Biomedical subjects

P Immonen-Räihä

Publications and source records attributed to P Immonen-Räihä.

23 records · Page 2Linked to original sources

PubMed1996

Decline of coronary heart disease mortality in Finland during 1983 to 1992: roles of incidence, recurrence, and case-fatality. The FINMONICA MI Register Study.

BACKGROUND: The rate of coronary heart disease (CHD) mortality in eastern Finland has been the highest in the world. The official mortality statistics suggest, however, that is has declined by 60% during the past 20 years. The aim of the present study was to examine the contributions of incidence, recurrence, and case fatality of coronary events to the trends in CHD mortality in three areas of Finland. METHODS AND RESULTS: Population-based myocardial infarction registers have been operating in the provinces of North Karelia and Kuopio in eastern Finland and the Turku/Loimaa area in southwestern Finland from 1983 to 1992. During this 10-year period, each suspected coronary event in persons 35 to 64 years of age was evaluated for registration. Of these, 13,566 fulfilled the criteria of myocardial infarction or coronary death. Almost one fourth (22.4%) of the coronary events were sudden, out-of-hospital deaths. Among men, the average change in mortality was -7.1% per year (95% confidence interval, -8.4% to -5.8%) in North Karelia, -5.0% per year (-7.0% to -3.0%) in Kuopio, and -4.9% per year (-8.2% to -1.6%) in Turku/Loimaa. Among women, the corresponding changes were -5.6% (-11.1% to -0.1%), -4.4% (-8.1% to -0.7%), and -8.1% (-13.0% to -3.2%). In eastern Finland, the decline in CHD mortality was due to a decline in recurrent coronary events but also in the incidence of first coronary events, whereas in southwestern Finland, the decline in case-fatality rate had the major role. CONCLUSIONS: The decline in CHD mortality rate in Finland appears to be the result of a successful combination of primary and secondary prevention measures and improvements in acute coronary care.

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PubMed1996

21 year trends in incidence of myocardial infarction and mortality from coronary disease in middle-age.

The aim of this study is to describe the 21 year trends in myocardial infarction among middle-aged inhabitants in the city of Turku, in southwestern Finland. Since 1972 the coronary register in Turku has monitored acute coronary events leading to hospital admission or death, first according to the methods of the World Health Organization Heart Attack Register Study, and since 1982 according to the methods of the WHO MONICA. From 1972 to 1992 we registered 7374 events of suspected myocardial infarction, of which 6045 events occurring in inhabitants of Turku aged 35-64 years, fulfilled the criteria for myocardial infarction. Within 28 days, 2266 coronary events proved fatal. During the 21-year period, the incidence of definite myocardial infarction fell by 55% in men and by 62% in women, and coronary mortality fell by 66 and 81%, respectively. From 1972 to 1982, total mortality and coronary mortality decreased in parallel. Later on, the decrease in total mortality levelled off, even though coronary mortality fell still steeper, because mortality from external causes of death increased. The favourable long-term trends reflect favourable changes in total cholesterol and blood pressure in the middle-aged population, and the improvement in the treatment of myocardial infarction. Further efforts are needed to enhance this trend, but also to reduce total mortality among middle-aged people.

Adult↗

PubMed1996

Seasonal variation in the occurrence of stroke in a Finnish adult population. The FINMONICA Stroke Register. Finnish Monitoring Trends and Determinants in Cardiovascular Disease.

