Secular trends in ischemic heart disease and stroke mortality from 1970 to 1976 in Spanish-surnamed and other white individuals in Bexar County, Texas

Abstract

Secular trends in age-adjusted cardiovascular mortality from 1970-1976 were examined for Spanish-surnamed and other white men and women in San Antonio and surrounding Bexar County, Texas. Declines in ischemic heart disease (IHD) mortality were observed in Spanish-surnamed men and women and in other white men; these trends were significant in Spanish-surnamed women and other white men. Acute myocardial infarction mortality declined in all four sex/ethnic groups, and these declines were significant in Spanish-surnamed women and in other white women and men. Mortality from chronic IHD declined significantly in Spanish-surnamed women, but not in the other three goups. No secular trends were seen in cerebrovascular mortality. Declines in diabetes mortality in the Spanish-surnamed population were also observed, and were accompanied by an upward trend in the male-to-female ratio in IHD mortality in this group. Given the disproportionate effect of diabetes on fatal coronary heart disease in women compared to men, this latter finding suggests that the force of diabetes on IHD mortality may also have waned in this ethnic group during these years. Changes in personal health habits have been considered as a possible explanation for the decline in IHD mortality nationally. Research in the social sciences, however, suggests that lower socioeconomic status individuals tend to adopt health innovations more slowly than upper socioeconomic status individuals. Thus, the fact that in our data the favorable trends in IHD mortality were shared equally by Spanish-surnamed and other white individuals suggests that factors other than changes in health habits may have played at least a contributory role. Additional possible explanations which we have considered include fluctuations in influenza and pneumonia mortality, improved control of hypertension, and improvements in emergency medical services and in-hospital coronary care.