Ecological studies are a poor means of testing aetiological hypotheses

BMJ 1998;317:678 ( 5 September )

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Ecological studies are a poor means of testing aetiological hypotheses

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EDITOR $---$ The declines in cardiovascular diseases in Poland, "apparently without precedent in peacetime,"¹ are similar tothe declines seen in Britain over the same period.² The tableshows secular declines in mortality from cardiovascular diseasesin Britain: between 1991 and 1994, death rates from both ischaemicheart disease and stroke fell dramatically, particularly amongmen at all ages and women aged over 55 years. In Britain thesedeath rates are continuing to fall, in contrast to Poland. Furthermore,as mortality from ischaemic heart disease in Britain plateauedbetween 1980 and 1985 and then fell, the declines observed between1985 and 1989 were as striking as those in Poland: 18.5% and 15%for men and women aged 55-64 years respectively, compared withPolish declines between 1991 and 1994 of 20% and 16% for men andwomen aged 45-64 years respectively. In contrast, mortality fromstroke in Poland did not fall nearly so much as in Britain: 4%for men and no . . . [Full text of this article]

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Ecological study of reasons for sharp decline in mortality from ischaemic heart disease in Poland since 1991: Witold A Zatonski, Anthony J McMichael, and John W Powles
BMJ 1998 316: 1047-1051. [Abstract] [PDF]

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