The risk of fallacious conclusions from autopsy data on the incidence of diseases with applications to heart disease

Mainland, Donald

doi:10.1016/0002-8703(53)90306-8

Cited by 136 publications

(20 citation statements)

References 4 publications

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“…Second, autopsy studies potentially involve serious selection bias, which can contribute to spurious associations of risk factors and atherosclerosis. 1 A partial solution to these problems can be found in those rare instances in which autopsy determinations of cerebral atherosclerosis can be made for individuals who have participated in prospective epidemiologic studies. By definition, biologic risk factors and lifestyle characteristics have been measured before the onset of clinical disease, thus providing estimates of risk based on exposure status.…”

mentioning

confidence: 99%

A prospective study of cerebral artery atherosclerosis.

Reed

Resch

Hayashi

et al. 1988

Stroke

100

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Atherosclerosis in the circle of Willis and its major branches was studied prospectively in 198 men in the Honolulu Heart Program who were free of cardiovascular disease at the entry examination. The level of atherosclerosis was greater in the large arteries of the circle of Willis than in the small arteries, and autopsy-verified cerebral infarction was strongly associated with increasing severity of atherosclerosis in both. Analyses of the association of atherosclerosis scores with biologic and lifestyle characteristics measured at entry into the study indicated that atherosclerosis in the large arteries was consistently related to age, diastolic blood pressure, serum cholesterol, and height (inversely). Weak trends of association were also found with increasing serum glucose concentration, increasing cigarette use, and decreasing alcohol intake. Atherosclerosis scores in the small arteries were associated with diastolic blood pressure and serum triglyceride concentration. Analysis of dietary intake indicated that atherosclerosis scores were higher for men who reported low intakes of fat and animal protein and high intakes of vegetable protein and total carbohydrates. These patterns were consistent with similar findings on the incidence of clinical stroke in this cohort. Age-adjusted and -specific atherosclerosis scores from both the large and small arteries declined significantly during the period 1965-1983 . (Stroke 1988 19:820-825)

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mentioning

confidence: 99%

A prospective study of cerebral artery atherosclerosis.

Reed

Resch

Hayashi

et al. 1988

Stroke

100

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“…Differences in age and sex struc ture of the autopsy series, the whole popula tion and of different periods of investigation further limit comparisons. Even when we take into account that cholelithiasis in fluenced death in only 0.26-3% of necropsies [3,12,29], extrapolation of the data to the whole population is difficult [20]. In our ma terial, it is striking that in all periods consid ered the number of autopsies performed in men is nearly double that in women.…”

Section: Discussionmentioning

confidence: 80%

Epidemiology of Gallstones in a German Industrial Town (Essen) from 1940–1975

Balzer¹,

Goebell²,

Breuer³

et al. 1986

Digestion

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The prevalence of gallstones was studied in 11,840 consecutive autopsies from 1940 to 1975 in the University hospitals of Essen. The total prevalence was 20.7%: 13.1 % for men and 33.7% for women. The male to female sex ratio is 1 : 2.6. The crude prevalence for three 12-year periods showed a significant increase from 8.2 to 15% in men and from 25.7 to 36.3% in women ( p < 0.001). A detailed analysis showed that this increase occurred only in the age groups over 60 and was the consequence of the fact that a greater proportion of women over 60 came to autopsy. The age- and sex-specific morbidity ratio was calculated to standardize the data. This demonstrated considerable fluctuations in 3-year periods since 1940. It can be concluded that no real increase in the prevalence of gallstones occurred in the last 30 years.

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“…When the significance of the results is interpreted, the most important source of bias is obviously the selective composition of autopsy materials. This problem has been discussed by many authors (Mainland, 1953;McMahan, 1962;Sternby, 1968;Rissanen, 1972). There is considerable consensus that persons dying of violent causes constitute the best possible crosssectional sample of population for the study of atherosclerosis (Strong and McGill, 1962;Sternby, 1968;Vihert et al, 1970).…”

Section: Discussionmentioning

confidence: 99%

Coronary and aortic atherosclerosis in chronic alcoholics

Rissanen

1974

Z Rechtsmed

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The severity of the atherosclcrotic involvement of the coronary arteries and the abdominal aorta was compared in a medico-legal autopsy series of chronic alcoholics and violent deaths. Atherosclerosis was quantitatcd by surface area measurements made by the point--counting technique. Coronary fatty streaks were less extensive in chronic alcoholics than in violent deaths. The extent of coronary and aortic raised lesion and the severity of coronary stenosis did not differ in medico-legally autopsied chronic alcoholics from that in persons who died of violent causes.Zusammen]assung. Atherosklerose der Herzkranzschlagadern und der abdominalen Aorta wurde bei Alkoholikern und bei Unfalltoten in einem gerichtsmedizinischen Sektionsmaterial untersucht. Die Fetteinlagerungen in der Intima der Coronararterien waren leichter bei Alkoholikern als bei Unfalltoten. Es war keine signifikante Differenz zwischen Alkoholikern und Unfalltoten in der St~irke der Atheromatose und Coronarstenosen.

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The risk of fallacious conclusions from autopsy data on the incidence of diseases with applications to heart disease

Cited by 136 publications

References 4 publications

A prospective study of cerebral artery atherosclerosis.

A prospective study of cerebral artery atherosclerosis.

Epidemiology of Gallstones in a German Industrial Town (Essen) from 1940–1975

Coronary and aortic atherosclerosis in chronic alcoholics

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