Using the Community Health Index, general practitioner records and the National Health Service Central Registry for a 14 year follow-up of a middle-aged cohort in the west of Scotland.

Record linkage provides an opportunity for relatively inexpensive follow-up in cohort studies. Most studies have used hospital records. However, the Community Health Index, which is a computer-held list of all patients registered with General Practitioners (GPs), now offers opportunities for measuring morbidity at the primary care level. Searching for patients individually on this computer-held Index, we identified 96% of a middle-aged cohort recruited 14 years earlier in a longitudinal study in the West of Scotland. Of these, information was obtained for 78% through direct postal survey and for 87% through contact with GPs. In total, follow-up information was obtained on 903 (92%) of those thought to be alive. The National Health Service Central Registry records data and cause of death and will pass this information to special studies which have 'flagged' individuals' records. Seven per cent of the deaths in this sample had been missed by this process. This may need to be taken into account in previous studies of mortality for this cohort. New studies could expect successful long-term follow-up through record linkage to the Index or the Registry, and automatic record linkage with the Index would be worth investigating.link_to_subscribed_fulltex

Gender differential in all-cause and cardiovascular disease mortality

The gender differential in mortality from ail causes, cardiovascular disease (CVD), ischaemic heart disease (IHD) and stroke during the mean follow-up of 11.6 years (range 10-14) was examined among 4696 men and 5714 women aged 45-64 at entry in West of Scotland. Overall mortality was 19.4/1000 person-years of observation among men and 10.8/1000 person-years among women. A multiple logistic regression model was used to control the influence of gender, along with seven other cardiovascular risk factors simultaneously. The risk factors considered were age, systolic (SBP) and diastolic blood pressure (DBP), serum cholesterol, casual blood glucose, body mass index (BMI) and cigarette smoking. Both the prevalence of risk factors and relative mortality risk associated with them differed by gender. Adjustment slightly reduced the gender differential in overall mortality from 2 to 1.9 and from 1.5 to 1.4 for stroke deaths. Multiple logistic regression increased minimally the gender differential for mortality from 2.4 to 2.8 for CVD and from 2.8 to 3.4 for IHD, suggesting that these cardiovascular risk factors do not account for the overall gender difference in mortality rates. Age, SBP, DBP, blood glucose and cigarette smoking were significant predictors of mortality for both genders. Serum cholesterol was a statistically significant predictor of CVD death only for men.link_to_subscribed_fulltex

A prospective population based study of gender differential in mortality from cardiovascular disease and 'all causes' in asymptomatic hyperglycaemics

There have been few prospective epidemiological studies of asymptomatic hyperglycaemia as a risk factor for cardiovascular disease and all causes mortality in women. Gender-specific all causes, cardiovascular disease (CVD), ischaemic heart disease (IHD) and stroke mortality rates and relative risks for asymptomatic hyperglycaemics (top 5%) have been compared to normoglycaemics (bottom 95%) during a mean follow-up of 11.6 years (range 10-14) among 4696 men and 5714 women aged 45-64 at entry in the west of Scotland. Univariate analysis showed that asymptomatic hyperglycaemia was associated with increased risk of all causes, CVD, IHD and stroke mortality in both genders. The degree of this association was greater in women than in men. Using multiple logistic regression (MLR) analysis to take into account differences in age, systolic (SBP) and diastolic blood pressure (DBP), serum cholesterol, body mass index (BMI), and cigarette smoking, high casual blood glucose level was still a significant risk factor for CVD mortality in both genders. It was also a significant risk factor for all causes, IHD and stroke mortality in women but not in men. This study shows that to a lesser degree asymptomatic hyperglycaemia shows the same gender differentials in risk of mortality as have been demonstrated amongst known diabetics.link_to_subscribed_fulltex

Trends in mortality from stroke in Scotland, 1950-1986

The Scottish Registrar General's Annual Reports have been used to study trends in mortality from stroke in Scotland during 1950-1986 in those aged 45 to 74. In 1950 the age-adjusted mortality rate was 347.4 per 100,000 population for men and 360.8 for women, falling to 199.6 for men and 155.8 for women in 1986. This downward trend has increased from 1976 for males. The average annual decline in age-adjusted mortality from stroke over the 37-year period was 4.0 per 100,000 in males and 5.5 in females. This reduction in death rates was proportionally higher for women compared with men in all age groups over 55 years. As with cardiovascular deaths, mortality from stroke was lower in the east than in the central region and west of Scotland. The reduction in mortality resulted in a substantial 'saving' of lives, estimated at 12,500 between 1980 and 1984.link_to_subscribed_fulltex