Stress from a psychiatric epidemiological perspective

Community social change and mortality

This paper first reviews the types of explanations that have been used in analyzing unequal distribution in coronary heart disease among different groups and changes in prevalence over time. The explanations have mostly focused on the individual: individual behaviors, personalities, stressors, or social ties. It is suggested here that a shift in focus to community-level characteristics may also aid in understanding changes in mortality. Data are presented from Roseto, PA--a town that became known in the 1960's for its strong Italian traditions and very low mortality from myocardial infarction and that subsequently experienced a sharp rise in mortality--and from the adjacent comparison town of Bangor. Data collected over several decades--in some cases as far back as 1925--on marriages, population composition, organizational memberships, voting patterns, and social class indicators suggest that important community changes that accelerated significantly in the 1960's coincided with and may help to explain Roseto's loss of protection from coronary heart disease deaths after 1965.

The Roseto effect: a 50-year comparison of mortality rates

OBJECTIVES

Earlier studies found striking differences in mortality from myocardial infarction between Roseto, a homogeneous Italian-American community in Pennsylvania, and other nearby towns between 1955 and 1965. These differences disappeared as Roseto became more "Americanized" in the 1960s. The present study extended the comparison over a longer period of time to test the hypothesis that the findings from this period were not due to random fluctuations in small communities.

METHODS

We examined death certificates for Roseto and Bangor from 1935 to 1985. Age-standardized death rates and mortality ratios were computed for each decade.

RESULTS

Rosetans had a lower mortality rate from myocardial infarction over the course of the first 30 years, but it rose to the level of Bangor's following a period of erosion of traditionally cohesive family and community relationships. This mortality-rate increase involved mainly younger Rosetan men and elderly women.

CONCLUSIONS

The data confirmed the existence of consistent mortality differences between Roseto and Bangor during a time when there were many indicators of greater social solidarity and homogeneity in Roseto.