Perspectives on the Rise and Fall of Swedish Cardiac Epidemics

Morbidity and mortality in cardiovascular diseases (CVD) can be described as an ongoing epidemic, although a very protracted one, lasting more than 100 years. Cardiovascular diseasesstill top mortality rates in the world today, accounting for about 30% of all deaths around the globe. But it is in the industrialized world that CVD dominate, although differences are great among various regions. Myocardial infarctions are significantly more common in Sweden than in southern Europe, but less common than in Eastern Europe. The overall question concerns the consequences for health in areas on the road to a post-industrial society. Over the years a clearer link has become visible between lifestyle and health. In Sweden, infectious diseases diminished as result of rising living standards. At the same time cardiovascular diseases were beginning their upward phase, reaching a peak in the 1960s. Deaths due to CVD bring to light significant discrepancies related to socio-economic and cultural factors. A comparison of the Swedish twin cities Linköping and Norrköping show considerable differences in death rates in favour of Linköping, amounting to about 30% fewer in the 1920s with a tendency toward rising differences thereafter. A preliminary investigation of diagnoses has shown that links commonly made between health and socio-economic patterns need revision. The differences in cardiovascular morbidity show another pattern than was expected. It is obvious that the neighbourhood environments themselves have significance, and that the inequalities need additional research based on complementary explanatory models.