Trends in age-standardised and age-specific mortality from ischaemic heart disease in Germany.

backgroundResearch from some industrialised countries indicated a flattening of the declining ischaemic heart disease (IHD) mortality trends in certain population groups. This study aims to investigate age-standardised, as well as sex- and age-specific time trends in IHD mortality in Germany.

methodsUsing German vital statistics between 1980 and 2007, age-standardised and age-specific IHD mortality rates for men and women were calculated. Joinpoint software was used to estimate average annual percentage changes (AAPC) together with 95% confidence intervals and to identify changing trends in mortality. To account for the reunification in 1990 trends for West Germany alone were investigated in sensitivity analysis.

resultsSince 1980, marked decreases in mortality of 50% in men and 39% in women were observed, with AAPC of 2.4 and 1.5%, respectively. While moderate declines in mortality were observed since the early 1980s in men, significant decreases in women were only found after 1995. Trends in mortality varied substantially across age groups, showing decreases in older age (75+ years) only during the last 5-10 years. A flattening of mortality declines was not observed. In West Germany, overall decreases and AAPC were larger and differences between men and women were somewhat smaller.

conclusionGerman IHD mortality trends present a complex picture with profound decreases since 1980. However, declines were smaller and delayed compared to other industrialised countries. Also, time trends were not homogeneous in men and women, as well as across age groups. Preventive measures need to be strengthened to account for failures in the past and to counter the increasing burden of modifiable risk factors.