Trends in the Incidence and Survival of Patients with Hospitalized Myocardial Infarction, Olmsted County, Minnesota, 1979 to 1994 Ve ´ ronique L. Roger, MD, MPH; Steven J. Jacobsen, MD, PhD; Susan A. Weston, MS; Tauqir Y. Goraya, MD, PhD; Jill Killian, BS; Guy S. Reeder, MD; Thomas E. Kottke, MD, MSPH; Barbara P. Yawn, MD, MSc; and Robert L. Frye, MD Background: Evidence indicates that deaths from coronary dis- ease are decreasing less in elderly persons and women. Under- standing the determinants of these trends is important for preven- tion. Objective: To test the hypothesis that trends in incidence and survival of hospitalized myocardial infarction differ according to sex and age. Design: Longitudinal observational study. Setting: Community-dwelling persons in Olmsted County, Min- nesota. Patients: 5117 patients who had an estimated 1820 incident myocardial infarctions from 1979 to 1994. Measurements: Myocardial infarctions were validated by using epidemiologic criteria. Rates were directly adjusted to the age distribution of the 2000 U.S. population. Results: Of the 1820 incident infarctions, 44% occurred in women and 36% in persons 75 years of age or older. In 1979, the age-adjusted incidence of myocardial infarction was 205 per 100 000 persons (95% CI, 162 to 247 per 100 000 persons). Between 1979 and 1994, the age-adjusted incidence of myocar- dial infarction decreased by 8% (CI, 23% to 10%) in men but increased by 36% (CI, 9% to 70%) in women. A 31% decrease in the incidence of infarction over time was observed in men 40 years of age compared with a 49% increase in women 80 years of age. Survival improved predominately in younger persons. Conclusions: Over time, the incidence of hospitalized infarction decreased in men but increased in women and elderly persons. Survival benefits were clustered among younger persons. These results suggest that both incidence and survival contribute to the contrasting mortality trends by age and sex and that the burden of coronary disease has shifted toward elderly persons, a finding that has public health implications in an aging population. Ann Intern Med. 2002;136:341-348. www.annals.org For author affiliations, current addresses, and contributions, see end of text. A lthough age-adjusted mortality due to coronary dis- ease had decreased in recent decades, the continu- ing burden of coronary disease should not be underesti- mated, and the determinants of this decrease have not been fully elucidated. Recent data from the United States indicate that the incidence of hospitalized myocardial infarction decreased modestly in recent years (1, 2), sug- gesting that medical care has contributed greatly to the decrease in mortality. Conversely, the World Health Orga- nization Monitoring Trends and Determinants in Cardio- vascular Disease study conversely found that changes in incidence were the major reason for the decrease in deaths from coronary disease (3). These divergent find- ings warrant further analyses in different populations. Moreover, because neither of these studies included persons older than 74 years of age, trends among elderly persons, the fastest growing segment of the population, could not be measured (1, 3–5). The Worcester Heart Attack Study showed that survival after myocardial in- farction improved over time, but advancing age had a markedly adverse effect on survival (6). Although the explanations for these adverse findings are probably multifactorial and include more comorbid conditions and less use of efficacious therapies in elderly persons, these results emphasize the importance of monitoring coronary disease trends in this group. Data from Olmsted County, Minnesota, for per- sons of all ages indicated that the decrease in coronary mortality affected primarily middle-aged men; this find- ing suggests that the burden of coronary deaths has been shifted toward women and elderly persons (7). These data further highlight the importance of including older age groups in studies and the need to elucidate age- and sex-specific mortality trends. We sought to examine the trends in incidence and survival of patients with hospitalized myocardial infarc- tion in Olmsted County, Minnesota. We tested two hypotheses: 1) that the incidence of myocardial infarc- tion has not decreased overall over time, but that trends differ by sex and age, and 2) that survival after incident myocardial infarction has improved over time but that the magnitude of improvement differs by sex and age. Annals of Internal Medicine Article © 2002 American College of Physicians–American Society of Internal Medicine 341