The diet of Auckland men and women aged 25-64 years

The dietary intake of a sample of 537 men and 372 women aged 25-64 years, randomly selected from the Auckland general electoral rolls, was assessed in order to describe current nutritional patterns in Auckland and to compare dietary intakes between men and women. A 118 item food frequency questionnaire was given to each participant to recall usual intake over the previous three months. After adjusting for energy intake, men consumed significantly more fat and cholesterol than women, consistent with their increased intake of red meat (median serves per month = 28 for men, 23 for women) and their greater tendency to eat fried meat (80.3% v 71.7%) and to drink full cream milk (82.7% v 70.7%). In contrast, women consumed more carbohydrate and fibre than men after adjusting for energy, consistent with their increased intake of vegetables (median serves per month = 136 for women, 116 for men) and fruit (median serves per month = 71 for women, 39 for men). These dietary differences between men and women may partly explain the increased coronary heart disease rates in men.

Coronary heart disease mortality in Auckland Maori and Europeans

This paper investigates the differential between Maori and European coronary heart disease mortality in Auckland by analysing data from an Auckland register of coronary heart disease. The age standardised coronary heart disease mortality rate for Maori men is 1.6 times higher than for European men, and the rate for Maori women is 4.2 times higher than that of European women. Maori mortality is disproportionately high for women, and for the younger age groups. Maori and European who died of definite myocardial infarction in Auckland between 1983-86 showed little difference in severity of coronary artery occlusion at post mortem, and the likelihood of cardiomyopathy contributing a major part to Maori heart disease mortality is small.

The Auckland diet: results from a seven day food diary

Dietary intakes of 113 men and women aged 50-66 years, sampled from the Auckland electoral roll, were measured by a prospective seven day dietary diary. The mean intakes of percentage of energy due to fat and saturated fat were 32% and 16% in men and 34% and 15% in women. Compared with earlier New Zealand dietary studies, which used different methods, there has been an apparent decrease in both the absolute amount and proportion of cholesterol and saturated fat. The absolute and relative amount of protein consumed appears to have remained stable while carbohydrate intake has increased. In comparison with current guidelines for dietary fat intake there remains a need for further improvement in the typical New Zealand adult diet.

Science, advocacy and health policy: lessons from the New Zealand tobacco wars

The New Zealand Smoke-Free Environments Act was passed in August 1990 and is a central component of a comprehensive tobacco control policy. The passage of the Act was preceded by a long campaign. The essential components of this campaign were: international scientific evidence and the estimates of tobacco-caused mortality in New Zealand; activists groups supported by established health charities and the health professions; a sympathetic Health Department bureaucracy; a committed and powerful Minister of Health; and a relatively weak industry. The legislation passed despite adverse timing, the absence of bipartisan political support, and the pressure of industry-supported sports lobby groups. The campaign provides a model for other health issues in New Zealand and lessons for the tobacco wars elsewhere.

Decreased blood selenium and risk of myocardial infarction

The relationship between whole blood selenium levels and risk of acute myocardial infarction was investigated in a community-based control study in Auckland, New Zealand. A pilot study in 14 patients admitted to hospital within 4 hours of onset of symptoms demonstrated that selenium levels were stable in the first 16 hours after admission for an acute myocardial infarction. Some 252 cases (199 men, 53 women) presenting to hospital within 20 hours of onset of acute myocardial infarction were compared with 838 controls (500 men, 338 women), group-matched for age and sex. Myocardial infarction patients had significantly lower mean selenium levels: 82.8 and 87.9 micrograms/l in male cases and controls (p = 0.003) and 82.1 and 88.5 micrograms/l in female cases and controls (p = 0.02) respectively. The relative risks of myocardial infarction in participants with selenium levels below the median level (85 micrograms/l) in comparison with participants above the median were 1.6 (95% CL 1.1-2.2) and 1.7 (95% CL 0.9-3.5) in men and women respectively. The effects of a low selenium level on risk of myocardial infarction were confined to cigarette smokers. These results suggest the hypothesis that a decreased blood selenium in the presence of cigarette smoking is a risk factor for coronary heart disease.

