Abstract P396: Thirty Years of Cardiovascular Mortality in Quebec, is the Decline Slowing in the Younger Population?

Background: It has been demonstrated in many countries that cardiovascular mortality has decreased over recent decades and the decline was accelerating for people aged 35 years and older and slowing in the younger population. Coronary heart disease (CHD) and stroke were the major causes responsible of this decline. We hypothesized that this fall and deceleration of the decline has occurred also in Quebec, Canada and looked if other diseases, such as heart failure (HF) and high blood pressure (HBP) presented a similar decline. Methods: Age-adjusted and specific mortality rates were obtained with the Quebec registry of death for each year of 1978–2007 period for all cardiovascular diseases and divided into CHD, stroke, HF and HBP for people aged ≥35 years and for each 10 year-age groups respectively. Joinpoint regressions on these mortality rates were used to estimate the annual percentage change (APC) and to detect points in time at which significant changes in the trends occurred. Several methods of forecasting were compared to predict age-adjusted mortality rates for the next decade (2008–2017). Results: There were 542,712 cardiovascular deaths. All CHD age-adjusted mortality rates for both sexes combined declined with a marked acceleration in 1997 (APC 1978–1997 and 1997–2007 of −3.05 and −5.99 respectively) while stroke presented with a lower decline between years 1988 and 1997 and reaccelerated thereafter (APC 1978–1988: −4.72, 1988–1997: −2.22 and 1997–2007: −5.39). HF presented an increase between years 1978 and 1981 (APC: 6.28) followed by a decline (APC 1981–2007: −3.58). Death due to HBP in the same group showed a deceleration of the decline in 1992 (APC 1978–1992: −7.46 and APC 1992–2007: −1.97). In the group aged 35–44 years, when both sexes were combined, only HF presented an increase in the mortality rate (APC 1978–1992: −7.76 and 1992–2007: 4.97). CHD and stroke presented constant declines for this age group (APC 1978-2007: −5.17 and −4.73, respectively) while HBP had no mortality at all. CHD mortality for all ages is projected to decrease to an adjusted rate of 100 per 100,000 person-year in 2017 (−38% from 2007). Conclusions: Death due to HBP was the only cause responsible of a slowing of the decline in people aged 35 years and older. However, when looking at the younger population, HF is presenting not only a slowing of the decline but, more importantly, an increase in the mortality rate. The forecasting of cardiovascular deaths seems to get a constant decline for the principal cause, CHD.

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