Heart disease among middle -aged and elderly persons in the United States: Trends and a multistate model.

摘要

This dissertation investigates heart disease in the middle-aged and older US population with two major concerns: time trends and length of life with and without heart disease. First, it examines trends in mortality, prevalence, onset, related disability, and death rates among those with and without heart disease. Second, it estimates the average length of an individual's life with and without heart disease and estimated implied prevalence from multistate models.;Results indicate that heart disease mortality rates have continuously declined for three decades for both sexes. Older persons show faster mortality declines in overall heart disease and myocardial infarction (MI). Men show greater annual percent declines in heart disease mortality rates than women, except for overall heart disease among older age groups. While the overall heart disease prevalence rate has increased, the ischemic heart disease (IHD) prevalence rate has decreased among men. Women have opposite results: a decrease in overall heart disease prevalence and an increase in ischemic heart disease. Women tend to have more recent onset of heart disease than do men. Both men and women with heart disease have less disability in recent years. Death rates from all causes and death rates due to heart disease among those with and without heart disease have decreased for both sexes.;Estimated years of life with and without heart disease and the implied prevalence of heart disease differ by sex due to different transition rates into and out of states of health defined by heart disease. Men and women are expected to live different years with and without heart disease. The likelihood of having had a heart attack is higher for men than women.;These research findings benefit researchers and policymakers by providing information on time trends of heart disease and related issues as well as changes in a population's health status and information on life with and without heart disease.