Cardiovascular disease (CVD) mortality has declined more than 30% in the last thirty years. Almost two-thirds of this decline occurred between 1970 and 1980. Despite this decreased mortality, CVD is still the leading cause of death. It is also the disease category associated with the most rapidly rising health care costs. Secular trends in lifestyle, self-care, improved access to medical care, and improvements in diagnostic and curative medicine have all been implicated. An understanding of the mechanisms contributing to this decline is necessary in order to develop a scientific basis for palliative and preventive care. Previous work by the investigators which explored secular trends in CVD incidence and mortality has shown that there were significant differences in 13-year CVD mortality and in 10-year case-fatality rates among three similarly-aged birth-cohorts in the Framingham Heart Study population. This was not due to a decrease in CVD incidence, a change in case mix, or a decline in prevalence of CVD. The dramatic decline in CVD mortality has raised the issue of the quality of life among the survivors. The question is raised whether more people are surviving but with """"""""worsening health"""""""" in terms of increased incidence and prevalence of disease as well as increased levels of functional limitation. Through the proposed research, the question of the influence of secular trends on CVD mortality and subsequent morbidity can begin to be addressed. The logistic and multiple regression techniques discussed will enable the investigators to ascertain the effects of trends in risk factors, comorbidity, and medical care on CVD mortality as well as ascertain their contribution to subsequent morbidity and functional limitation among survivors.
Showing the most recent 10 out of 41 publications
