Unexplained Increased Deaths from Heart Disease in New York

I presume this is related to poverty and many unmeasured variables, but according to epidemiologists, the increased death rate is mysterious and unexplained. As an aside, I've personally noticed that there's an unusual incentive to put "Ischemic Coronary Disease" down on the death certificate as the cause of death at the New York hospitals at which I've worked and trained. Anything significantly more complicated or arcane is likely to get rejected by the hospital administration, which is a hassle for the residents, who have to then fill out a new death certificate. So if an unusual incentive in New York exists to put heart disease down on the death certificate (for whatever reason), this could also explain the data. From the New York Times:

Death rates from heart disease in New York City and its suburbs are among the highest recorded in the country, and no one quite knows why...

There is no obvious explanation. Some speculate about the potential role of stress. It is widely believed that life in New York is more difficult, and stress has been linked to higher heart disease mortality. A 1999 study showed that people were more likely to die of a heart attack in New York City than elsewhere. The authors suggested stress could play a role because the excess death rate affected both visitors and residents; they found no other explanation.

"There's an acute effect of being in New York," said Nicholas Christenfeld, a psychologist at the University of California at San Diego who did the study. "You're wired the whole time." But stress is difficult to measure, and there is no proof that life is more stressful in and around New York, despite the popular notions...

The role of lipids is very large in heart disease," he said, adding: "People think we eat badly in the South, but the worst meal I ever had was at a deli in New York. I'd never heard of schmaltz before that," referring to chicken fat.

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