concerned primarily with the im- pact of IHD on overall health care utilization, however, multiple hospitalizations do not rep- resent a serious problem for estimating the pub- lic health burden of IHD. Thus, the NHDS provides useful indicators of the morbidity and public health burden related to IHD in the United States. 27 References 1. National Center for Health Statistics. Vital and Health Statistics Reports, Series 13, Annual Summaries. 2. National Center for Health Statistics. Vital and Health Statistics Reports; Series 13; No. 111. Hyattsville, MD: National Center for Health Statistics, May 1992. Estimates from two survey designs: National Hospital Discharge Survey. 3. SAS User’s Guide, Version 6. Cary, North Carolina: SAS Institute, 1990. 4. Fleiss JL. Statistical Methods for Rates and Propor— tions. New York: John Wiley, 1981. 5. Feinlieb M, Havlik RJ, Gillum RF, et al. Coronary heart disease and related procedures: National Hospital Discharge Survey data. Circulation 1989;79(suppl l):l13- I18. Endnote *Age-specific hospital discharge rates among black men and black women were not presented because the stability of the estimates was generally low. In order to improve the stability of the rates and also provide basic surveillance information on these two groups, the data were combined across age group and only crude and age-adjusted rates were reported. The reader should also note that the percent of discharge records missing information on race is concentrated in certain hospitals and varies by year. 28 lschemic Heart Disease Surveillance Chapter 2 Tables Table 2.1 Distribution of Primary Diagnoses among all Hospital Discharges with lschemic Heart Disease as Any Listed Diagnosis, United States, 1989 Primary Diagnosis (iCD-9-CM Codes) Percent lschemic Heart Disease (410-414) 50.1 Diseases of the Circulatory System exclusive of lschemic Heart 18.0 Disease (390-459) Diseases of the Respiratory System (460-519) 6.7 Diseases of the Digestive System (520-579) 6.5 injury and Poisoning (800-999) 3.5 Endocrine, Nutritional and Metabolic Diseases and immunity 3.0 Disorders (240-279) Diseases of the Genitourinary System (580-629) 2.9 Neoplasms (140-239) 2.8 Diseases of the Musculoskeletal System and Connective Tissue 1.7 (710-739) Infectious and Parasitic Diseases (001-139) 1.0 Mental Disorders (290—319) 0.9 Diseases of the Nervous System and Sense Organs (320-389) 0.9 Diseases of the Skin and Subcutaneous Tissue (680-709) 0.8 Diseases of the Blood and Blood-Forming Organs (280-289) 0.6 Other 0.5 Congenital Anomalies (740-759) 0.1 lschemic Heart Disease Surveillance 31 Table 2.2 Estimated Numbers in Thousands of Hospital Discharges and Discharge Rates per 10,000 Population for Ischemic Heart Disease as the Primary Diagnosis, by Age Group and Year, United States, 1980-1989 Age 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 0-34 Number 19 26 23 21 22 19 24 20 19 18 Rate 1.4 2.0 1.7 1.6 1.6 1.4 1.8 1.5 1.4 1.3 35-44 Number 93 94 106 105 115 114 107 107 103 98 Rate 35.9 35.8 37.9 36.0 37.8 36.0 32.6 31.2 29.4 27.1 45-54 Number 283 288 290 295 292 310 293 313 291 286 Rate 124.2 127.5 129.0 131.5 130.2 137.5 128.9 135.1 120.9 115.4 55-64 Number 472 477 519 545 522 515 538 558 507 485 Rate 217.0 217.3 234.9 245.5 234.4 231.5 242.7 254.7 233.5 226.0 65-74 Number 482 509 528 560 584 578 639 650 61 1 610 Rate 308.2 320.3 326.3 340.1 350.0 341.2 370.0 369.3 342.8 337.1 75-84 Number 333 353 400 427 383 390 41 1 408 405 389 Rate 427.9 442.7 489.7 510.1 446.3 443.1 455.1 440.5 427.5 400.9 85+ Number 105 113 138 128 117 125 128 114 113 109 Rate 462.0 481.7 562.5 504.9 446.1 464.5 462.5 399.0 387.6 361.2 Total Number 1787 1861 2002 2080 2035 2051 2139 2169 2049 1994 Crude Rate 78.6 81.1 86.4 89.0 86.3 86.2 89.1 89.5 83.8 80.8 Age—adjusted Rate 78.6 80.8 85.6 87.6 84.6 84.1 86.6 86.8 80.7 77.6 Table 2.3 Estimated Numbers in Thousands of Hospital Discharges and Discharge Rates per 10,000 Population for Ischemic Heart Disease as the Primary Diagnosis, by Age Group and Year, Men, United States, 1980-1989 Age 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 0-34 Number 14 18 16 15 15 13 16 13 14 13 Rate 2.1 2.7 2.3 2.2 2.2 1.9 2.3 1.9 2.0 1.9 35-44 Number 73 74 82 84 90 90 83 81 77 76 Rate 58.0 57.3 59.6 58.8 60.2 58.1 51.1 47.9 44.2 42.5 45-54 Number 201 214 208 222 212 232 214 219 205 203 Rate 182.5 196.1 191.0 204.7 194.6 212.0 193.8 194.2 175.7 168.9 55-64 Number 320 321 345 366 352 345 357 373 351 325 Rate 314.6 312.9 334.0 351.6 336.7 330.1 343.0 361.1 342.9 320.8 65-74 Number 260 287 288 312 329 317 356 364 357 352 Rate 382.5 414.8 408.9 433.8 450.2 425.2 467.5 467.3 451.6 437.0 75-84 Number 144 141 172 186 156 167 178 185 176 170 Rate 497.7 475.6 566.2 598.0 487.1 507.8 529.6 533.2 494.0 463.2 85+ Number 38 40 51 44 42 41 47 33 39 35 Rate 551.2 567.9 704.5 593.1 550.7 537.1 594.6 417.4 481.1 408.6 Total Number 1050 1095 1161 1229 1195 1205 1251 1268 1219 1174 Crude Rate 95.1 98.2 103.1 108.1 104.2 104.1 107.0 107.4 102.4 97.6 Age-adjusted Rate 105.1 108.2 113.8 118.4 113.0 112.6 115.7 115.2 109.4 103.6 32 Ischemic Heart Disease Surveillance Table 2.4 Estimated Numbers in Thousands of Hospital Discharges and Discharge Rates per 10,000 Population for lschemic Heart Disease as the Primary Diagnosis, by Age Group and Year, Women, United States, 1 980-1 989 Age 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 0-34 Number 5 8 7 7 7 6 8 7 5 5 Rate 0.7 1.3 1.1 1.0 1.0 0.9 1.2 1.0 0.8 0.7 35-44 Number 19 20 24 21 25 23 25 26 27 22 Rate 14.7 15.0 16.9 14.0 16.1 14.6 14.7 14.9 14.9 12.0 45-54 Number 82 74 82 72 80 78 79 94 85 82 Rate 69.7 63.3 70.9 62.8 69.6 67.3 67.8 79.2 69.1 64.8 55-64 Number 152 155 173 179 170 170 180 186 156 160 Rate 131.2 133.2 147.6 151.8 143.9 144.0 153.7 160.0 136.0 141.1 65-74 Number 223 223 240 248 255 262 283 286 