Why Heart-Disease Deaths in 1900 and 2000 Are Not Directly Comparable
The population, the diagnoses, the treatments, and the causes of death all changed. "Heart disease" did not mean the same thing in 1900, which is why a century-long comparison cannot settle a nutrition argument.
Comparing heart-disease mortality in 1900 with heart-disease mortality in 2000 sounds straightforward.
It is not.
The population was much younger
In 1900, the American population was much younger. Nearly one-third of deaths occurred in children younger than five. Pneumonia, tuberculosis, diarrhea, and other infections killed large numbers of people before they reached the ages when coronary artery disease commonly becomes clinically apparent.
The diagnostic categories were different
A death labeled "heart disease" in 1900 might have included rheumatic valve disease, myocarditis, endocarditis, kidney-related cardiovascular disease, poorly characterized heart failure, and a range of conditions that would be classified differently today.
Heart attacks and coronary thrombosis were not identified with anything approaching modern consistency. By 2000, infectious and rheumatic causes of heart disease had become much less common, while ischemic coronary disease dominated the category.
That does not mean atherosclerosis was absent in 1900. It means the population, the competing causes of death, the diagnostic tools, the medical vocabulary, and the death-certificate classifications had all changed.
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Mortality reflects far more than saturated fat
Heart-disease mortality also tracks smoking patterns, blood-pressure treatment, diabetes, obesity, cholesterol treatment, statins, emergency cardiac care, revascularization, and improved survival after a cardiac event.
A century-long national comparison therefore cannot prove that saturated fat caused, or did not cause, the historical heart-disease curve. It tells us something more useful.
“Simple stories usually fail when the system is complicated. And the human body is a complicated system.”
Biology has opinions. So does history. Neither is particularly interested in fitting neatly onto a bumper sticker.
This week's practical step
When someone shows you two historical numbers and claims one caused the other, ask three questions. Were the populations comparable? Were the diagnoses defined the same way? What other major factors changed?
Good reasoning does not require rejecting every conclusion. It requires refusing to skip the middle.
Former military, strength athlete, and physician who rebuilt his own health after struggling with weight through training and residency. Dr. James writes about the real causes of chronic disease and what it actually takes to fix them.
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