Articles: mortality.
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A comparison has been made of the recent changes in coronary heart disease mortality in Australia, the USA, and in the United Kingdom (England and Wales). Sharp declines in mortality dating from 1966 in Australia and from 1968 in the USA in both sexes contrast with a persistent increase in men in England and Wales until 1972 (after which a sight fall occurred) and a consistent slight fall in women since 1950. An investigation has been made of changes in 3 major risk factors-hypertension, cigarette smoking and diet in the 3 countries in an attempt to determine to what extent such changes might correlate with the different patterns of mortality. ⋯ In Australia and the USA increases in vegetable fat consumption have occurred since 1950 with a reduction in animal fat in Australia but not in the USA. In the United Kingdom increases in vegetable fat have not been observed while there has been some increase in animal fat. It is concluded that the different patterns of coronary heart disease mortality in the 3 countries do correlate to some extent with changes in diet and cigarette smoking.
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The author tests McKeown's hypothesis that socioeconomic improvement was the most important cause of mortality decline in England and Wales. First, McKeown's basic work is replicated using data on childhood mortality in Rhode Island between 1860 and 1970. "Then the effect of socioeconomic change on mortality change is examined in ways that differentiate it from other effects. Next, socioeconomic and public health effects on disease are differentiated by computing case-fatality and incidence rates." The results provide support for McKeown's argument.