BACKGROUND AND PURPOSE: Seasonal influence on the incidence of and mortality from cerebrovascular disease has been reported during the last three decades, but generally with some discrepancy in results, particularly regarding stroke subtypes. The aim of this study was to examine seasonal variation in the incidence, mortality, and case-fatality rate of stroke in data from the FINMONICA population-based stroke register. METHODS: During 1982 to 1992, 15449 stroke events were registered in the monitored populations aged 25 to 99 years in three geographic areas of Finland: the provinces of Kuopio and North Karelia in eastern Finland and the Turku/Loimaa area in southwestern Finland. We analyzed the seasonal and monthly incidence, mortality, and case-fatality rate of stroke and subtypes of stroke by pooling the data for the three areas and stratifying by sex and age. RESULTS: The rate of occurrence of ischemic stroke events was 12% (95% confidence interval [CI], 5% to 20%) greater in men and 11% (95% CI, 4% to 19%) greater in women in winter than in summer. For intracerebral hemorrhage, we observed a 28% (95% CI, 3% to 58%) greater rate of occurrence in men and a 33% (95% CI, 6% to 66%) greater rate of occurrence in women in winter than in summer. The occurrence of subarachnoid hemorrhage did not vary significantly by season. The greater incidence of ischemic strokes in winter was particularly prominent among men aged 25 to 64 years and less prominent in elderly men and in women. The 28-day case-fatality rate of ischemic stroke showed significant seasonal variation only in women (P = .001), with the lowest rate in summer. CONCLUSIONS: There is a significantly greater incidence of ischemic strokes and intracerebral hemorrhages during winter in Finland. Further research that also takes meteorologic and sociodemographic factors into account is warranted, since it may help to determine new ways to prevent strokes.

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PubMed1996

Ten-year trends in stroke incidence and mortality in the FINMONICA Stroke Study.

BACKGROUND AND PURPOSE: The trends in stroke incidence reported so far have not been entirely consistent, although declining trends in mortality from stroke have been reported from a number of studies around the world. This study aims to evaluate the 10-year trends (from 1983 through 1992) in incidence, attack rate, and mortality of stroke in the Finnish population. METHODS: A population-based stroke register was set up in the early 1980s to collect data on all suspected events of acute stroke that occurred in the population aged 25 to 74 years permanently residing in three geographic areas of Finland: the provinces of Kuopio and North Karelia in eastern Finland and the Turku-Loimaa area in southwestern Finland. Trends in age-standardized attack rates, incidence, and mortality were calculated for the period studied. RESULTS: During the 10-year study period, 11 392 acute stroke events occurred in the monitored populations. A statistically significant decline was observed in the pooled FINMONICA data, both in the incidence of stroke (-1.7% with 95% confidence interval [CI], -3.0% to -0.5% per year in men; -2.2% with 95% CI, -3.6% to -0.7% per year in women) and in mortality from stroke (-5.2% with 95% CI, -8.2% to -2.2% per year; -4.7% with 95% CI, -8.2% to -1.2% per year). The attack rate of stroke also declined significantly in both sexes. When the areas were considered separately, the declining trends were observed within each area. The decline in incidence of stroke was, however, statistically significant only among men and women in Kuopio and among women in Turku/Loimaa. Mortality declined significantly in all three areas among men but among women only in Kuopio. The incidence to mortality rate ratio increased during the study period, indicating a steeper fall in mortality than in incidence. CONCLUSIONS: A substantial decline in both stroke incidence and mortality was observed in the adult and elderly population in the FINMONICA study areas. Part but not all of the decline in stroke mortality, observed also in the official mortality statistics, can be attributed to the decline in stroke incidence during this 10-year period.

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PubMed1994

A statistical analysis system macro for age-standardized incidence rates.

The Statistical Analysis System (SAS) is a commercial software system for data analysis. We designed a SAS macro that produces age-specific rates of any given disease directly from the basic patient data on SAS files. The macro conforms to the statistical methods of the World Health Organization's MONICA project, which is a multinational project for MONItoring of trends and determinants in CArdiovascular disease. The data of the Coronary Register of the City of Turku, Finland, was used to test this macro. The data consists of both men and women between the ages of 35 and 64 years. Acute coronary events leading to hospitalization and acute coronary death events outside hospital have been registered since 1972. For age-standardization Segi's world population was used as the standard. The weights were then calculated for five consecutive years. Individual weights related to the population size of the reporting unit and the standard population were calculated for each subject in the population using the population size of the reporting unit and the standard population. This yielded the age-standardized rates of the acute myocardial infarction and the corresponding standard deviations. The macro permits standardization of the incidence rates of any disease. It will present the required figures instantly.

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