253 258 Rate 251.2 247.6 262.6 267.5 271.9 275.3 292.9 291.4 255.9 257.0 75-84 Number 189 212 228 241 228 224 232 223 229 219 Rate 386.7 423.3 444.6 458.1 422.1 404.7 410.8 385.0 387.4 363.0 85+ Number 67 73 87 84 75 84 81 80 74 75 Rate 423.3 445.0 503.3 468.8 403.9 435.5 410.3 391.8 351.2 342.8 Total Number 737 766 841 852 840 846 888 901 830 821 Crude Rate 63.1 64.9 70.7 70.9 69.3 69.2 72.1 72.5 66.2 64.9 Age-adjusted Rate 56.4 57.5 62.1 61.8 60.4 59.9 62.2 62.7 56.5 55.3 Table 2.5 Estimated Numbers in Thousands of Hospital Discharges and Discharge Rates per 10,000 Population for lschemic Heart Disease as the Primary Diagnosis, by Age Group and Year, White Men, United States, 1980-1989 Age 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 0-34 Number 12 17 11 10 12 1O 13 8 11 8 Rate 2.1 3.1 2.0 1.8 2.2 1.7 2.2 1.5 1.9 1.4 3544 Number 61 66 71 72 76 75 66 64 64 62 Rate 55.1 58.2 58.6 57.2 58.4 55.2 47.1 43.7 42.5 40.3 45-54 Number 170 200 182 191 177 194 179 182 167 174 Rate 174.5 206.7 189.9 199.6 185.4 203.1 185.5 185.3 164.3 165.5 55-64 Number 267 301 301 318 303 298 298 314 297 275 Rate 291.3 326.1 324.3 341.4 325.1 319.0 321.7 343.6 328.6 307.6 65-74 Number 219 271 252 271 283 271 308 311 303 296 Rate 357.7 435.7 397.6 417.7 429.7 404.7 449.7 443.7 426.7 411.1 75—84 Number 121 134 148 160 134 143 155 155 151 144 Rate 463.6 501.3 540.3 568.0 463.6 481.1 507.3 495.1 467.6 432.7 85+ Number 31 37 42 39 36 35 39 28 30 30 Rate 491.2 587.3 642.0 589.6 522.1 513.1 550.8 384.8 404.3 392.7 Total Number 881 1027 1008 1060 1021 1026 1057 1062 1022 988 Crude Rate 92.6 107.1 104.3 109.0 104.2 103.9 106.3 106.0 101.3 97.2 Age-adjusted Rate 98.3 113.3 110.2 114.3 108.2 107.6 109.9 108.6 103.3 98.5 lschemic Heart Disease Surveillance 33 Table 2.6 Estimated Numbers in Thousands of Hospital Discharges and Discharge Rates per 10,000 Population for lschemic Heart Disease as the Primary Diagnosis, by Age Group and Year, White Women, United States, 1980-1989 Age 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 0-34 Number 5 8 5 5 6 5 7 5 3 3 Rate 0.9 1.4 0.8 1.0 1.0 0.9 1.2 0.9 0.6 0.6 35-44 Number 14 15 20 16 20 17 19 20 20 17 Rate 12.0 13.2 16.0 12.5 15.2 12.4 13.4 13.4 13.0 11.0 45-54 Number 68 62 66 58 63 61 61 71 64 60 Rate 66.7 61.4 65.5 58.4 63.5 61.0 61.5 69.7 60.3 55.7 55-64 Number 125 137 147 150 141 140 143 144 122 123 Rate 120.7 131.9 141.3 143.7 134.9 134.1 138.4 141.8 122.3 124.4 65-74 Number 186 203 207 213 21 1 222 240 237 203 209 Rate 233.3 250.8 252.8 256.6 250.4 260.9 278.7 270.5 230.5 234.3 75-84 Number 164 199 197 208 198 189 196 184 191 180 Ftate 365.7 433.7 418.8 431.9 402.9 375.4 381.5 350.1 356.4 328.7 85+ Number 54 71 74 76 66 70 68 67 63 69 Rate 367.1 463.9 466.6 457.5 382.6 398.8 374.1 356.5 328.5 345.3 Total Number 615 694 715 726 704 703 735 727 667 661 Crude Rate 61.5 68.9 70.5 71.1 68.5 68.0 70.6 69.4 63.2 62.3 Age-adjusted Rate 52.3 57.8 58.8 58.6 56.5 55.7 57.6 56.8 50.9 49.9 Table 2.7 Estimated Numbers in Thousands of Hospital Discharges and Discharge Rates per 10,000 Population for lschemic Heart Disease as the Primary Diagnosis, by Year, Black Men and Black Women, United States, 1980-1989 Group 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 Black Men Number 46 49 48 60 61 58 68 72 62 50 Crude Rate 36.0 38.3 37.0 45.6 45.7 42.6 48.9 51.6 43.7 34.5 égte-adeSted 52.6 55.3 53.6 65.0 64.1 61.4 69.6 72.2 61.8 47.2 a e Black Women Number 49 55 55 58 65 65 69 63 70 67 Crude Rate 35.0 38.4 37.6 39.2 43.6 42.6 44-9 40.7 44.1 41.6 Age-adjusted 43.6 47.1 45.6 47.9 52.9 51.2 53.7 48.6 52.1 49.3 Rate 34 lschemic Heart Disease Surveillance Table 2.8 Estimated Numbers in Thousands of Hospital Discharges and Discharge Rates per 10,000 Population for lschemic Heart Disease as Any Listed Diagnosis, by Age Group and Year, United States, 1980-1989 Age 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 0-34 Number 35 44 38 35 31 34 35 32 30 25 Rate 2.6 3.3 2.9 2.6 2.4 2.6 2.6 2.4 2.2 1.9 35-44 Number 123 119 135 138 149 138 141 139 133 129 Rate 47.8 45.2 48.2 47.1 49.1 43.7 42.9 40.8 37.8 35.4 45-54 Number 413 422 428 426 414 431 404 413 405 392 Rate 181.5 187.0 190.4 190.4 184.7 191.6 177.8 178.1 168.4 158.2 55-64 Number 790 796 843 895 884 843 858 882 820 771 Rate 363.0 362.8 381.7 403.3 397.2 378.8 387.5 402.3 377.4 359.1 65-74 Number 1060 1131 1138 1207 1283 1222 1296 1298 1224 1223 Rate 677.4 711.1 704.0 733.1 768.9 720.8 750.7 738.0 687.3 676.7 75-84 Number 925 988 1048 1143 1141 1073 1100 1082 1039 1021 Rate 1188.5 1240.9 1283.3 1364.8 1329.4 1218.7 1219.1 1169.4 1096.2 1052.2 85+ Number 377 381 423 446 440 430 436 419 416 423 Rate 1662.0 1619.3 1729.4 1759.6 1680.9 1600.1 1575.7 1469.4 1420.8 1398.5 Total Number 3723 3881 4053 4289 4343 4172 4270 4266 4066 3984 Crude Rate 163.8 169.1 175.0 183.5 184.2 175.3 177.8 176.1 166.3 161.4 Age-adjusted Rate 163.8 168.1 172.5 179.3 178.7 169.2 170.5 167.9 157.6 151.9 Table 2.9 Estimated Numbers in Thousands of Hospital Discharges and Discharge Rates per 10,000 Population for lschemic Heart Disease as Any Listed Diagnosis, by Age Group and Year, Men, United States, 1980-1989 Age 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 0-34 Number 21 28 23 22 20 23 22 18 20 16 Rate 3.1 4.2 3.4 3.4 3.0 3.4 3.3 2.6 3.0 2.4 35-44 Number 93 89 101 105 114 107 104 100 95 95 Rate 73.1 68.6 73.8 72.8 76.0 68.6 64.2 59.5 55.0 53.3 45-54 Number 278 294 287 303 284 307 277 277 273 271 Rate 253.1 269.2 263.8 278.7 260.6 281.0 251.0 245.7 233.5 225.0 5564 Number 502 491 525 562 558 542 548 570 544 506 Rate 493.2 478.2 507.7 540.6 534.3 518.1 526.1 552.3 531.0 499.5 65-74 Number 554 610 594 636 692 657 703 718 695 686 Rate 815.3 882.8 843.3 884.9 946.5 882.6 923.4 921.6 878.8 852.8 75-84 Number 394 396 442 477 461 459 483 500 456 455 Rate 1364.4 1339.2 1456.7 1533.1 1442.1 1398.8 1432.7 