Oversterfte aan coronaire hartziekten in Groningen : achtergronden en interventiemogelijkheden

During the late eighties and early nineties, much information was published in The Netherlands concerning regional differences in mortality rates. During that same period, a network of Municipal Health Service Agencies (MHSA) was developed throughout The Netherlands. In one of the first MHSA epidemiological reports in Groningen, the regional mortality pattern since 1980 was described. The most remarkable conclusion was that mortality caused by coronary heart disease (CHD) was 17% higher in Groningen than was reported nationally for that time period. Approximately 150 more people died per year of CHD in the province of Groningen, than would be expected based on national statistics. Myocardial infarcts (M.I.) were responsible for three quarters of the deaths attributable to CHD. In this thesis we discuss three central research questions. The first question deals with possible explanations for the increased registered mortality rate due to CHD in Groningen. The second question focuses on the patients and their medical needs when they have an M.I. We look at the time interval between the initial complaint and the initiation of treatment in a hospital. Related to this second question, we examine the options available to help reduce treatment delay. With the third question we look at possibilities for the prevention of CHD. A closer look is taken at smoking (specifically the general practitioner’s role in advising patients to stop smoking), and at the effects of different forms of nutrition education for people who have a high risk for developing CHD.