Cardiovascular diseases are the main
cause of mortality in almost all OECD countries, and accounted for 35% of all deaths
in 2009. They cover a range of diseases related to the circulatory system, including
ischemic heart disease (known as IHD, or heart attack) and cerebrovascular disease (or
stroke). Together, IHD and stroke comprise two-thirds of all cardiovascular deaths, and
between them they caused almost one-quarter of all deaths in OECD countries in 2009.
Ischemic heart disease is caused by
the accumulation of fatty deposits lining the inner wall of a coronary artery, restricting
blood flow to the heart. IHD alone was responsible for 15% of all deaths in OECD countries
in 2009. Mortality from IHD varies considerably, however (Figure 1.3.1). Central and eastern European countries report the highest IHD
mortality rates; the Slovak Republic for both males and females, followed by Estonia,
Hungary and the Czech Republic. IHD mortality rates are also relatively high in Finland,
Poland and Ireland, far ahead of Korea and Japan, the countries with the lowest rates.
There are regional patterns to the variability of IHD mortality rates. Closely following
the two OECD Asian countries, the countries with the lowest IHD mortality rates are five
countries located in southern Europe and the Mediterranean: France, Portugal, Spain,
Israel and Italy. This lends support to the commonly held hypothesis that diet - an
important underlying risk factor - explains much of the difference in IHD mortality across
Death rates for IHD are much higher
for men than for women (Figure 1.3.1). On average across OECD
countries, IHD mortality rates in 2009 were nearly two times greater for men. The
disparity was greatest in France and Luxembourg with male rates two-to-three times higher,
and least in Mexico and the Czech and Slovak Republics, at 60% higher.
Since 1980, IHD mortality rates have
declined in nearly all OECD countries. The decline has been most remarkable in the
Netherlands, the Nordic countries (Denmark, Norway, Sweden and Iceland), Australia, the
United Kingdom and Israel, with rates being cut by two-thirds or more. Declining tobacco
consumption contributed significantly to reducing the incidence of IHD, and consequently
to reducing mortality rates. Improvements in medical care have also contributed to reduced
mortality rates (see Indicator 4.6
"In-hospital mortality following acute myocardial
infarction" ). A small number of countries however, including Hungary,
Poland and the Slovak Republic, have seen little or no decline since 1980. The rate in
Greece has declined only slightly, although it was already comparatively low in 1980. Only
in Korea and Mexico have mortality rates increased.
Stroke was the underlying cause for
about 8% of all deaths in OECD countries in 2009. It is a loss of brain function due to
disruption of the blood supply to the brain. In addition to being an important cause of
mortality, the disability burden from stroke is also substantial (Moon et al., 2003). As with IHD, there are large variations in
stroke mortality rates across countries (Figure 1.3.2). The rates are
highest in the Slovak Republic, Hungary, Poland and the Czech Republic. They are the
lowest in Israel, Switzerland, France and the United States.
Looking at trends over time, stroke
mortality has decreased in all OECD countries (except Poland and the Slovak Republic)
since 1980. Rates have declined by around three-quarters in Austria, Portugal and Japan.
As with IHD, the reduction in stroke mortality can be attributed at least partly to a
reduction in risk factors. Tobacco smoking and hypertension are the main modifiable risk
factors for stroke. Improvements in medical treatment for stroke have also increased
survival rates (see Indicator 5.4 "In-hospital mortality following
Definition and comparability
Mortality rates are based on
numbers of deaths registered in a country in a year divided by the size of the
corresponding population. The rates have been directly age-standardised to the 1980
OECD population to remove variations arising from differences in age structures across
countries and over time. The source is the WHO Mortality
Deaths from ischemic heart disease
are classified to ICD-10 codes I20-I25, and stroke to I60-I69. Mathers et al. (2005) have provided a general assessment of the
coverage, completeness and reliability of data on causes of death.