1440.8 1279.8 1240.2 85+ Number 129 126 150 152 151 134 154 139 140 145 Rate 1871.3 1802.2 2079.7 2062.3 2008.0 1746.0 1960.5 1734.0 1704.3 1716.9 Total Number 1969 2034 2121 2257 2279 2229 2291 2321 2223 2175 Crude Rate 178.4 182.4 188.4 198.6 198.7 192.5 196.0 196.7 186.6 180.8 Age-adjusted Rate 204.2 207.6 214.1 223.9 222.2 213.6 216.9 215.9 203.6 196.1 lschemic Heart Disease Surveillance 35 Table 2.10 Estimated Numbers in Thousands of Hospital Discharges and Discharge Rates per 10,000 Population for lschemic Heart Disease as Any Listed Diagnosis, by Age Group and Year, Women, United States, 1 980-1 989 Age 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 0-34 Number 14 16 16 12 11 11 13 15 9 9 Rate 2.1 2.4 2.4 1.8 1.7 1.7 2.0 2.2 1.4 1.4 35-44 Number 31 31 34 33 36 32 37 39 37 33 Rate 23.4 22.7 23.5 22.4 23.0 19.6 22.2 22.7 21.0 18.1 ‘ 45-54 Number 135 128 141 124 131 124 127 136 132 121 Rate 114.5 110.0 121.5 107.4 113.2 107.4 108.8 114.3 106.7 95.0 55-64 Number 288 305 318 333 326 301 310 312 276 264 Rate 248.6 261.3 270.8 282.2 275.8 255.2 264.4 268.8 240.4 233.4 65-74 Number 507 521 545 570 591 564 593 580 529 537 Rate 571.8 579.2 596.5 615.4 630.5 593.9 614.3 592.0 534.5 535.4 75-84 Number 531 592 606 666 681 614 617 583 583 566 Rate 1084.8 1182.9 1180.9 1265.3 1262.7 1111.7 1091.7 1006.7 985.4 937.9 85+ Number 249 254 273 294 288 296 282 280 276 278 Rate 1571.1 1541.5 1583.3 1635.4 1548.6 1541.8 1423.6 1365.9 1310.7 1275.1 Total Number 1753 1847 1932 2032 2064 1 943 1980 1945 1843 1808 Crude Rate 150.1 156.6 162.3 169.2 170.4 159.0 160.6 156.4 146.9 142.9 Age—adjusted Rate 131.4 135.8 139.5 143.4 143.5 132.8 133.8 129.9 120.6 116.4 Table 2.11 Estimated Numbers in Thousands of Hospital Discharges and Discharge Rates per 10,000 Population for lschemic Heart Disease as Any Listed Diagnosis, by Age Group and Year, White Men, United States, 1980-1989 Age 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 0-34 Number 16 27 17 15 15 16 16 11 15 11 Rate 2.9 4.8 3.1 2.8 2.8 2.8 2.9 1.9 2.8 1.9 3544 Number 75 78 86 88 93 88 84 79 78 75 Rate 68.1 69.1 71.1 69.9 71.4 65.1 59.5 53.9 52.1 48.7 45-54 Number 235 272 249 257 235 256 229 227 224 223 Rate 241.0 281.7 260.1 268.7 245.7 267.7 238.3 232.0 219.6 212.9 55-64 Number 41 1 457 452 487 483 460 459 480 461 430 Rate 447.7 494.8 487.3 523.2 518.0 493.0 495.8 524.6 509.9 482.2 65-74 Number 462 573 515 552 591 567 610 612 600 590 Rate 754.9 920.4 811.9 851.9 897.9 845.1 890.4 873.7 845.5 817.9 75-84 Number 331 375 383 413 401 397 418 419 396 387 Rate 1264.8 1402.1 1396.3 1467.4 1388.7 1339.3 1371.2 1334.3 1230.4 1167.2 85+ Number 105 119 129 138 133 116 128 117 120 130 Rate 1674.9 1872.8 1974.8 2064.8 1949.3 1688.9 1823.2 1620.4 1634.0 1712.5 Total Number 1636 1903 1832 1950 1952 1900 1944 1944 1895 1846 Crude Rate 171.8 198.4 189.7 200.4 199.2 192.5 195.6 194.1 187.8 181.7 Age-adjusted Rate 188.4 216.3 206.0 216.1 212.8 203.9 206.2 202.7 195.0 187.5 36 lschemic Heart Disease Surveillance Table 2.12 Estimated Numbers in Thousands of Hospital Discharges and Discharge Rates per 10,000 Population gar Ischemic Heart Disease as Any Listed Diagnosis, by Age Group and Year, White Women, United tates, 1980-1989 Age 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 0-34 Number 11 13 11 10 1O 9 10 11 5 5 Rate 2.1 2.4 2.1 1.8 1.8 1.7 1.9 2.0 0.9 0.9 35-44 Number 22 23 26 25 28 23 28 30 28 27 Rate 19.2 20.2 21.0 19.5 20.8 16.5 19.9 20.3 18.3 17.3 45-54 Number 109 105 110 96 102 95 97 101 95 87 Rate 106.2 103.6 109.5 96.5 103.2 95.5 96.6 99.2 89.9 79.8 55-64 Number 229 267 261 274 265 248 246 241 219 204 Rate 221.8 257.1 250.4 261.9 254.1 238.5 238.5 237.1 218.8 207.5 65-74 Number 420 474 469 487 498 471 504 477 431 445 Rate 525.9 586.8 571.6 585.6 591.9 554.2 584.8 545.1 487.9 498.5 75-84 Number 442 553 524 578 594 528 526 491 495 479 Rate 985.7 1206.7 1115.9 1203.1 1207.2 1048.7 1022.7 932.7 922.7 875.6 85+ Number 203 240 234 254 251 257 237 239 239 249 Rate 1388.9 1576.0 1469.4 1536.1 1463.0 1456.7 1304.1 1274.9 1239.8 1253.5 Total Number 1436 1676 1635 1724 1747 1631 1649 1590 151 1 1496 Crude Rate 143.6 166.4 161.2 168.8 170.1 157.7 158.4 151.8 143.3 140.9 Age-adjusted Rate 119.1 136.1 130.8 134.9 134.8 123.9 124.2 118.3 110.1 107.2 Table 2.13 Estimated Numbers in Thousands of Hospital Discharges and Discharge Rates per 10,000 Population for Ischemic Heart Disease as Any Listed Diagnosis, by Year, Black Men and Black Women, United States, 1980-1989 Group 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 Black Men Number 97 99 102 117 128 125 129 138 120 110 Crude Rate 76.3 77.1 78.1 88.4 95.1 91.7 93.0 98.0 84.6 75.9 age-adjusted 116.9 116.9 118.5 131.7 141.6 136.7 138.0 144.7 124.0 109.0 a e Black Women Number 126 133 137 146 153 148 154 146 154 138 Crude Rate 89.3 93.2 93.9 99.3 102.7 97.6 100.5 94.0 97.6 86.2 Age-adjusted 112.1 115.2 115.2 121.6 125.0 117.8 119.8 112.5 115.7 102.3 Rate Ischemic Heart Disease Surveillance 37 Table 2.14 Number of Hospital Discharges in Thousands with lschemic Heart Disease as Primary Diagnosis and Discharge Rate per 10,000 Population, by Region and Year, United States, 1980-1989 Region 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 Northeast Number 437 415 461 483 452 462 474 485 500 487 Rate 88.8 84.2 93.6 97.5 91.2 92.9 94.8 96.6 99.0 96.1 Adjusted Rate 81.8 76.2 85.5 88.3 82.3 83.2 84.9 86.2 87.7 84.6 North Central Number 486 512 533 521 556 534 568 589 521 540 Rate 82.5 86.9 90.6 88.7 94.6 90.7 96.3 99.6 87.8 90.6 Adjusted Rate 86.5 84.8 91.2 88.2 93.6 89.6 95.1 99.2 85.9 86.6 South Number 580 624 682 712 701 704 730 689 698 646 Rate 76.6 81.1 87.1 89.7 87.3 86.5 88.6 82.9 83.2 76.3 Adjusted Rate 77.1 83.8 88.5 90.9 87.1 85.0 86.7 81.1 81.0 74.3 West Number 284 310 326 364 324 351 367 406 331 323 Rate 65.4 69.9 72.1 78.9 69.1 73.2 