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Premature Mortality Continued

Rates of premature mortality due to IHD in 1985 were also high in the parts of the Northeast and Midwest that experienced higher rates of age-adjusted IHD deaths (Figures 1 and 2). Additionally, several states in the Southeast and Appalachian regions experienced premature mortality from IHD that was more than 10% above the

FIGURE 1. State-specific death rates* due to ischemic heart disease for men 35-64 years of age, presented as a percentage of the U.S. rate, 1985

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*Per 100,000 population.
*International Classification of Diseases, 9th Revision, codes 410-414.

FIGURE 2. State-specific death rates* due to ischemic heart disease for women 35–64 years of age, presented as a percentage of the U.S. rate, 1985

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Percent of U.S. Rate

< 90%
Z 90% to 110%

> 110%
*Per 100,000 population.
*International Classification of Diseases, 9th Revision, codes 410-414.

Premature Mortality Continued national mean. With the addition of California and Connecticut, areas with IHD premature mortality rates at least 10% below the national mean were similar to those with low age-adjusted IHD deaths. Reported by: Epidemiology Br, Div of Nutrition, Center for Health Promotion and Education, CDC. Editorial Note: Current geographic variations in premature IHD rates are probably associated with long-term trends in overall IHD deaths (348). Although each age, sex, racial, and geographic group has experienced significant declines in deaths from IHD, significant differences exist. In 1950, the West Coast ranked as high as the East Coast states, but in the 1960s, the rate in the west began to decline (6). By 1978, the highest rates clustered in the Appalachian and Northeastern regions. These regional trends in premature mortality due to IHD were similar for men and women as well as for blacks and whites.

Some of the current differences in state-specific IHD premature mortality rates may result from sociodemographic differences or population shifts over time. Blacks have higher rates of premature IHD (9). In addition, although blacks and whites had similar rates of decline in IHD deaths from 1968–1975, the rate of decline among white females and blacks of both genders from 1975 to 1985 has been half that of white men (10).

Finally, variations among states in IHD premature mortality rates may reflect geographic differences in the availability or effectiveness of interventions against IHD or in the prevalence of risk factors, such as cigarette smoking, high levels of serum cholesterol, high blood pressure, overweight, and low levels of physical activity. A review of available evidence suggests that reductions in serum cholesterol and in cigarette smoking are responsible for over half of the decline in overall IHD death rates over the last 2 decades ( 11 ).

Geographic variations in premature IHD, rather than age-adjusted IHD deaths for all ages combined, should direct epidemiologists and public health practitioners in examining regional or state-specific patterns of risk factors known to contribute to premature mortality due to IHD. Furthermore, an examination of the environmental, behavioral, and social factors underlying these differences in risk factors might be beneficial. These investigations may provide insight into the most promising prevention strategies. References 1. National Center for Health Statistics. Vital statistics of the United States, 1984. Vol II:

Mortality, Part A. Washington, DC: US Department of Health and Human Services, Public

Health Service, 1987; DHHS publication no. (PHS)87-1122. 2. Bureau of the Census. County population estimates (experimental) by age, sex, and race:

1980, 1982, and 1984 (machine-readable data file). Washington, DC: Bureau of the Census,

Data User Services Division, 1987. 3. Enterline PE, Stewart WH. Geographic patterns in deaths from coronary heart disease.

Public Health Rep 1956;71:849–55. 4. Sauer HI, Enterline PE. Are geographic variations in death rates for the cardiovascular

diseases real? J Chronic Dis 1959;10:513–24. 5. Friedman GD. Cigarette smoking and geographic variation in coronary heart disease

mortality in the United States. J Chronic Dis 1967;20:769–79. 6. Leaverton PE, Feinleib M, Thom T. Coronary heart disease mortality in United States blacks,

1968–1978: interstate variation. Am Heart J 1984;108:732–7. 7. Levy RI. The decline in cardiovascular disease mortality. Annu Rev Public Health 1981;

2:49–70.

Premature Mortality Continued 8. Ragland KE, Selvin S, Merrill DW. The onset of decline in ischemic heart disease mortality

in the United States. Am J Epidemiol 1988;127:516–31. 9. Centers for Disease Control. Health, United States, 1987. Hyattsville, Maryland: US Depart

ment of Health and Human Services, Public Health Service; DHHS publication no.

