Matti Romo

Incidence and prognosis of ischaemic heart disease with respect to marital status and social class. A national record linkage study.

Increased mortality from ischaemic heart disease (IHD) has been found in previous studies among divorced, widowed, and unskilled middle-aged Finnish men. In this study all cases of IHD in men aged 40-64 during 1972 were analysed by linking death certificates and hospital records (7499 cases with 3136 deaths). Age-adjusted incidence, mortality, and survival rates of the first and third year were calculated by marital status and social class. The highest mortality rate was found among unskilled workers, the highest incidence among widowers and those in the lower professional classes, and the lowest survival rate among divorcees, single persons, and unskilled workers. The ratio of mortality by marital status (1.77) was in part due to survival (ratio 1.44) and in part due to incidence (ratio 1.32). The ratio of mortality by social class (1.44) seemed to be due more to differences in incidence (ratio 1.36) than to differences in survival (ratio 1.18). The distribution of conventional risk factors of IHD by marital status and social class seems to explain only part of the mortality differences.

Psychosocial and environmental correlates of coronary-prone behavior in Finland☆

Coronary-prone behavior pattern was studied in a Finnish population sample consisting of 11364 adults (5419 males and 5945 females). A questionnaire-based short rating scale developed by Bortner was used. The distribution of the study population on the A-B axis was unimodal with no distinctive grouping into A- and B-types. Age-specific mean scores were highest in 30–40 yr olds. The highest and lowest deciles were designated to represent type A and type B respectively. A-type men were more often married, self-employed or in white collar work, and had larger incomes and more changes of residence. A-type persons were more extrovert and their life satisfaction was greater. A-type men slept less on average than B-type men. A-type persons experienced their daily activities more tiring, but their work less monotonous. A-type persons used spirits a little more often and smoked slightly more cigarettes. B-type persons spent more time on leisure-time physical activity, both the time spent per session and the frequency of sessions being greater. In this cross-sectional study the A-type men reported more often a history of myocardial infarction diagnosed by a physician (2.0 vs 0.6%, ns) and severe chest pain in the Rose questionnaire (8.7% vs 5.3%, p < 0.05) compared to the B-type men, as well as a higher prevalence of Rose-positive angina pectoris (7.5% vs 5.7%, ns). The study cohort is being followed-up for incidence of coronary heart disease events and mortality.

Work behavior, time urgency and life dissatisfactions in subjects with myocardial infarction: A cross-cultural study☆

Abstract Two hundred and twenty-nine men from three different countries (Finland, Sweden, the United States) who recently survived a myocardial infarction completed a brief work behavior, time urgency and life dissatisfactions questionnaire. All subjects were still in their working years, all had been in good health over the 2 yr prior to their infarctions, and all were less than 65 yr of age. Six of the 14 questions proved to have high subscription rates by persons in all three samples—two work behavior questions (responsibility at work, and overtime work), two time urgency questions (time urgency and hostility when slowed by others) and two life dissatisfaction questions (dissatisfaction with level of education, and dissatisfaction with achievement of life goals). Significant intersample differences were found for 11 of the 14 questions. Finns registered relatively low work behavior and time urgency while reporting nearly twice the level of life dissatisfactions as the other two samples. Swedes registered high work behavior and high time urgency, with intermediate subscription to the life dissatisfactions questions. Americans indicated high subscription to work behavior items, intermediate subscription to time urgency responses, and lowest levels of life dissatisfactions. Possible cultural explanations of these findings are discussed.

Changes in incidence and prognosis of ischaemic heart disease in Finland: a record linkage study of data on death certificates and hospital records for 1972 and 1981.

The components of the decline in mortality from ischaemic heart disease in Finland were studied by analysing the changes in incidence and prognosis between 1972 and 1981. Using personal identification numbers, hospital discharge records and death certificates were linked for all men and women aged 40-64. During this period mortality decreased 15.9% in men and 23.5% in women, incidence 14.2% in men and 19.3% in women, being greatest among 40-49 year olds living in urban areas, and case fatality 7.3% in men and 10.3% in women, owing primarily to a decrease in patients dying of ischaemic heart disease without being admitted to hospital; survival was also better among patients admitted to hospital. Factors explaining these changes remain unknown because data on risk factors and factors influencing prognosis are limited and largely ecological.

Coronary behavior in three regions of Finland

Abstract A brief coronary behavior questionnaire was administered to subjects living in three geographical regions in Finland. Two regions (East and West Finland) were rural, the third (Helsinki) was urban. When controlled for differences in coronary heart disease prevalence, East Finns showed significantly more striving and time urgency behavior than West Finns, and significantly less work dissatisfaction. Helsinki post-MI survivors showed significantly higher striving and time-urgency behavior than post-MI patients in East and West Finland. No coronary behavior differences were found between abrupt coronary death victims and survivors of myocardial infarction in Helsinki. Finally, work dissatisfaction was seen to be negatively related to striving and time urgency dimensions as well as to autopsy evidence of prolonged heart disease in a sample of coronary death victims.

Social functioning of elderly coronary heart disease patients

1Unit of General Practice, Oulu University Hospital and Department of Public Health Science and General Practice, University of Oulu, Oulu, and Department of Public Health and General Practice, University of Turku, Turku, 2Department of Public Health and General Practice, University of Turku, Turku, 3Medical School, University of Tampere, Tampere, 4Biometry Unit, Tampere School of Public Health, University of Tampere and Tampere University Hospital, Tampere, 5Finnish Heart Association, Helsinki, 6Unit of General Practice, Oulu University Hospital and Department of Public Health Science and General Practice, University of Oulu, Oulu, Finland