Stroke, Vol 17, 234-240, Copyright © 1986 by American Heart Association
C La Vecchia and A Decarli
Trends in age-specific and age-standardized death certification rates from
all cerebrovascular diseases and various diagnostic subcategories in Italy
during the period 1955-78 have been analysed. In both sexes, a decrease in
excess of 25% was evident in the overall age-standardized cerebrovascular
disease mortality. However, rates were roughly stable in males up to age 50
and in females up to age 45, and slightly but consistently increasing in
the younger age groups (under 40), mostly in females. The largest downward
trends were for both sexes in the 55 to 74 age groups, and the declines
were more marked in females, averaging 3% per year. Since death
certification is most reliable in the younger age groups and it is
difficult to imagine any modification of risk factors which should affect
mortality in later middle age but not in younger age groups, there is no
obvious and simple interpretation of this pattern of trends. A comparison
with similar trends in ischemic heart disease and other causes of death
suggests that the decline in overall cerebrovascular disease mortality
might be partially or largely artefactual, though a between-sexes
comparison indicates that at least part of the decrease registered in
females may well be real. The extent of the decline, however, has been
almost certainly more limited in Italy than in most other Western
countries. Only in the younger age group (30-34) did rates show a larger
increase in females, which might be related to increased prevalence of
cigarette smoking, or the use of oral contraceptives.
ARTICLES
Trends in mortality from cerebrovascular disease in Italy, 1955-78
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