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Biomedical subjects

R Beaglehole

Publications and source records attributed to R Beaglehole.

At least 91 records · Page 5Linked to original sources
PubMed1990

Trends in coronary heart disease mortality and morbidity in Auckland, New Zealand, 1974-1986.

Routine mortality statistics show that coronary heart disease (CHD) death rates have declined consistently in Auckland men since 1968; in women, death rates declined between 1968 and 1986 but since 1981 there may have been a reduction in the rate of decline. Data from CHD registers conducted in Auckland, New Zealand in 1974, 1981, and since 1983 as part of the WHO MONICA Project, have been used to investigate the validity and reasons for the decline in the age group 35-64 years. In Auckland age-standardized sudden coronary death rates in men declined by approximately 2% per year between 1974 and 1986; there was no apparent decline in women. There was also an indication of a decline in age-standardized definite myocardial infarction rates but again only in men; 28 day case fatality in patients with a definite myocardial infarction has not changed significantly in the period 1981-1986. These results validate the mortality trends based on death certificates and in particular the differing recent trends in men and women. The decline in CHD mortality in men without a concomitant change in case fatality and the lack of recent decline in women, suggest that changes in the natural history of the disease rather than treatment are responsible for the mortality trends. Since disease events are rare in absolute numbers, long-term monitoring of coronary heart disease in large population groups will be necessary to usefully study disease trends, particularly in women.

Adult↗
PubMed1990

Myocardial infarction is inversely associated with plasma 25-hydroxyvitamin D3 levels: a community-based study.

The relation between the plasma level of 25-hydroxyvitamin D3, the main metabolite of sun-induced vitamin D, and myocardial infarction (MI) was investigated in a community-based case-control study. Some 179 MI patients presenting to hospital within 12 hours of the onset of symptoms were individually matched with controls by age, sex and date of blood collection. MI patients had significantly lower mean 25-hydroxyvitamin D3 levels than controls (32.0 versus 35.5 nmol/L; p = 0.017), with the case-control differences being greatest in winter and spring. The relative risk of MI for subjects with 25-hydroxyvitamin D3 levels equal to or above the median was 0.43 (95% confidence limits = 0.27, 0.69) compared to subjects below the median. The decrease in MI risk associated with raised vitamin D3 levels was observed in all seasons. These results provide support for the hypothesis that increased exposure to sunlight is protective against coronary heart disease.

Adult↗
PubMed1990

Decreased blood selenium and risk of myocardial infarction.

The relationship between whole blood selenium levels and risk of acute myocardial infarction was investigated in a community-based control study in Auckland, New Zealand. A pilot study in 14 patients admitted to hospital within 4 hours of onset of symptoms demonstrated that selenium levels were stable in the first 16 hours after admission for an acute myocardial infarction. Some 252 cases (199 men, 53 women) presenting to hospital within 20 hours of onset of acute myocardial infarction were compared with 838 controls (500 men, 338 women), group-matched for age and sex. Myocardial infarction patients had significantly lower mean selenium levels: 82.8 and 87.9 micrograms/l in male cases and controls (p = 0.003) and 82.1 and 88.5 micrograms/l in female cases and controls (p = 0.02) respectively. The relative risks of myocardial infarction in participants with selenium levels below the median level (85 micrograms/l) in comparison with participants above the median were 1.6 (95% CL 1.1-2.2) and 1.7 (95% CL 0.9-3.5) in men and women respectively. The effects of a low selenium level on risk of myocardial infarction were confined to cigarette smokers. These results suggest the hypothesis that a decreased blood selenium in the presence of cigarette smoking is a risk factor for coronary heart disease.

Adult↗
PubMed1990

International trends in stroke mortality: 1970-1985.

We compared the pattern of cerebrovascular disease (stroke) mortality in men and women aged 40-69 years in 27 countries during 1970-1985 with the decline in coronary heart disease mortality during the same period. Stroke mortality rates declined in 21 and 25 countries for men and women, respectively. In 23 countries the decline in stroke mortality in women was greater than that in men. Countries with the highest rates of stroke mortality are also those with the least favorable secular trend. The rate of decline for stroke mortality is greater than that for coronary heart disease mortality in those countries that experienced a decline in both categories. International comparisons of risk factor levels over time are required to explain the striking differences between countries.

Adult↗
PubMed1989

Trends in antihypertensive medication costs in a cohort of Aucklanders 1982-87.

This study examines the trends in drug treatment and costs of hypertension in a cohort of 1600 adult Aucklanders between 1982 and 1987. In 1987 prices the average daily cost of antihypertensive drug treatment per person increased from 42 cents to 74 cents over the five year period. The increase in cost seen in antihypertensive therapy in this cohort is explained by the introduction of new and more expensive drugs rather than by increases in the proportion of the population being treated for hypertension, daily dosage, number of antihypertensives per individual or in real prices of antihypertensives.

Adult↗
PubMed1989

Patterns in the drug treatment of hypertension in Auckland, 1982-7.

