Does the southern European cardiovascular mortality advantage extend to total mortality? 50-year trends in death risks between 40 and 70 years of age in Western European men and women

Abstract

To study 50-year mortality trends in men and women of northern and southern Western Europe. The World Health Organization mortality data base and multiple decrement life table methods was used to compute all-cause and cause-specific risks of middle-age death (40-69 years of age) for northern (Denmark, Finland, Germany, Ireland, Netherlands, Norway, Sweden, and UK) and southern (France, Italy, Spain, and Switzerland) Western European countries. From 1952 to 2001, the risk of a cardiovascular death in middle age was higher in the north compared to the south. The north/ south cardiovascular mortality ratios (MR) peaked in 1990-1993 and were 1.57 among women and 1.47 among men in 2001. In 1952, the all-cause risks of middle-age death were similar in the north and south for both women and men (39% and 27%, respectively). In 2001, middle-age death risks were similar for men in the north and the south (24% and 23%, MR = 1.05), but higher among women in the north compared to the south (14% and 11%, MR = 1.28). Cause-specific death risks demonstrated that the cardiovascular advantage for southern European men was countered by a disadvantage in cancer death risk (2001 north/south cancer MR = 0.85). For northern European women in 2001, there was a disadvantage also in the other major cause-of-death groups: cancer (MR = 1.22) and other diseases (MR = 1.28). The southern European cardiovascular middle-age mortality advantage extended to total mortality much more for women than for men. We suggest that forces behind this gender difference in this north/south mortality gradient include life style factors.