Clinicians and epidemiologists view crude death rates differently

EDITOR—We agree with Tunstall-Pedoe that crude death rates are misleading in comparisons.1 However, clinicians and epidemiologists have different attitudes towards these health indicators. Mortality from ischaemic heart disease has been low in Japan.2 None the less, its recent trends were interpreted differently by clinicians and epidemiologists. On the basis of their experience, clinicians believed that mortality from ischaemic heart disease was on the rise. Trends in crude rates were compatible with their belief. Epidemiologists argued that to see the secular trend …