Academic journal article Bulletin of the World Health Organization

Changes in Premature Deaths in Finland: Successful Long-Term Prevention of Cardiovascular Diseases

Academic journal article Bulletin of the World Health Organization

Changes in Premature Deaths in Finland: Successful Long-Term Prevention of Cardiovascular Diseases

Article excerpt

Background

Owing to exceptionally high cardiovascular disease (CVD) mortality rates, especially from coronary heart disease (CHD), in the eastern regions of Finland (1-3), the North Karelia project was launched in 1972 as an intensive preventive programme to reduce this heavy burden of CVD (4). During the original project period (1972-77), the activities were carried out in the province of North Karelia (pilot area), which continued to serve as a national demonstration area, these experiences being the basis for national CVD prevention. The main objective at the outset was to achieve a substantial decline in CHD mortality, especially among middle-aged men. When the project joined the WHO Country Integrated Noncommunicable Diseases Intervention (CINDI) and Interhealth programmes, there was a greater emphasis on more integrated approaches for noncommunicable disease (NCD) prevention.

A public health strategy was developed to reduce the population levels of the main CVD risk factors (elevated serum cholesterol, hypertension, and smoking). Great emphasis was put on promoting cholesterol-lowering dietary changes. A comprehensive community-level approach was adopted, involving the health and other services, voluntary organizations, local media, businesses, and public policy. On the national level, expert guidelines were issued, the involvement of industry was promoted, and public policy was enacted (e.g. antismoking legislation). Details of the implementation of the project (5) and descriptions about the national activities to promote cholesterol-lowering dietary changes and to fight smoking have been published (6, 7).

The project was evaluated using carefully standardized surveys of cross-sectional population samples. These were carried out every rive years in North Karelia, in the initial reference area (Kuopio province) and then in other parts of the country for nationwide monitoring (5). The previously published 20-year risk-factor changes show, among middle-aged men (30-59 years), a major reduction in the population levels of the target risk factors (8). The results also show that during the original project period (1972-77) these reductions were significantly greater in North Karelia than in the reference area. When the surveys showed some levelling-off in the risk-factor trends of 1982-87, new intensive activities were started in North Karelia and nationwide to further promote cholesterol-lowering dietary changes. This coincided with further international expert recommendations, and increasing interest from and collaboration with the food industry.

Earlier publications from the North Karelia project reported a major decline in CHD mortality, which was significantly greater in North Karelia than in the reference province of Kuopio in the 1970s (9), but stabilized in the early 1980s (10). The present paper describes the latest findings in mortality trends in North Karelia and nationwide, in the context of the long-term potential of successful CVD prevention.

Materials and methods

The mortality data for North Karelia and all of Finland were obtained from Statistics Finland, an organization which reviews the diagnoses made by local doctors on individual death certificates in accordance with the eighth revision of the International Classification of Diseases (ICD) from 1969 to 1986, and the ninth revision thereafter. The following ICD codes were used for the mortality categories: diseases of the circulatory system 390-459, ischaemic heart disease 410-414, cerebrovascular disease 430-438, all neoplasms 140-239, and lung cancer 162 (includes also malignant neoplasm of trachea and bronchus).

The mortality rates were calculated on the basis of population data from the national population registry. Age adjustment was done using World Standard Population (35-44 years (12), 45-54 years (11), 55-64 years (8)) as the standard. The mortality trends and changes for North Karelia and Finland and the 95% confidence intervals were calculated using linear regression, where the logarithms of the mortality rates were used as dependent variables and the year, area and year-area interaction as independent variables. …

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