Community surveillance of coronary heart disease in the atherosclerosis risk in communities (ARIC) study: Methods and initial two years' experience

Alice D. White, Aaron R. Folsom, Lloyd E. Chambless, A. Richey Sharret, Kiduk Yang, David Conwill, Millicent Higgins, O. Dale Williams, H. A. Tyroler

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The community surveillance component of the Atherosclerosis Risk in Communities (ARIC) Study is designed to estimate patterns and trends of coronary heart disease (CHD) incidence, case fatality, and mortality in four U.S. communities. Community surveillance involves ongoing review of death certificates and hospital discharge records to identify CHD events in community residents aged 35-74 years. Interviews with next of kin and questionnaires completed by physicians and medical examiners or coroners were used to collect information on deaths, and review and abstraction of hospital records were used to collect information on possible fatal and nonfatal myocardial infarctions (MIs). Events were classified using standardized criteria. The initial 2 years' experience with case ascertainment and availability of information needed for classification of events is described. Average annual age adjusted attack rates of definite MI and CHD mortality rates for blacks in two communities and whites in the four communities are presented and compared with rates based on unvalidated hospital discharge data and vital statistics, Age adjusted rates based on ARIC classification of definite MI were lower than those based on hospital discharge diagnosis code 410 (e.g., 5.60/1000 and 11.50/1000 among Forsyth County white men, respectively). Age adjusted rates of definite fatal CHD based on ARIC classification were similarly lower than rates based on underlying cause of death code 410; for example, Jackson black men had rates of 2.82/1000 and 4.52/1000 for definite fatal CHD and UCOD 410-414 or 429.2, respectively.

Original languageEnglish (US)
Pages (from-to)223-233
Number of pages11
JournalJournal of Clinical Epidemiology
Issue number2
StatePublished - Feb 1996

Bibliographical note

Funding Information:
When all data for an out-of-hospital death were complete, linking programsu sing name, Social Security number, birth date, race, and sex were used to search the databasef or hospitalizationso f the decedent within 28 days of death. Myocardial infarction diagnosis was assignedb y computerb eforef urther review to assignf atal CHD diagnosis of death if the death occurred in-hospital. An “Event Summary Form” was generatedt hat listed all pertinent information organizedb y sourceo f data (informant interview, medical examiner, hospital record abstraction, etc.). The Event Summary Form was provided to two memberso f the Mortality and Morbidity Classification Committee (MMCC), who applied ARIC criteria independently [6] and assigned a “validated” cause of death. The MMCC is made up of physicians associatedw ith each field center, the coordinating center, and the National Institutes of Health (NIH) ARIC project office. When the two reviewersd isagreedo n any componentso f the criteria for assigning cause of death, the chairman of the MMCC made the final classification. Deaths were classifiedi nto one of five categories:


  • Case fatality
  • Community surveillance
  • Coronary heart disease
  • Mortality


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