Why heart disease mortality is low in France

BMJ 1999;319:255 ( 24 July )

Letters

Why heart disease mortality is low in France

Miscoding may explain Japan's low mortality from coronary heart disease

Authors' hypothesis is wrong

Miscoding may explain Japan's low mortality from coronary heart disease

The first 150 words of the full text of this article appear below.

EDITOR $---$ We agree with Law and Wald that one must consider the cohort effect $---$ the time lag $---$ in investigating the association oflevels of risk factors with mortality from coronary heart disease.¹Analysis of mortality from coronary heart disease in birth cohortssince the second world war is thereforeimportant.

We evaluated mortality from coronary heart disease in the United States, Japan, South Korea, and other countries, as wellas within the United States by state, for men aged 35-44. We foundthat the very low mortality from coronary heart disease in Japan(5.5/100 000, compared with 11.4/100 000 in South Korea and 26.4/100000 among American white men in 1992) might be anartefact.

A substantial proportion of mortality from coronary heart disease among men aged 35-44 may be miscoded as heart failure (ICD-9,code 428) because in Japan more than 60% of mortality fromdiseases of the heart (codes 390-429) was . . . [Full text of this article]

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Why heart disease mortality is low in France: the time lag explanation • Commentary: Alcohol and other dietary factors may be important • Commentary: Intrauterine nutrition may be important • Commentary: Heterogeneity of populations should be taken into account • Authors' response: Malcolm Law, Nicholas Wald, Meir Stampfer, Eric Rimm, D J P Barker, Johan P Mackenbach, and Anton E Kunst
BMJ 1999 318: 1471-1480. [Extract] [Full Text] [PDF]