75.2 81.5 65.0 62.0 Adjusted Rate 73.5 76.1 79.7 86.5 74.7 78.8 79.9 85.8 67.3 63.2 Table 2.15 Number of Hospital Discharges in Thousands with lschemic Heart Disease as Any Listed Diagnosis and Discharge Rate per 10,000 Population, by Region and Year, United States, 1980-1989 Region 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 Northeast Number 968 963 1012 1045 1077 1090 1090 1078 1079 1009 Rate 197.0 195.6 205.4 211.2 216.9 219.1 218.2 214.8 213.9 199.2 Adjusted Rate 182.5 175.6 186.2 189.0 193.0 192.9 190.7 186.7 184.9 170.9 North Central Number 1031 1079 1114 1111 1186 1093 1093 1114 1065 1104 Rate 175.1 183.1 189.3 189.2 201.6 185.6 185.4 188.4 179.4 185.5 Adjusted Rate 183.7 177.7 189.7 186.2 196.2 180.3 179.3 184.1 170.4 172.9 South Number 1 194 1272 1329 1441 1428 1337 1392 1333 1333 1279 Rate 157.6 165.3 169.7 181.5 177.7 164.3 169.0 160.3 158.9 151.1 Adjusted Rate 158.2 170.6 171.8 182.6 175.7 160.4 163.5 154.3 153.0 144.6 West Number 529 567 598 692 652 651 695 741 589 592 Rate 121.8 127.9 132.2 149.9 138.9 136.0 142.3 148.6 115.9 113.9 Adjusted Rate 139.1 140.8 147.2 165.3 151.0 146.5 151.4 156.1 119.8 115.8 33 lschemic Heart Disease Surveillance Chapter 3. Prevalence and Incidence of Nonfatal Ischemic Heart Disease Introduction In this section we present data on the prevalence and incidence of ischemic heart dis- ease (IHD) in the United States during the pe- riod 1980—1989. The data are limited to questionnaire respondents who were aware that they had a condition related to IHD. IHD prevalence is defined as the total number of people known to have IHD at a particular point in time, and IHD incidence as the number of people who discovered they had IHD for the first time during the year preceding the inter— view. We present results by calendar year, age, sex, and race. Methods The incidence and prevalence of self-re- ported IHD were determined from the 1980— 1989 National Health Interview Surveys (NHIS)* (see endnote page 45). The NHIS is a multistage cluster sample survey that has been continuously conducted since 1957. It provides information about the health status of the civil— ian, noninstitutionalized population of the United States. The reader should note that the NHIS was redesigned in 1985 and some changes in questionnaire format were made during the decade. Such changes may have had an effect on the estimates of annual prevalence and incidence.1 The NHIS questionnaire includes lists of selected health conditions, including ones re- lated to IHD. For this report, we selected con- ditions that were coded in the 410-414 range according to the International Classification of Disease, Ninth Revision (ICD—9). The IHD Ischemic Heart Disease Surveillance conditions list included the following ques- tions: 1) "During the past 12 months, did any- one in the family have coronary heart disease, angina pectoris, myocardial infarction, or other heart attack?"; 2) "Who was this?"; and 3) "Dur- ing the past 12 months, did anyone else have coronary heart disease, angina pectoris, myo— cardial infarction, or other heart attack?" If someone in the household had one of the indi- cated conditions, the time when the condition first occurred was ascertained. An incident case of IHD was considered to be a person who reported the initial onset of an IHD condition during the past 12 months. The annual number of respondents to the questions related to IHD ranged from 17,000 to 20,000, except for 1985 (15,000) and 1986 (10,000). For each year, the numbers of preva- lent and incident cases of IHD among survey respondents were projected to reflect national estimates. We used the SESUDAAN computer software package to calculate incidence and prevalence rates and their standard errors.2 Es- timates of the non-institutionalized civilian population of the United States were used as denominators in calculating rates. We age-ad- justed the incidence and prevalence rates by direct standardization t0 the 1980 US. non-in- stitutionalized civilian population. The preva- lences were based upon the number of individuals with any IHD-related diagnosis rather than the number of conditions experi- enced by all survey respondents (the latter method has been used by NCHS to estimate the prevalence of IHD and other conditions). 39 Results IHD Prevalence From 1980 through 1989, the estimated number of persons in the United States with IHD was approximately 5 to 6 million; in 1989, an estimated 5.8 million persons were aware that they had IHD (Figure 3.1). We present estimates of the prevalence of IHD by year of interview, age, sex, and race (Tables 3.1—3.5); note that in Table 3.6 for black men and women, the estimates are less reliable because of the smaller number of cases of IHD. The age—ad- justed prevalence of IHD was about 22 to 26 per 1,000 between 1980 and 1989 (Figure 3.2). IHD prevalence was highest among white men (Figure 3.3, Table 3.4). For these men, the age—adjusted prevalence ranged from 28 to 36 per 1,000 during 1980 to 1989 (Table 3.4). The prevalence for white women ranged from 15 to 22 per 1,000 during the lO-year period (Table 3.5). The age—adjusted prevalence for black 8. g e. .9 Figure 3.1 Number of Persons with E Ischemic Heart Disease, E 4 United States, 1980-1989 a ' 83 ”5 B 2. .D E 3 Z 0 . 30. 25. . . g 20. Figure 3.2 Age-adjusted Prevalence of E’— lschemic Heart Disease, '3 15_ United States, 1980-1989 E g 10- E [L 5. 0 80 men and black women were less stable than those for whites and fluctuated between 8 and 22 per 1,000 for black men and between 8 and 26 per 1,000 for black women (Tables 3.6). As expected, the prevalence of IHD dif— fered markedly by age group for both men and women, with older age groups generally having higher prevalences than younger age groups. The trends in IHD prevalence by age group exhibited generally similar patterns for men and women (Figures 3.4 and 3.5; Tables 3.2—3.3). The 75 to 84 year old age group showed the largest increase——from 104 per 1,000 in 1980 to 188 per 1,000 in 1989 among men and from 100 to 122 per 1,000 among women for the same period. The prevalence of IHD in the 45 to 54 year old age group decreased for both sexes. No clear upward or downward trends emerged in the other age groups. 