Infant mortality, stomach cancer, stroke, and coronary heart disease: ecological analysis

doi:10.1136/bmj.320.7251.1705

BMJ 2000;320:1705-1706 ( 24 June )

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Infant mortality, stomach cancer, stroke, and coronary heart disease: ecological analysis

Editorial by Forman and Goodman

David A Leon, reader in epidemiology ^a, George Davey Smith, professor of clinical epidemiology ^b.

^a London School of Hygiene and Tropical Medicine, London WC1E 7HT, ^b Department of Social Medicine, University of Bristol, Bristol BS8 2PR

Correspondence to: D A Leon d.leon@lshtm.ac.uk

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

Mortality from stomach cancer and stroke shows an international correlation, consistent inverse socioeconomic gradients, aparticular dependence on socioeconomic circumstances in childhood,¹and parallel patterns of decline in most industrialised countriesover the past 30-40 years. The plausibility of the hypothesisthat salt intake underlies this similarity has been weakened overthe past decade as evidence for Helicobacter pylori as the keyfactor in the aetiology of non-cardia stomach cancer has increased.²H pylori is thought to be acquired in childhood, and risk of infectionis closely related to living conditions, hygiene, and housingstandards. Geographical, socioeconomic, and secular variationsin the prevalence of H pylori fit well with the correspondingtrends and differences in mortality from stomach cancer betweenand within countries.²

Infant mortality in the early part of the 20th century indicates living conditions and, in particular, standards of hygiene.We investigated how far international variations in infant mortality. . . [Full text of this article]

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