Læknablaðið : fylgirit - 01.03.1983, Blaðsíða 96

Table 6 shows that the degree of coronary atherosclerosis is
similar in the two groups but males had more atherosclerosis and
higher degrees of stenosis in the coronary arteries, than females.
Myocardial infarcts, as shown in table 7, occured less frequently
in the older group. Myocardial infarcts were also a rarer cause
of death (table 2).
Table 8 shows the prevalence of gallstones, diverticulosis and
dementia. There was a rising incidence of gallstones, diverti-
culosis and dementia into very old age and the prevalence was
higher in females for these three diseases.
Discussion
A few decades ago senility was rated as a common cause of death in
the mortality statistics. In 1951-1960, senility was the under-
lying cause of death in 4.1% of Icelandic males and 6.3% of females
who died older than 65 years of age. At the same time the compar-
able figures in Europe ranked from 9.6 - 11.4% in Belgium to the
lowest in England & Wales, 1.2 - 2.1% for males and females (7).
With the general improvement of the health services and better
education of medical practitioners the incidence of "senility" as
a cause of death has been reduced. Over the same period of time
the average age at death has increased and the incidence of major
diseases has changed.
Mortality statistics are mostly based on clinical diagnoses from
death certificates with a varying proportions from autopsies. The
comparison of the clinical diagnoses and the autopsy diagnoses at
death has shown 6 to 68% discrepancies (mean of 39%) (8.9). Clinical
diagnosis is usually more difficult in the elderly and more dis-
crepancies can be expected on death certificates in old age (7).
However when our autopsy results are compared with the Icelandic
national mortality statistics, the major deviations are seen in the
low incidence of ischemic heart disease and the high incidence of
respiratory diseases in the very old.
During this century the life expectancy has been increasing stead-
ily towards an ideal life span. During 1975-1980 the life expect-
ancy of Icelanders over 65 years of age has increased by 1.9 years
when compared with the previous five year period. The major causes
of death during the early part of this century were infections of
various kinds. Today these diseases have been replaced by cardio-
vascular and neoplastic deseases. The national health services in
the preantibiotic area during the early and middle part of this
century were aimed to deal with infectious diseases and only lately
has the emphasis been changed to cardiovascular and neoplastic dis-
eases.
Cardiovascular diseases had become prevalent in Britain around 1920
but this epidemic reached Iceland 30 years later. There are indi-
cations that death rate from coronary artery disease has levelled in
Iceland and in some western countries there has been a considerable
decrease over the last two decades (10.11). Recent studies with
coronary arteriograms have indicated that age has little effect on
the progression of coronary artery diseases (12). In our study
groups with more than 20 years difference in age, the incidence of
atherosclerotic lesions in the coronary arteries was similar but
94