Coronary heart disease among Pacific Island people in New Zealand

Coronary heart disease is the leading cause of death in New Zealand. Death rates are higher among the Maori than the European population but rates have been declining in both groups over recent years. The occurrence of coronary heart disease among the Pacific Island population in New Zealand is unknown. Data from the National Health Statistics Centre (NHSC) and the Auckland coronary or stroke (ARCOS) study were used to describe the occurrence of coronary heart diseases among Pacific Island people. Age standardised mortality rates show that coronary heart disease is an important cause of death among Pacific Island men. Death rates have declined between 1973-77 and 1978-82 but this trend did not continue among men in the 1983-86 period. Age standardised mortality rates from coronary heart disease from the ARCOS data are 175/100,000 and 52/100,000 for Pacific Island men and women compared with 325/100,000 and 141/100,000 for Maori men and women. Age standardised rates for European men and women are 154/100,000 and 36/100,000 respectively.

Myocardial infarction is inversely associated with plasma 25-hydroxyvitamin D3 levels: a community-based study

The relation between the plasma level of 25-hydroxyvitamin D3, the main metabolite of sun-induced vitamin D, and myocardial infarction (MI) was investigated in a community-based case-control study. Some 179 MI patients presenting to hospital within 12 hours of the onset of symptoms were individually matched with controls by age, sex and date of blood collection. MI patients had significantly lower mean 25-hydroxyvitamin D3 levels than controls (32.0 versus 35.5 nmol/L; p = 0.017), with the case-control differences being greatest in winter and spring. The relative risk of MI for subjects with 25-hydroxyvitamin D3 levels equal to or above the median was 0.43 (95% confidence limits = 0.27, 0.69) compared to subjects below the median. The decrease in MI risk associated with raised vitamin D3 levels was observed in all seasons. These results provide support for the hypothesis that increased exposure to sunlight is protective against coronary heart disease.

Trends in cardiovascular risk factors in Auckland, 1982 to 1987

This paper examines trends in Auckland over a five year period (1982-87) in the major cardiovascular risk factors: serum total cholesterol, blood pressure and cigarette smoking; trends in body mass index are also presented. The data came from two independent random samples of European people aged 40-64 years chosen from the central Auckland electoral rolls in 1982 (915 men and 476 women) and 1986-88 (503 men and 359 women); response rates were over 80% in both surveys. In the five year period self reported smoking declined by 22% in men and 10% in women; the decline was particularly marked in upper socioeconomic men and women aged 55-64 years. There were no consistent changes in either blood pressure or body mass index levels. Serum cholesterol levels, after adjustment for the change in laboratory methods, declined by approximately 1% in both men and women. Cardiovascular risk factor levels remain high in Auckland; comprehensive population based prevention programmes, such as Heartbeat (New Zealand), are urgently required in New Zealand.

International trends in stroke mortality: 1970-1985

We compared the pattern of cerebrovascular disease (stroke) mortality in men and women aged 40-69 years in 27 countries during 1970-1985 with the decline in coronary heart disease mortality during the same period. Stroke mortality rates declined in 21 and 25 countries for men and women, respectively. In 23 countries the decline in stroke mortality in women was greater than that in men. Countries with the highest rates of stroke mortality are also those with the least favorable secular trend. The rate of decline for stroke mortality is greater than that for coronary heart disease mortality in those countries that experienced a decline in both categories. International comparisons of risk factor levels over time are required to explain the striking differences between countries.

Trends in coronary heart disease mortality and morbidity in Auckland, New Zealand, 1974-1986

Routine mortality statistics show that coronary heart disease (CHD) death rates have declined consistently in Auckland men since 1968; in women, death rates declined between 1968 and 1986 but since 1981 there may have been a reduction in the rate of decline. Data from CHD registers conducted in Auckland, New Zealand in 1974, 1981, and since 1983 as part of the WHO MONICA Project, have been used to investigate the validity and reasons for the decline in the age group 35-64 years. In Auckland age-standardized sudden coronary death rates in men declined by approximately 2% per year between 1974 and 1986; there was no apparent decline in women. There was also an indication of a decline in age-standardized definite myocardial infarction rates but again only in men; 28 day case fatality in patients with a definite myocardial infarction has not changed significantly in the period 1981-1986. These results validate the mortality trends based on death certificates and in particular the differing recent trends in men and women. The decline in CHD mortality in men without a concomitant change in case fatality and the lack of recent decline in women, suggest that changes in the natural history of the disease rather than treatment are responsible for the mortality trends. Since disease events are rare in absolute numbers, long-term monitoring of coronary heart disease in large population groups will be necessary to usefully study disease trends, particularly in women.

