Estimating Deaths From Cardiovascular Disease: A Review of Global Methodologies of Mortality Measurement

According to the National Center for Health Statistics, of 2 471 984 total deaths in the United States in 2008, 616 828 were caused by heart disease and 134 148 were caused by cerebrovascular disease (Table 1). By these statistics, heart disease is the leading cause of death in the United States.1 Worldwide, the Global Burden of Disease study estimated that in 2001, 12.45 million of >56 million total worldwide deaths were caused by cardiovascular disease (CVD) and cerebrovascular disease. Ischemic heart disease was the leading cause of global mortality, accounting for 1.4 million deaths in the developed world and 5.7 million deaths in developing regions.2 View this table: Table 1. Leading Causes of Death, United States, 2008 These impressive statistics are used for the design and subsequent evaluation of health policies and interventions, and increasingly, attention is being drawn to the need to redistribute funding on the basis of disease and mortality burden.3 But how much do practitioners know about the strength of data such as these? Many cardiovascular clinicians and researchers consider mortality data to be the most basic type of data on which to make interventions and policy decisions. Although the conclusions drawn from various clinical trials may be challenged, it is generally taken for granted that CVD mortality data in developed countries are valid. But mortality data, like all data, are subject to limitations based on how the data are collected. Furthermore, as the cardiology community begins to focus its attention on the prevalence of CVD in developing countries, it is important to determine how best to assess CVD-associated mortality in settings where most people die at home without death certificates or prior health records. The purpose of this review is to elucidate how mortality statistics are currently collected in both developed and developing countries, the various limitations …