Why heart disease mortality is low in France

doi:10.1136/bmj.319.7204.255

From trainee to consultant, BMJ Group offers doctors around the world tailored information, special events, learning resources and recruitment services at every step along their career path.

... by doctors, for doctors, for patients
We are open for entries!

Online learning

BMJ Learning

High-quality CME / CPD for doctors and other healthcare professionals. BMJ Learning features hundreds of accredited, peer-reviewed learning modules in text, video, and audio formats. Find out more

Courses and Qualifications

BMJ Masterclasses

BMJ Masterclasses, led by experts, help clinicians to use the latest evidence and recent guidelines in practice and meet their CPD/CME requirements. Find out more

Exam Preparation

The leading provider of online exam preparation, helping over 167,000 healthcare professionals to pass their exams. Find out more

onExamination

Search all BMJ comment articles:

From

Limit by

Access to the full text of this article requires a subscription or payment. Please log in or subscribe below.

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

Akira Sekikawa, Fellow (akira+@pitt.edu),
Lewis H Kuller, Professor

Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA
Råbygatan 2, Lund, Sweden

EDITOR—We agree with Law and Wald that one must consider the cohort effect—the time lag—in investigating the association of levels of risk factors with mortality from coronary heart disease.1 Analysis of mortality from coronary heart disease in birth cohorts since the second world war is therefore important.

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

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 from diseases of the heart (codes 390-429) was coded as heart failure. This …