81 82 83 84 85 Year 86 87 88 89 M 40 80 84 85 86 87 88 89 Year 81 82 83 lschemic Heart Disease Surveillance Figure 3.3 Age-adjusted Prevalence of Ischemic Heart Disease by Race and Sex, United States, 1980—1989 Figure 3.4 Age-adjusted Prevalence of Ischemic Heart Disease by Age Group Among Men, United States, 1980-1989 Figure 3.5 Age-adjusted Prevalence of Ischemic Heart Disease by Age Group Among Women, United States, 1980-1989 Ischemic Heart Disease Surveillance 40. /'\ )— ’\. /" V \ §30_ 0/. O. 0/ as 8 m 20. 8 g mm > 9 WHEIQWRFI‘R a 10- - '1» JilacLMgn. 0 glackWomeg 80 81 82 83 84 85 86 87 88 89 Year 2001 A 150. o o O. '63 8100. 0) U C 2 m > 9 50. n. O l I l I I I I I I l *I 80 81 82 83 84 85 86 87 88 89 Year 150. 8 8_ 100. ._ _, 1— / \ 5-, I ‘0 /" \ Q / \ / \ , °\ 45 4 8 I \o/ \- \.°—-5 -‘ 5 . ‘ ...55:.6.4... (g 50. g '1...“ O 2 . ._65-_74, D— . ........ g‘ 0' ........ .s‘ 0 ,IO 75-84 \0 —o x ‘\ \f o\ O O I l I I l l l I l I I 80 81 82 83 84 85 86 87 88 89 Year 41 IHD Incidence The age—adjusted incidence rate of nonfa- tal IHD was between 2.2 and 2.4 per 1,000 persons per year from 1980 through 1982 (Fig— ure 3.6, Table 3.7). In 1983, the rate increased to 3.2 per 1,000 and fluctuated between 2.8 and 3.1 per 1,000 over the remaining years through 1989. The sex-specific incidence rates were de- termined predominantly by the rates for white men and women. Because of small sample sizes, the rates for black men and women were too unstable to allow reliable estimates For white women, the age-adjusted incidence rate of nonfatal IHD increased from 1.2 to 2.7 per 1,000 per year from 1980 to 1989 (with a large increase between 1982 and 1983) (Figure 3.7, Table 3.11). During the same time period, the incidence rate for white men decreased slightly from 3.7 to 3.3 per 1,000 per year (Table 3.10). The incidence rates for specific age groups tended to be unstable (Figure 3.8, Table 3.7); however, incidence was generally higher for older age groups. The most notable finding in the age-specific incidence rates was the large increase in the rates in 1983 among the 75 to 84 year old age group--from 7.0 per 1,000 in 1982 to 17.1 per 1,000 in 1983. The 55 to 64 year age group appeared to have a generally upward trend in incidence rates, whereas among 45 to 54 year olds the trend appeared to be generally downward. 4i A 3_ h (a 8 / \ 0/ \.\o 0 Figure 3.6 Age-adjusted Rates for Incidence v: o—o of Nonfatallschemic Heart Dis— 3 2 / ease, United States, 1980-1989 E E E 1- 0 I I I I I I l I l l 80 81 82 83 84 85 86 87 88 89 Year 5. 0/ \ o 4. Figure 3.7 Age-adjusted Rates for Incidence of Nonfatal Ischemic Heart Dis- ease Among White Men and Women, United States, 1980-1989 Incidence (per 1 ,000) White Mgr. .WhiifiWPm‘it‘. 80 42 81 82 83 84 85 86 87 88 89 Year ischemic Heart Disease Surveillance 20. Figure 3.8 Age—adjusted Rates for Incidence of Nonfatal Ischemic Heart Disease by Age Group, United States, 1980-1989 Incidence (per 1,000) 8 Discussion Nearly six million people in the United States report living with IHD. That number has remained fairly constant since 1983, as has the prevalence of about 25 per 1,000. The prevalence during the period 1980 through 1989 was consistently highest for white men, the only group of the four race-sex groups to show an increasing trend in prevalence over the 10-year period. Among 75 to 84 year old men, the prevalence of IHD nearly doubled between 1980 and 1989. For both men and women 45 to 54 years of age, the prevalence of IHD de— creased. The incidence rate of IHD exhibited a step increase in 1983 and remained relatively con— stant thereafter at about 3.0 new cases per 1,000 persons per year. The step increase in 1983 was most marked among people 75 to 84 years old. Incidence rates also increased among the 55 to 64 year age group, but decreased among those who were 45 to 54 years old. One of the most remarkable findings was the doubling of the incidence rate for white women. In 1980, the incidence rate of IHD was more than two times higher for white men than for white women, but by 1988 the rate for white women approached that for white men. The estimates of incidence and prevalence of nonfatal IHD from NHIS are based on self— reports of survey respondents. A number of Ischemic Heart Disease Surveillance \o- 83 84 85 86 87 88 89 Year 80 81 82 factors in addition to actual disease trends could be influencing the findings. Kannel estimated that one in five coronary events is heralded by sudden death as the first and only indication of the disease.3 Thus, the incidence results from the NHIS may underestimate the actual inci- dence of IHD by about 20%. Sudden death as the only clinical manifestation of IHD, how— ever, would not affect the prevalence estimates. Self—reported IHD is also influenced by diagnosis and awareness of IHD-related condi— tions. A large proportion of people with IHD do not know they have the disease. Data from the Framingham Study4 indicate that 26% of myocardial infarctions in men and 34% in women may be unrecognized; that is, the person experiences no symptoms that would suggest that he or she is having a heart attack. Thus, estimates of the incidence and prevalence of IHD that are based on self-reports would tend to underestimate the true burden of IHD. Awareness and reporting of IHD also are not perfect. Studies have found that 56% to 84% of self—reported heart disease or myocar- dial