An Anglo-American Comparison of the Prevalence of Bronchitis

Several intriguing differences in the reported mortality experience of middle-aged men in the United States and in England and Wales have stimulated speculation about their reality and their explanation (Reid, 1960). Roughly speaking, while the white North American male aged 45 to 54 is twice as likely to die from ischaemic heart disease as his contemporary in England and Wales, the latter suffers a twofold excess in mortality from lung cancer and perhaps -a fivefold excess in the risk of death from the broad group of diseases comprising chronic bronchitis, emphysema, and bronchiectasis. Discrepancies in diagnostic concepts and customs in death certification could explain some of these differences in reported mortality, but the American members of the Joint U.S.-U.K. Board set up by the United States Public Health Service National Heart Council reported after a tour of British hospitals that although such discrepancies certainly existed they could not explain all of the British excess in serious respiratory disease (Meneely et al., 1960). Because of the clinical complexity of the terminal condition in chronic cardio-respiratory disease, there is a clear need for surveys in both countries of the prevalence of earlier forms of respiratory disorder in which the patient's condition can be precisely defined and specifically related-for example, to his environment at home or at work and to his personal habits. In this way Anglo-American differences in experience of respiratory disease might be denied or confirmed. Since it is unlikely that genetic influences are here important, a finding of a real disparity between morbidity levels associated with differences in environment or personal habits could point to major factors in the causation of chronic lung disease and thus indicate possible preventive measures. We here report a comparison between two surveys where the results of the use of standardized clinical methods give a clearer indication of the differences in respiratory morbidity than any other survey results yet available.