Cardiovascular disease (CVD) mortality declined more than 30% in the United States between 1950 and 1980. Secular trends in life style, in access to medical care, and in diagnostic and curative medicine have all been implicated in this decline. Concomitantly, the issue of """"""""worsening health"""""""" among these """"""""new survivors"""""""" has arisen. The long-term objectives of this research proposal are: (1) to delineate the mechanisms behind the decline in CVD mortality and (2) to investigate trends in health and functional status related to improvements in CVD mortality status related to improvements in CVD survival. This is a resubmission of an application for a competitive renewal of an ancillary study of the Framingham Heart Study to examine the mechanism behind the decline in CVD mortality and to investigate trends in health and functional status related to improvements in CVD survival. In the past two and one-half years, we have developed and refined new methods for conducting modified cross-sectional analyses using the Framingham Heart Study data. We have shown that cardiovascular disease mortality fell -66% for men and -59% for women between 1950 and 1979. However, despite significant improvements in CVD risk factors, incidence declined only -24% for men and -14% for women during this period. Thus, we find that more than two-thirds of the decline in CVD mortality could be attributed to gains in case fatality rates. Life table, survival regression (Cox proportional hazard and Weibull models), loglinear, logistic regression, and time dependent analytic techniques will be used. Through the proposed analyses, we will be able to elucidate the short and long-term factors behind the decline in CVD mortality and evaluate the contribution of secular trends in risk factors and medical care to that decline. Further, we will be able to assess the effect of trends in morbidity and functional limitation on the health status of survivors.
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