infarction can be corroborated by medical records. Conversely, 52% to 79% of persons for whom a medical record mentions that he or she has heart disease, do not report the condi- tion. Thus, the problems of overreporting and underreportin g heart disease seem to be of simi- 43 lar magnitude, and their combined net effect on self—reported estimates of overall heart disease incidence and prevalence may not be large. The degree to which reporting accuracy varies be— tween different population groups or over time, however, is not known, and differences in re- porting may be influencing some of the results and trends identified in this report. Changes in medical care reimbursement policies may also have influenced the estimates of trends in the occurrence of IHD. In 1983, Medicare instituted the prospective payment system with diagnosis—related groups (DRGs) for reimbursement. In 1983, we also noted step increases in the overall prevalence and inci- dence of reported IHD, as well as increases in IHD incidence among 75 to 84 year old people and among white women. The Medicare reim- bursement change may have resulted in more people receiving a diagnosis of IHD as a reason for hospitalization and then reporting this con- dition in subsequent surveys. A major limitation of the NHIS data is the relatively small number of blacks and other minorities included in the survey. As a result, we were not able to obtain stable estimates of IHD trends for groups other than white men and white women. Because the estimates of IHD are based upon self—reports, the NHIS does not provide perfect estimates of the true IHD incidence and prevalence. However, it can point out trends that deserve attention. One of the largest in— creases in IHD prevalence during the 19805 occurred among 75 to 84 year old men, among whom the prevalence nearly doubled from 104 per 1,000 in 1980 to 188 per 1,000 in 1989. Possible reasons for the increase include in- creased diagnosis of IHD in the older age groups as a result of improved or more aggres— 44 sive diagnostic testing, increased diagnosis of IHD in the elderly in response to prospective payment and DRGs, and longer survival of persons with IHD as a result of improvements in treatment. Another striking trend from the N HIS data is the substantial increase in IHD incidence among white women. The largest increase oc— curred in 1983 and may be related to the insti- tution of DRGs. Also, increasing awareness of IHD as an important health problem among women may have contributed to some of the increased diagnosis and reporting of IHD by women during the 1980s. Both of these possi- bilities would suggest that less specific symp- toms of possible IHD were more likely to be diagnosed and reported as IHD. To determine if this actually happened, we examined the in- dividual conditions composing ICD—9 codes 410-414 in NHIS. If most of the increase in incidence among women had been due to more frequent attribution of nonspecific symptoms of IHD, we would have expected to see an increas- ing proportion of IHD conditions being repre— sented by angina pectoris. Among reported incident cases of IHD among women in 1980, 1985, and 1989, the proportion that was due to angina pectoris remained stable at 28% (among men, the proportion varied from 27% to 36%). Thus, increased diagnosis and awareness of IHD probably do not account for the increase in IHD incidence among women. The decreasing prevalence and incidence of IHD in the 45 to 54 year old age group are among the more encouraging trends that emerged from the NHIS data. Current heart disease prevention activities will likely first reduce the incidence of IHD among the young age groups. Such a decrease in the young, in particular, would suggest that efforts to de— crease heart disease risk factors and promote a healthier lifestyle may prevent, or reduce the number of new cases of heart disease. lschemic Heart Disease Surveillance References 1. National Center for Health Statistics, Vital and Health Statistics Reports, Series 1, No. 18, The National Health Interview Survey Design, 1973-84, and Proce— dures, 1975-83. 2. Shah BV. SESUDAAN: Standard errors program for conputing of standardized rates from sample survey data. Research Triangle Park, North Carolina: Research Triangle Institute, 1981 3. Kannel WB, Doyle JT, Ostfeld AM, et al. Optimal resources for primary prevention of atherosclerotic dis- eases. Circulation 1984;70:157A-205A. 4. Kannel WB, Cupples LA, Gagnon DR. incidence, precursors and prognosis of unrecognized myocardial infarction. Adv Cardiol. Basel, Karger, 1990;37:202-14. 5. Harlow SD, Linet MS. Agreement between question- naire data and medical records. Am J Epidemiol 1989; 1 292233—48. Endnote *Age-specific prevalence among black men and black women were not presented because the stability of those estimates was generally low. in order to improve the stability of the prevalence estimates and also provide basic surveillance information on these two groups, data were combined across age group and only crude prevalence and age-adjusted prevalence were reported. Because estimates of incidence for black men and black women were even more unstable, no incidence estimates were reported for these two groups. Ischemic Heart Disease Surveillance 45 Chapter 3 Tables Table 3.1 Estimated Numbers in Thousands and Prevalence per 1,000 Population of lschemic Heart Disease, by Age Group and Year, United States, 1980-1989 Age 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 0-34 Number 84 128 121 109 37 33 251 129 69 125 Prevalence 0.7 1.0 0.9 0.8 0.3 0.3 1.9 1.0 0.5 0.9 35-44 Number 305 192 209 267 224 173 273 252 336 275 Prevalence 12.0 7.3 7.6 9.2 7.4 5.5 8.4 7.5 9.7 7.6 45-54 Number 796 939 703 733 602 615 892 687 698 466 Prevalence 35.3 41.9 31.6 33.1 27.1 27.5 39.3 29.7 29.2 18.9 