Letter

Why heart disease mortality is low in France

BMJ 1999; 319 doi: 10.1136/bmj.319.7204.255 (Published 24 July 1999)
Cite this as: BMJ 1999;319:255

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

  1. Akira Sekikawa, Fellow (akira+@pitt.edu),
  2. Lewis H Kuller, Professor
  1. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA
  2. 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 …

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