Are regional mortality patterns in the Netherlands culturally determined?

Abstract

Geographical mortality variation within the Netherlands is dominated by a contiguous area of high mortality in the southeast. This pattern originated from the 19th century. In this analysis, it was examined whether this pattern is related to cultural and/or to socio-economic factors. In a multiple regression analysis, percentage of Roman-catholics, income level and degree of urbanization were related to geographical mortality differences in 1950-1954 and 1980-1984 respectively. For 1980-1984, the strongest relationships were found with the most " cultural" variable, the percentage of the population of Roman-catholic affiliation. Over the period 1950-1954 to 1980-1984, this association has however become less strong. In contrast, a negative relationship with income level has emerged in the same period, among others for ischémie heart disease. These associations can probably in part be attributed to differences in smoking.