55-64 Number 1234 1162 1531 1702 1760 1788 1359 1483 1786 1587 Prevalence 58.8 53.4 69.9 77.4 79.8 80.8 61.7 67.9 82.5 74.1 65-74 Number 1428 1680 1481 1920 2172 1899 1829 2088 1920 1631 Prevalence 93.8 107.7 93.5 119.7 133.3 113.8 107.7 120.6 109.3 91.5 75-84 Number 711 748 841 932 1094 1004 1243 1104 1269 1319 Prevalence 101.4 96.0 109.7 117.2 138.0 117.5 144.3 127.6 141.0 146.5 85+ Number 159 173 176 232 186 292 245 352 178 351 Prevalence 95.8 118.4 93.0 122.7 86.7 161.0 126.7 160.9 84.2 146.8 Total Number 4716 5022 5061 5897 6074 5803 6092 6096 6257 5753 Crude Prevalence 21.6 22.3 22.3 25.7 26.2 24.8 25.8 25.6 26.0 23.6 Age-adjusted Prevalence 21.6 22.4 22.2 25.5 25.9 24.4 25.2 24.8 25.2 22.7 Table 3.2 Estimated Numbers in Thousands and Prevalence per 1,000 Population of lschemic Heart Disease, by Age Group and Year, Men, United States, 1980-1989 Age 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 0-34 Number 56 84 57 66 12 0 130 50 48 100 Prevalence 0.9 1.3 0.9 1.0 0.2 0.0 2.0 0.8 0.7 1.5 35-44 Number 172 106 141 151 152 75 186 159 198 133 Prevalence 14.2 8.3 10.5 10.7 10.3 4.9 11.7 9.7 11.7 7.6 45-54 Number 512 622 463 502 425 383 614 429 487 365 Prevalence 47.0 57.6 43.2 47.0 39.6 35.3 56.0 38.3 42.0 30.5 55-64 Number 667 757 1120 1012 1174 1050 920 1095 1171 1165 Prevalence 67.3 74.6 109.7 98.6 114.1 101.1 89.0 106.6 115.0 115.3 65—74 Number 835 889 856 1017 1264 1076 1123 1186 1099 977 Prevalence 126.0 131.4 124.7 145.9 178.6 147.1 150.0 154.7 140.9 123.2 75-84 Number 271 281 302 399 442 394 537 500 593 631 Prevalence 103.9 96.0 101.4 133.1 151.8 130.5 152.7 153.6 169.8 188.0 85+ Number 46 43 91 80 82 173 65 150 59 135 Prevalence 76.5 91.1 172.1 130.5 112.4 223.8 186.8 206.9 96.7 158.1 Total Number 2559 2783 3030 3227 3549 3150 3576 3568 3654 3506 Crude Prevalence 24.3 25.6 27.7 29.1 31.8 27.9 31.3 30.9 31.3 29.7 Age-adjusted Prevalence 26.2 27.8 30.0 31.7 34.6 30.1 33.7 33.1 33.2 31.9 lschemic Heart Disease Surveillance 49 Table 3.3 Estimated Numbers in Thousands and Prevalence per 1,000 Population of lschemic Heart Disease, by Age Group and Year, Women, United States, 1980-1989 Age 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 0—34 Number 28 44 64 43 25 33 120 79 21 25 Prevalence 0.4 0.7 1.0 0.7 0.4 0.5 1.8 1.2 0.3 0.4 35—44 Number 132 86 68 117 72 98 88 93 138 141 Prevalence 10.1 6.3 4.8 7.8 4.7 6.1 5.2 5.4 7.8 7.7 45-54 Number 283 317 240 231 177 233 278 258 212 101 Prevalence 24.3 27.3 20.8 20.1 15.4 20.1 23.8 21.7 17.1 7.9 55—64 Number 567 405 41 1 690 587 738 439 388 615 422 Prevalence 51.2 34.9 35.1 58.8 49.9 62.8 37.5 33.6 53.7 37.3 65—74 Number 593 791 624 904 908 823 706 903 821 654 Prevalence 68.9 89.6 69.6 99.6 98.6 87.8 74.3 93.6 84.0 66.1 75-84 Number 440 466 539 533 652 610 706 604 677 688 Prevalence 99.9 96.0 114.9 107.6 130.0 110.4 138.5 112.0 122.8 121.8 85+ Number 113 130 85 153 104 118 180 202 120 216 Prevalence 106.8 131.4 62.3 118.9 73.5 114.1 113.5 138.1 79.2 140.5 Total Number 2156 2239 2031 2670 2525 2653 2517 2528 2603 2247 Crude Prevalence 19.1 19.2 17.3 22.5 21.1 22.0 20.6 20.5 21.0 17.9 Age-adjusted Prevalence 17.7 17.7 15.7 20.3 18.8 19.7 18.2 18.0 18.5 15.1 Table 3.4 Estimated Numbers in Thousands and Prevalence per 1,000 Population of lschemic Heart Disease, by Age Group and Year, White Men, United States, 1980-1989 Age 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 0-34 Number 56 84 46 66 12 0 108 50 48 87 Prevalence 1.1 1.5 0.9 1.2 0.2 0.0 2.0 0.9 0.9 1.6 35-44 Number 172 106 141 137 139 75 138 149 183 117 Prevalence 16.1 9.6 12.0 11.1 10.8 5.5 10.0 10.4 12.3 7.8 45—54 Number 488 597 421 460 389 383 588 422 467 331 Prevalence 50.6 62.2 44.5 48.7 41.4 40.3 61.6 43.7 45.8 31.9 55-64 Number 643 744 1048 951 1093 988 866 1069 1037 1077 Prevalence 72.3 81.8 113.9 104.2 116.7 105.6 94.5 117.2 116.8 120.9 65-74 Number 826 879 856 1004 1180 988 1 105 1171 1056 888 Prevalence 138.9 145.4 137.9 158.6 183.0 149.1 164.8 168.8 150.3 124.0 75-84 Number 237 264 302 362 442 394 505 477 572 625 Prevalence 98.6 98.2 113.3 135.6 165.2 145.0 166.5 166.9 184.4 205.9 85+ Number 46 43 91 80 82 173 65 145 54 125 Prevalence 89.3 107.3 184.7 137.6 114.5 233.4 197.6 211.6 92.9 162.3 Total Number 2468 2717 2905 3061 3337 3000 3375 3484 3417 3251 Crude Prevalence 27.1 29.0 31.0 32.2 34.9 30.9 34.8 35.5 34.6 32.5 Age-adjusted Prevalence 28.2 30.4 32.1 33.6 35.9 31.8 36.1 36.3 35.1 33.3 50 lschemic Heart Disease Surveillance Table 3.5 Estimated Numbers in Thousands and Prevalence per 1,000 Population of lschemic Heart Disease, by Age Group and Year, White Women, United States, 1980-1989 Age 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 0-34 Number 28 13 52 43 25 33 96 74 12 25 Prevalence 0.5 0.2 1.0 0.8 0.5 0.6 1.8 1.4 0.2 0.5 35-44 Number 105 76 57 105 72 75 88 48 74 94 Prevalence 9.2 6.5 4.8 8.3 5.5 5.4 6.2 3.3 4.9 6.0 45-54 Number 223 228 205 221 162 221 263 183 161 64 Prevalence 21.9 22.6 20.3 22.5 16.4 22.4 27.3 17.9 15.3 5.9 55-64 Number 496 352 398 638 510 624 433 362 547 376 Prevalence 50.1 34.1 38.4 61.6 48.6 59.9 42.6 36.0 55.2 38.3 65-74 Number 507 693 597 876 835 803 608 862 784 616 Prevalence 65.3 87.2 74.2 107.3 100.7 95.9 71.1 100.7 90.0 69.7 75-84 Number 393 452 539 496 596 610 698 600 631 653 Prevalence 97.8 102.7 127.4 110.4 131.4 121.5 147.8 122.4 125.4 127.6 85+ Number 106 108 85 122 104 118 178 185 115 188 Prevalence 109.6 116.9 65.7 103.0 80.7 119.2 141.6 137.4 85.4 137.0 Total Number 1858 1923 1935 2501 2305 2484 2363 2315 2325 2017 Crude Prevalence 19.2 19.3 19.4 24.9 22.7 24.3 23.1 22.3 22.3 19.2 Age-adjusted Prevalence 17.0 16.8 16.7 21.5 19.2 20.6 19.5 18.5 18.6 15.3 I'able 3.6 Estimated Numbers in Thousands and Prevalence per 1,000 Population of lschemic Heart Disease, by Year, Black Men and Black Women, United States, 1980-1989 Group 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 