La mortalité par maladies du cœur

Mortality from heart disease, updating and evaluations. Mortality from heart disease is a category of cause of death which is particularly hard to measure. A number of deaths which are attributed only to vague causes (syncope, collapse, heart failure etc.) may in fact be the consequence of genuine cardiac troubles. On the other hand, the attribution of a death to heart failure without any further details, may be an easy way out. In an earlier study (Remarques sur l'évolution de la mortalité par maladies du cœur, Études statistiques, n° 2, 1962) I.N.S.E.E. tried to evaluate, on the basis of death certificates, the probable number cf deaths from heart disease. The method used was to study the comparative variations of certificates showing ill-defined causes and certificates expressly attributing death to heart disease. This led to the presumption that the increase in mortality from heart disease observed after the Second World War reflected, at any rate largely, an improvement in medical certificates. In the present study this research is resumed for the post-war period. For this purpose, three five-year periods have been compared, 1950-1954, 1955-1959, 1960-1964. By valuing, for each of these periods, the correction attributable to ill defined or uncertified causes, it was found that mortality from heart affections (in all forms) had probably not increased except in the case of adult males, and then only minimally. In the younger age groups the regression is undoubted. If this trend is examined by category of heart disease it is found to be due to the progressive mastery of acute rheumatic affections, while coronary attacks have an increasing incidence, at least on male mortality. This analysis is particularly uncertain, since doctors often fail to specify the form of heart disease in question. The circumstances (ignorance of medical history ) may also prevent the doctor who signs the death certificate from specifying the cause. The result is, in any event, that the number of deaths from ischaemic heart disease (coronary arteriosclerosis, infarction, angina pectoris etc.) as certified by doctors is considerably under-estimated. The probable correction seems to indicate that this number should be trebled. In the last analysis, the average annual aggregate mortality from heart disease during the period 1960-1964 is estimated at about 120,000 or 254 per 100,000 population. Deaths from cardiac ischaemia would amount, for the same period, to 85,000 a year, representing a rate of 181 deaths per 100,000 population. These rates are close to those observed in countries of a comparable social and economic level with France.En raison de l'intérêt qui s'attache à la mortalité par maladies du cœur , catégorie de causes de décès la plus fréquente, il a paru utile de mettre à jour une étude précédente de l'I.N.S.E.E. sur la question : «Remarques sur l'évolution de la mortalité par maladies du cœur» (Études Statistiques, n° 2, 1962). A cette occasion on a essayé de rectifier d'une façon probable les niveaux et les tendances de cette mortalité, difficiles à mesurer en raison de l'imprécision qui affecte tout particulièrement cette section de la statistique des causes de décès. On a été ainsi conduit à proposer une évaluation de la mortalité globale par maladies du cœur ou attribuable à une forme de cardiopathie particulièrement fréquente, l'ischémie cardiaque, en attirant l'attention sur les répercussions que les variations de validité de la statistique (et notamment de la spécification des causes de mort ) ont sur les tendances apparentes de ces mortalités.Aubenque Maurice, Deruffe Louise. La mortalité par maladies du cœur. In: Etudes et conjoncture - Institut national de la statistique et des études économiques, n°1, 1968 (23ᵉ année). pp. 83-103