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August 15, 1977

The Changing American Health Scene

JAMA. 1977;238(7):582. doi:10.1001/jama.1977.03280070022014

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To the Editor.—  In "The Changing American Health Scene" (237:1710-1714, 1977), Rogers and Blendon indicate that nationally age-adjusted death rates, infant and maternal mortality, and death rates from coronary artery disease have fallen substantially in recent years. This is also true for Seattle-King County.However, in Seattle-King County coronary heart disease mortality reached its highest rates by the late 1940s. The peak age-adjusted rates (US standard million, 1940) were 270.3 deaths per 100,000 men in 1949 and 91.9 to 93.9 deaths per 100,000 women on several occasions between 1949 and 1965. An international coding change for deaths has made distortions in comparison of coronary heart disease mortality since 1968, causing rates to be only about 87% of what they would be with prior coding. Nevertheless, adjusting for this, Seattle-King County rates declined by about 20% from peak rates. The decline for those under 60 years of age is more striking.