Black Men Number 92 66 103 140 154 132 81 74 118 226 Crude 7.8 5.3 8.2 11.1 12.1 10.1 6.2 5.5 8.7 16.2 Prevalence Age-Adjusted 12.5 8.1 11.2 15.3 18.2 14.6 8.7 8.3 12.9 22.4 Prevalence Black Women Number 244 302 97 158 195 169 129 191 238 198 Crude 18.2 21.3 6.7 10.8 13.1 11.2 8.5 12.4 15.2 12.4 Prevalence Age-Adjusted 22.4 26.0 7.8 13.1 16.5 13.8 10.7 14.3 16.8 13.5 Prevalence lschemic Heart Disease Surveillance 51 Table 3.7 Estimated Numbers in Thousands and Incidence Rates per 1,000 Population of Nonfatal lschemic Heart Disease, by Age Group and Year, United States, 1980-1989 Age 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 0-34 Number 29 26 23 14 0 0 48 1 1 0 46 Rate 0.2 0.2 0.2 0.1 0.0 0.0 0.4 0.1 0.0 0.3 35-44 Number 66 24 94 50 49 35 59 26 52 52 Rate 2.6 0.9 3.4 1.7 1.6 1.1 1.8 0.8 1.5 1.5 45—54 Number 78 154 89 108 150 97 102 89 86 31 Rate 3.6 7.1 4.1 5.0 6.9 4.4 4.7 4.0 3.7 1.3 55-64 Number 128 109 92 169 157 195 183 154 210 221 Rate 6.5 5.3 4.5 8.3 7.7 9.5 8.8 7.5 10.4 11.0 65-74 Number 111 144 147 205 167 155 124 269 162 91 Rate 8.0 10.3 10.2 14.3 11.7 10.4 8.1 17.4 10.2 5.6 75-84 Number 36 44 48 122 124 104 137 92 130 162 Rate 5.7 6.1 7.0 17.1 17.8 13.6 18.3 12.1 16.5 20.6 85+ Number 0 0 24 23 13 38 25 54 21 61 Rate 0.0 0.0 13.9 13.5 6.8 24.2 14.8 28.8 10.8 28.8 Total Number 448 501 518 692 660 623 679 695 661 663 Crude Rate 2.1 2.3 2.3 3.1 2.9 2.7 2.9 3.0 2.8 2.8 Age-Adjusted Rate 2.2 2.4 2.4 3.2 3.1 2.8 3.0 3.1 2.9 2.8 Table 3.8 Estimated Numbers in Thousands and Incidence Rates per 1,000 Population of Nonfatal lschemic Heart Disease, by Age Group and Year, Men, United States, 1980-1989 Age 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 0-34 Number 12 12 23 14 0 0 26 11 0 29 Rate 0.2 0.2 0.4 0.2 0.0 0.0 0.4 0.2 0.0 0.4 35-44 Number 32 24 94 13 49 14 39 12 25 13 Rate 2.6 1.9 7.0 1.0 3.4 0.9 2.5 0.7 1.5 0.7 45-54 Number 78 68 63 84 107 97 42 77 43 25 Rate 7.5 6.6 6.1 8.2 10.3 9.2 4.1 7.1 3.9 2.1 55-64 Number 96 95 81 119 94 66 107 130 133 118 Rate 10.3 10.1 8.8 12.7 10.2 7.0 11.3 14.0 14.5 13.0 65-74 Number 64 68 87 78 1 11 84 43 122 57 37 Rate 11.0 11.4 14.3 12.9 18.7 13.3 6.8 18.5 8.5 5.3 75-84 Number 24 31 25 70 36 21 40 30 42 70 Rate 10.1 11.4 9.2 26.1 14.5 8.0 13.1 10.8 14.4 25.1 85+ Number 0 0 0 11 13 21 25 25 O 34 Rate 0.0 0.0 0.0 19.8 20.4 33.2 82.4 41.6 0.0 44.7 Total Number 305 298 373 388 410 303 322 407 301 326 Crude Rate 3.0 2.8 3.5 3.6 3.8 2.8 2.9 3.6 2.7 2.8 Age-adjusted Rate 3.3 3.1 3.8 4.2 4.4 3.2 3.5 4.2 3.0 3.3 52 lschemic Heart Disease Surveillance Table 3.9 Estimated Numbers in Thousands and Incidence Rates per 1,000 Population of Nonfatal Ischemic Heart Disease, by Age Group and Year, Women, United States, 1980-1989 Age 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 0-34 Number 17 13 0 0 0 0 22 0 0 16 Rate 0.3 0.2 0.0 0.0 0.0 0.0 0.3 0.0 0.0 0.2 35-44 Number 34 0 0 36 0 20 21 14 27 39 Rate 2.6 0.0 0.0 2.5 0.0 1.3 1.2 0.8 1.5 2.2 45-54 Number 0 86 26 25 43 0 60 12 43 6 Rate 0.0 7.6 2.3 2.2 3.8 0.0 5.2 1.1 3.5 0.5 55—64 Number 32 13 12 51 63 130 76 23 77 103 Rate 3.1 1.2 1.0 4.5 5.6 11.6 6.7 2.1 7.0 9.3 65-74 Number 47 76 61 128 56 71 81 147 104 54 Rate 5.8 9.4 7.2 15.4 6.7 8.3 9.1 16.5 11.5 5.8 75-84 Number 12 13 23 53 87 83 98 62 87 92 Rate 3.0 3.0 5.6 11.7 19.6 16.5 21.8 12.8 17.8 18.1 85+ Number 0 0 24 12 O 17 0 29 21 27 Rate 0.0 0.0 18.6 10.5 0.0 18.1 0.0 22.9 15.0 20.0 Total Number 143 203 146 304 250 321 357 288 360 337 Crude Flate 1.3 1.8 1.3 2.6 2.1 2.7 3.0 2.4 2.9 2.7 Age-adjusted Rate 1.3 1.8 1.2 2.5 2.0 2.5 2.9 2.1 2.7 2.5 Table 3.10 Estimated Numbers in Thousands and Incidence Rates per 1,000 Population of Nonfatal Ischemic Heart Disease, by Age Group and Year, White Men, United States, 1980-1989 Age 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 0-34 Number 12 12 23 14 0 0 26 11 0 29 Rate 0.2 0.2 0.4 0.3 0.0 0.0 0.5 0.2 0.0 0.5 35-44 Number 32 24 94 O 49 14 39 12 25 13 Rate 3.0 2.1 8.1 0.0 3.9 1.1 2.8 0.8 1.7 0.9 45-54 Number 78 68 63 73 98 97 42 77 43 25 Rate 8.5 7.5 6.9 8.1 10.7 10.6 4.7 8.2 4.4 2.5 55-64 Number 96 95 81 93 94 66 94 130 100 99 Rate 11.5 11.3 9.8 11.2 11.2 7.8 11.2 15.9 12.6 12.5 65-74 Number 64 57 87 78 111 67 43 117 57 26 Rate 12.4 11.0 16.0 14.3 20.5 11.8 7.7 19.9 9.5 4.1 75-84 Number 24 31 25 33 36 21 40 30 28 64 Rate 10.9 12.4 10.4 14.1 16.0 9.0 15.4 12.5 10.9 25.9 85+ Number 0 0 0 11 13 21 25 25 O 24 Rate 0.0 0.0 0.0 21.1 20.8 35.0 87.8 44.1 0.0 35.4 Total Number 305 287 373 301 401 286 308 402 254 280 Crude Rate 3.4 3.1 4.1 3.3 4.3 3.0 3.3 4.2 2.7 2.9 Age-adjusted Rate 3.7 3.4 4.3 3.7 4.8 3.3 3.9 4.7 2.9 3.3 Ischemic Heart Disease Surveillance 53 Table 3.11 Estimated Numbers in Thousands and Incidence Rates per 1,000 Population of Nonfatal Ischemic Heart Disease, by Age Group and Year, White Women. United States, 1980-1989 Age 1980 1 981 1982 1983 1984 1985 1986 1987 1988 1989 0-34 Number 17 13 0 0 0 0 22 0 0 16 Rate 0.3 0.2 0.0 0.0 0.0 0.0 0.4 0.0 0.0 0.3 35-44 Number 23 0 O 36 0 20 21 14 27 32 Rate 2.1 0.0 0.0 2.9 0.0 1.5 1.5 0.9 1.8 2.1 45-54 Number 0 42 0 25 43 O 45 12 38 0 Rate 0.0 4.3 0.0 2.6 4.4 0.0 4.7 1.2 3.6 0.0 55-64 Number 32 13 12 51 63 121 70 19 73 103 Rate 3.4 1.3 1.2 5.2 6.3 12.2 7.1 2.0 7.7 10.8 65-74 Number 38 67 61 128 56 71 81 135 93 54 Rate 5.2 9.1 8.1 17.2 7.5 9.3 10.1 17.3 11.6 6.5 75-84 Number 12 13 23 37 87 83 98 62 87 92 Rate 3.3 3.3 6.3 9.2 21.7 18.4 23.7 14.2 19.5 20.1 85+ Number 0 0 24 12 O 17 0 24 21 27 Rate 0.0 0.0 19.6 11.2 0.0 19.0 0.0 20.2 16.9 22.3 Total Number 123 149 120 288 250 312 336 267 339 323 Crude Rate 1.3 1.5 1.2 2.9 2.5 3.1 3.3 2.6 3.3 3.1 Age-adjusted Rate 1.2 1.5 1.0 2.7 2.3 2.7 3.1 2.2 2.9 2.7 54 Ischemic Heart Disease Surveillance mirvaiitill: , .._ ”u ,_ h o _ ; 1J231833 U.C.BERKELEYlJBRARES CDHIESDE7H U.C. 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