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Breytingar á tíðni kransæðasjúkdóma á Íslandi

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Authors
Nikulás Sigfússon
Gunnar Sigurðsson
Uggi Agnarsson
Inga Ingibjörg Guðmundsdóttir
Ingibjörg Stefánsdóttir
Helgi Sigvaldason
Vilmundur Guðnason
Issue Date
2001-11-01

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Other Titles
Changes in myocardial infarction incidence and mortality in Iceland
Citation
Læknablaðið 2001, 87(11):889-96
Abstract
Introduction: According to public health reports ischaemic heart disease was an uncommon cause of death in Iceland at the beginning of the last century. This death rate increased steadily until the ninety-eighties whereafter it leveled off and started to decline. The objective of the present study is to assess in detail the changes in myocardial infarction attack, incidence and death rate as well as case fatality. Material and methods: Crude death rate from ischaemic heart disease is available from the Statistical Bureau of Iceland from 1911 to 1996 and age and sex standardized death rate from 1951. In this paper, however, the material is mainly from the MONICA Project, a multinational study of myocardial infarction under the auspices of the World Health Organization. The study, in which Iceland has participated since 1981, registers all myocardial infarctions in people aged 25-74 years in the whole country. The registration is performed according to standardized criteria and external quality control was applied throughout by WHO designated quality control centers. The registration now covers the period 1981-1998. Results: The crude death rate in ischaemic heart disease in both sexes combined increased steadily until about 1980 when it accounted for about 30% of deaths. Age and sex specific death rate from these diseases increased from 1951 to about 1970, leveled off for the next 10 years and has since decreased. The MONICA data show a decline of death rate from myocardial infarction of 57% in men aged 25-74 during 1981-1998 and a 51% decline in women. Incidence rate has declined by 40% and 34% in men and women respectively and attack rate by 49% and 44%. Incidence, death rate and case fatality in myocardial infarction in Iceland compares favorably with other European countries. Conclusions: Myocardial infarction incidence and death rates have been declining in Iceland during the last two decades. Case fatality is now among the lowest compared to other countries. Preventive measures are most likely to further reduce incidence and death rates in myocardial infarction in Iceland.
Inngangur: Samkvæmt gögnum Hagstofu Íslands voru blóðþurrðarsjúkdómar hjarta sjaldgæf dánarorsök í byrjun síðustu aldar. Dánartíðnin fór síðan stöðugt vaxandi fram á níunda áratuginn en fór eftir það að lækka. Markmið þessarar rannsóknar er að kanna ítarlega þær breytingar sem orðið hafa á nýgengi, dánartíðni og dánarhlutfalli vegna kransæðastíflu á síðustu öld. Efniviður og aðferðir: Upplýsingar um dánartíðni vegna kransæðasjúkdóms frá 1911-1996 eru fengnar frá Hagstofu Íslands en aldurstaðlaðar tölur eftir kyni frá 1951-1996. Í þessari grein er þó einkum byggt á niðurstöðum MONICA rannsóknarinnar, sem er fjölþjóðleg rannsókn á kransæðastíflu undir yfirstjórn Alþjóðaheilbrigðisstofnunarinnar. Í þessari rannsókn, sem Ísland hefur tekið þátt í síðan 1981, eru skráð öll tilfelli kransæðastíflu meðal allra karla og kvenna á aldrinum 25-74 ára á landinu öllu. Skráningin er gerð eftir stöðluðum skilmerkjum og gæðaeftirlit er framkvæmt af sérstökum eftirlitsstöðvum Alþjóðaheilbrigðisstofnunarinnar. Skráningin nær nú yfir tímabilið 1981-1998. Niðurstöður: Dánartíðni karla og kvenna í blóðþurrðarsjúkdómum hjarta fór stöðugt vaxandi fram yfir 1980 og var þá orsök um 30% dauðsfalla. Aldursstöðluð dánartíðni fór vaxandi hjá báðum kynjum frá 1951 til um 1970, stóð síðan nokkurn veginn í stað næstu 10 ár en hefur síðan lækkað. MONICA skráningin sýnir að dánartíðni vegna kransæðastíflu hefur lækkað um 57% hjá körlum á aldrinum 25-74 ára á tímabilinu 1981-1998 og um 51% hjá konum. Nýgengi hefur lækkað um 40% hjá körlum og 34% hjá konum og heildartíðni um 49% og 44%. Nýgengi, dánartíðni og dánarhlutfall vegna kransæðastíflu er hagstæðara á Íslandi en í flestum Evrópulöndum. Ályktanir: Nýgengi og dánartíðni vegna kransæðastíflu hefur farið lækkandi á Íslandi síðastliðna tvo áratugi. Dánarhlutfall er nú með því lægsta sem gerist samanborið við aðrar þjóðir. Líklegt er að forvarnaraðgerðir verði árangursríkastar til að lækka tíðni þessara sjúkdóma enn frekar.
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