The spectrum of coronary heart disease in a community of 30,000. A clinicopathologic study.

N ACCURATE ESTIMATION of the Li incidence of death from coronary heart disease in the United States has not been accomplished in a completely satisfactory manner.1, 2 White3 and Mainland4 showed that it is not possible to determine accurately the incidence of coronary heart disease from consecutive hospital necropsy series, since this incidence is a reflection of the hospital population, which in turn is a biased sample. Incidences based on death-certificate statisties not confirmed by necropsy are also inadequate for this purpose and are subject to obvious limitations. A unique opportunity to avoid these objections exists in Rochester, Minnesota, a community of 30,000 people that has its medical care furnished largely by the Mayo Clinic. Because of this relationship, necropsies are performed in more than two thirds of all deaths at all ages that occur in the community regardless of when or where death took place. Thus, deaths at home, sudden deaths in the city, and deaths in nursing homes, as well as hospital deaths and deaths that will invite the interest of the coroner all have a better thani 65 per cent chance of being investigated at necropsy by one pathologic service. Such a necropsy rate for all deaths in the entire community circumvents the inadequacies of deathcertificate statistics and the bias of selected