Differential trends in myocardial infarction mortality over 1975-2010 in France according to gender: An age-period-cohort analysis

Background: A dramatic reduction in mortality from myocardial infarction (MI) has been observed in France as in other western countries. The dynamics of this decline are likely to have differed according to age and sex. Our study sought to clarify the contributions of age, period and birth-cohort effects on post-MI mortality in France between 1975 and 2010 and to identify gender-specific trends.

Methods: Trends were analysed using an age-period-cohort (APC) model. MI mortality data were selected using the International Classification of Diseases (ICD) (8, 9 and 10th revision) codes from the French national mortality databases.

Results: Age-standardised MI mortality rates decreased by 70% from 1975 to 2010 in both sexes. Linear trend (drift) accounted for the majority of this decline and appeared very similar between genders. However, we found that increased MI mortality with advancing age was more pronounced in women than men beyond the age of 50. We also observed a slowdown in the decline among cohorts born after 1945, particularly in women.

Conclusions: MI mortality showed a dramatic downward trend for the last 35years in France. The linear decline was modulated by cohort effects, whereas no major period effect was identified. This study also showed noticeable differential age and cohorts' effects between genders, especially the no longer decline in MI mortality for women born after World War II. This highlights the need for specific preventive measures to target this population in the future.