This paper examines the pattern of drug treatment of hypertension in Auckland in the period 1982 to 1987 using data from a representative sample of the adult population interviewed in 1982 and followed up in 1987. In 1982 the age standardised prevalence of antihypertensive treatment for people aged 40-64 years was 12.2% (95%Cl 10.4, 14.0) and in 1987 it was 10.2% (95%Cl 8.5, 11.8). Over the five year period of this study, 6% of the sample untreated in 1982 began treatment with antihypertensive medication, while 24% of those on drugs in 1982 had stopped treatment by 1987. The most common medications used in both 1982 and 1987 for hypertension were diuretics and beta blockers. Over the five year period diuretic use fell and beta blocker use remained constant. In 1982 3% of hypertensives were taking a calcium antagonist but in 1987 13% were on these drugs and a further 13% were using ACE inhibitors. This study suggests that the prevalence of drug treatment for hypertension has plateaued in New Zealand; coincidentally there is a trend towards use of more expensive drugs.

Adult↗
PubMed1989

The validity of Maori mortality statistics.

Data from an Auckland coronary heart disease register have been used to assess the validity of Maori mortality statistics produced by the National Health Statistics Centre. During the period 1983-4, 804 people aged 35-64 years and resident in the Auckland statistical region, were identified by both the register and death registration data as having died of coronary heart disease. The coronary heart disease register failed to classify the ethnicity of thirteen of these people. Of the remaining 791 cases, the register classified 80 as Maori while only 44 were classified as Maori in the national death registration data; over the period 1983-4 Maori mortality due to coronary heart disease in the Auckland statistical region was understated by 82% (80-44/44). Although some of this discrepancy may be due to differences in classification of ethnicity, the major reason for the understatement is missing information on the death registration form. Simple changes in the documentation of ethnicity could markedly reduce the degree of underreporting.

Adult↗
PubMed1989

Health promotion: can it redress the health effects of social disadvantage?

Social disadvantage is an entrenched feature of contemporary New Zealand society and has a deleterious influence on health. Traditional health promotion activities, with their focus on the individual, have had only a limited impact. The World Health Organization is fostering a new approach to health promotion based on the Ottawa Charter, the two most important strategies being: building healthy public policy and strengthening community action. The new health promotion has great potential, especially with its emphasis on 'empowerment', but as yet only indirect evidence supports the effectiveness of this approach. Several current New Zealand community-based initiatives hold promise for the future and three of these are discussed. The greatest challenge is to ensure that the 'empowering' approach to health promotion continues to be developed by Area Health Boards and that this type of health promotion becomes a major priority at all levels of society. As social scientists, we need to support this approach and assist in the production of evidence to show whether it is capable of redressing the health effects of social disadvantage.

Community Participation↗
PubMed1989

Increased treatment of hypertension does not explain the decline in stroke mortality in the United States, 1970-1980.

The steady decline in mortality from stroke in the United States accelerated markedly in the 1970s. It has been widely assumed that an increase in the rate of treatment of hypertension is the most likely explanation for this major public health achievement. An analysis of available information, however, suggests that improvements in the community control of hypertension in the United States in the period 1970-1980 have contributed in only a minor way. There were 45,357 fewer deaths from stroke in 1980 among those aged 35-74 years than might have been expected if the death rates had stayed the same as in 1970. Data from the National Health and Nutrition Surveys indicate that six million more people received antihypertensive medication in 1980 than in 1970. Results from a pooled analysis of randomized controlled trials of the treatment of hypertension suggest that between 6% and 16% of the reduction in stroke mortality was due to the increased treatment of hypertension. Epidemiological observations indicate that between 16% and 25% of the overall decline in stroke mortality can be attributed to the treatment of hypertension, suggesting that clinical trials probably underestimate the community-wide benefits of treatment. These results also suggest that at least three quarters of the decline in stroke mortality in the United States in the period 1970-1980 is due to factors other than antihypertensive treatment.

Adult↗
PubMed1989

A review of the evidence concerning the impact of medical measures on recent mortality and morbidity in the United States.

Because it still is widely believed that one deadly disease after another is being eliminated, or diminished, largely because of medical interventions, there is little commitment to social change and even resistance to a reordering of national priorities. In this article we examine the contribution of medical measures to recent mortality changes in coronary heart disease, cancer, and stroke, which together account for two-thirds of total U.S. mortality and consume the vast majority of available resources. Morbidity changes are also examined and found to be not declining in a manner congruent with mortality and, in fact, increasing for some subgroups. Using a combined measure of mortality and morbidity (the probability of a life free of disability), it is demonstrated that although overall life expectancy has increased over several decades, most of this increase is in years of disability. Our late 20th century approach to the emerging AIDS pandemic (the frantic search for a "magic bullet"--either a treatment or a vaccine) belies any suggestion that the arguments and data presented concerning the modest contribution of medical measures are now passé.

Adult↗
PubMed1989

CHD in Australia and New Zealand.

Death rates from coronary heart disease (CHD) have been declining in Australia and New Zealand for 20 years. Data from the three MONICA Project Centres in Newcastle (Australia), Perth (Australia), and Auckland (New Zealand) show similar trends for fatal CHD but differing trends for non-fatal myocardial infarction (MI). In Auckland, there has been a consistent decline in out-of-hospital death rates but no decline in non-fatal MI rates. In Perth, the greater contribution to the overall decline has been from out-of-hospital deaths, but in-hospital death rates and non-fatal MI rates have also declined. There is also some evidence of an increase in survival following MI in Perth. In Newcastle, both death rates and non-fatal MI rates have declined. The limited data available suggest that at least one-half of the decline in mortality can be attributed to improvements in population risk-factor levels. Improvements in medical management of both risk factors and established disease are also making contributions to the decline.

Adult↗