(PHS)88-1232. 10. Sempos C, Cooper R, Kovar MG, McMillen M. Divergence of the recent trends in coronary

mortality for the four major race-sex groups in the United States. Am J Public Health (in

press). 11. Goldman L, Cook EF. The decline in ischemic heart disease mortality rates: an analysis of the

comparative effects of medical interventions and changes in lifestyle. Ann Intern Med 1984;101:825–36.

Errata: Vol. 37, No. 12

p. 182 The first two sentences of the first paragraph should read: "Immune globulin

(IG) (16.5 gm% protein) can be used to prevent or modify measles infection in HIV-infected persons if administered within 6 days of exposure. IG is especially indicated for measles-susceptible household contacts with asymptomatic HIV infection, particularly for those under 1 year of age, and for measles-susceptible pregnant women."

Vol. 37, Supplement No. S-4

p. 16

In Addendum 2, reference number 5 should read:
5. CDC. Acquired immune deficiency syndrome (AIDS): precautions for clinical and

laboratory staffs. MMWR 1982;31:577-80.

FIGURE I. Reported measles cases – United States, Weeks 16-19, 1988

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CASES REPORTED ONO REPORTT CASES The Morbidity and Mortality Weekly Report is prepared by the Contors for Disease Control, Atlanta, Georgia, and available on a paid subscription basis from the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402, (202) 783-3238.

The data in this report are provisional, based on wookly reports to CDC by state health departments. The reporting week concludes at close of business on Friday; compiled data on a national basis are officially released to the public on the succeeding Friday. The editor welcomes accounts of interesting cases, outbreaks, onvironmental hazards, or other public health problems of current interest to health officials. Such reports and any other matters pertaining to editorial or other textual considerations should be addressed to: Editor, Morbidity and Mortality Wookly Report, Centers for Disease Control, Atlanta, Georgia 30333. Director, Centers for Disease Control

Editor James O. Mason, M.D., Dr.P.H.

Michael B. Gregg, M.D. Director, Epidemiology Program Office

Managing Editor Carl W. Tyler, Jr., M.D.

Gwendolyn A. Ingraham

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JUN 8 1988
Progress in Chronic Disease Prevention
Chronic Disease ControPAivities of

PUBLIC HEALTH LIBRARY
Medical and Dental Organizations

A meeting of representatives of selected medical and dental organizations was convened by the Clinical Services Branch, Office of Disease Prevention and Health Promotion, Public Health Service, U.S. Department of Health and Human Services, in September 1987 to discuss future directions for implementing preventive services in clinical settings.* Organizations were asked to report on their current activities in disease prevention and health promotion. These reports indicate that organized medicine and dentistry are offering a variety of programs to prevent and control chronic diseases in the United States. Periodic Health Examinations

Several organizations have issued recommendations on screening for reversible risk factors and early disease. The American Academy of Pediatrics (AAP) has published periodic updates of its recommendations for well-child care, Guidelines for Health Supervision. The American College of Obstetricians and Gynecologists (ACOG) has published "Technical Bulletins" on gynecologic cancer screening and, in cooperation with AAP, on perinatal care. The scientific basis for various components of periodic health examinations is being evaluated by the American College of Physicians (ACP) as part of its Clinical Efficacy Assessment Program. Other organizational programs have emphasized selected aspects of periodic health examinations. For example, the American Academy of Family Physicians (AAFP) cosponsors with the American Society of Gastrointestinal Endoscopists a training program on flexible sigmoidoscopy for family physicians. The Journal of the American Medical

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*Participating members: Herbert F. Young, MD, Kenneth W. Whittington, MD (American Academy of Family Physicians); Karen Palchick, LPN, Kenneth O. Johnson, MD (American Academy of Pediatrics); Shirley Shelton, John T. Queenan, MD (American College of Obstetricians and Gynecologists); Margaret Radany, MD (American College of Physicians); William M. Kane, PhD, David Harris, MD (American College of Preventive Medicine); James Marshall, James V. Huerter, DDS (American Dental Association); Alan L. Engelberg, MD, Ray W. Gifford, Jr., MD (American Medical Association); Douglas Ward, PhD, Frederic N. Schwartz, DO (American Osteopathic Association).

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES / PUBLIC HEALTH SERVICE

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