Trends in antihypertensive medication costs in a cohort of Aucklanders 1982-87

This study examines the trends in drug treatment and costs of hypertension in a cohort of 1600 adult Aucklanders between 1982 and 1987. In 1987 prices the average daily cost of antihypertensive drug treatment per person increased from 42 cents to 74 cents over the five year period. The increase in cost seen in antihypertensive therapy in this cohort is explained by the introduction of new and more expensive drugs rather than by increases in the proportion of the population being treated for hypertension, daily dosage, number of antihypertensives per individual or in real prices of antihypertensives.

Patterns in the drug treatment of hypertension in Auckland, 1982-7

This paper examines the pattern of drug treatment of hypertension in Auckland in the period 1982 to 1987 using data from a representative sample of the adult population interviewed in 1982 and followed up in 1987. In 1982 the age standardised prevalence of antihypertensive treatment for people aged 40-64 years was 12.2% (95%Cl 10.4, 14.0) and in 1987 it was 10.2% (95%Cl 8.5, 11.8). Over the five year period of this study, 6% of the sample untreated in 1982 began treatment with antihypertensive medication, while 24% of those on drugs in 1982 had stopped treatment by 1987. The most common medications used in both 1982 and 1987 for hypertension were diuretics and beta blockers. Over the five year period diuretic use fell and beta blocker use remained constant. In 1982 3% of hypertensives were taking a calcium antagonist but in 1987 13% were on these drugs and a further 13% were using ACE inhibitors. This study suggests that the prevalence of drug treatment for hypertension has plateaued in New Zealand; coincidentally there is a trend towards use of more expensive drugs.

Increased treatment of hypertension does not explain the decline in stroke mortality in the United States, 1970-1980

The steady decline in mortality from stroke in the United States accelerated markedly in the 1970s. It has been widely assumed that an increase in the rate of treatment of hypertension is the most likely explanation for this major public health achievement. An analysis of available information, however, suggests that improvements in the community control of hypertension in the United States in the period 1970-1980 have contributed in only a minor way. There were 45,357 fewer deaths from stroke in 1980 among those aged 35-74 years than might have been expected if the death rates had stayed the same as in 1970. Data from the National Health and Nutrition Surveys indicate that six million more people received antihypertensive medication in 1980 than in 1970. Results from a pooled analysis of randomized controlled trials of the treatment of hypertension suggest that between 6% and 16% of the reduction in stroke mortality was due to the increased treatment of hypertension. Epidemiological observations indicate that between 16% and 25% of the overall decline in stroke mortality can be attributed to the treatment of hypertension, suggesting that clinical trials probably underestimate the community-wide benefits of treatment. These results also suggest that at least three quarters of the decline in stroke mortality in the United States in the period 1970-1980 is due to factors other than antihypertensive treatment.

A review of the evidence concerning the impact of medical measures on recent mortality and morbidity in the United States

Because it still is widely believed that one deadly disease after another is being eliminated, or diminished, largely because of medical interventions, there is little commitment to social change and even resistance to a reordering of national priorities. In this article we examine the contribution of medical measures to recent mortality changes in coronary heart disease, cancer, and stroke, which together account for two-thirds of total U.S. mortality and consume the vast majority of available resources. Morbidity changes are also examined and found to be not declining in a manner congruent with mortality and, in fact, increasing for some subgroups. Using a combined measure of mortality and morbidity (the probability of a life free of disability), it is demonstrated that although overall life expectancy has increased over several decades, most of this increase is in years of disability. Our late 20th century approach to the emerging AIDS pandemic (the frantic search for a "magic bullet"--either a treatment or a vaccine) belies any suggestion that the arguments and data presented concerning the modest contribution of medical measures are now passé.

The validity of Maori mortality statistics

Data from an Auckland coronary heart disease register have been used to assess the validity of Maori mortality statistics produced by the National Health Statistics Centre. During the period 1983-4, 804 people aged 35-64 years and resident in the Auckland statistical region, were identified by both the register and death registration data as having died of coronary heart disease. The coronary heart disease register failed to classify the ethnicity of thirteen of these people. Of the remaining 791 cases, the register classified 80 as Maori while only 44 were classified as Maori in the national death registration data; over the period 1983-4 Maori mortality due to coronary heart disease in the Auckland statistical region was understated by 82% (80-44/44). Although some of this discrepancy may be due to differences in classification of ethnicity, the major reason for the understatement is missing information on the death registration form. Simple changes in the documentation of ethnicity could markedly reduce the degree of underreporting.