Health, Alcohol And Psychosocial Factors In Eastern Europe Study Research Articles

Gender inequalities in mortality in Lithuania: the HAPIEE Study

Abstract Introduction Gender inequalities in morbidity and mortality are important problem in countries of Central and Eastern Europe. Mortality difference between men and women in Lithuania is one of the largest in Europe. The aim of this analysis was to identify factors that influence this difference in population-based sample of middle- and older-age men and women from Lithuanian arm of the HAPIEE Study. Methods Data come from the Lithuanian part of international Health, Alcohol and Psychosocial Factors In Eastern Europe (HAPIEE) longitudinal cohort study. The analytical sample included 3729 women and 3062 men aged 45-74 years at the study baseline. The study outcomes were all-cause, CVD and cancer mortality (mean follow-up approx. 10 years). Gender difference in study outcomes, and the role of wide range of socioeconomic, demographic, behavioural, metabolic and psychosocial covariates in this association was tested by regression modelling. Results There were 913 deaths (576 in men) during the follow-up. Men had higher odds of mortality compared to women: for all-causes OR 2.42 (95% CI 2.09-2.81); for CVD 2.48 (2.03-3.08); for cancer 1.92 (1.54-2.38). BMI was identified as an effect modifier for all-cause and cancer mortality. When adjusted for confounders such as smoking, alcohol consumption or paid work, and stratified for BMI, the gender difference reduced a little for CVD mortality but remained virtually unchanged for all-cause and cancer mortality. Conclusions We found substantial and statistically significant gender inequalities in mortality in this Lithuanian study. We found that men aged 45+ years were approximately two times more likely to die than women, with CVD mortality difference being even larger. Additionally, most of gender difference in mortality remained unexplained by the main social, psychosocial, behavioural and metabolic risk factors. Key messages • Large gender inequalities in mortality have been observed in this Lithuanian study of middle- and older-age men and women. • Most of the inequalities have not been explained by available social, psychosocial, behavioural and metabolic risk factors.

Relationship between Dietary Macronutrients Intake and the ATHLOS Healthy Ageing Scale: Results from the Polish Arm of the HAPIEE Study

Background: Despite extensive research, our knowledge on the relationship between nutrition and healthy ageing is limited. The aim of this study was to evaluate the associations between the intake of macronutrients and a single measure of healthy ageing (ATHLOS Healthy Ageing Scale). Methods: A cross-sectional analysis was performed using data from 9906 randomly selected citizens of Krakow (Poland) who were 45–69 years of age and participants of the Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study. Macronutrient intake was evaluated using a food frequency questionnaire. ATHLOS Health Ageing Scale was estimated from 41 variables in pooled data from 16 cohorts. Standardized beta coefficients were estimated using multivariable linear regression models. Results: In multivariable adjusted models, there were significant positive associations between the ATHLOS Healthy Ageing Scale score and intake of protein (b = 0.030, 95% CI 0.001; 0.059 in men; b = 0.056, 95% CI 0.027; 0.085 in women), monounsaturated fatty acids (MUFA) (b = 0.042, 95% CI 0.013; 0.071 in men; b = 0.035, 95% CI 0.006; 0.064 in women), polyunsaturated fatty acids (PUFA) (b = 0.053, 95% CI 0.024; 0.082 in men; b = 0.063, 95% CI 0.034; 0.092 in women), and omega-3 PUFA (b = 0.031, 95% CI 0.002;0.060 in men; b = 0.054, 95% CI 0.026; 0.082 in women). Carbohydrate intake was inversely associated with the ATHLOS Healthy Ageing Scale in women. Total fat intake was positively associated with the ATHLOS Healthy Ageing Scale in men. Conclusions: A number of nutrients were associated with the healthy ageing score, suggesting that dietary habits may play an important role in healthy ageing. Further research in other settings and with a prospective design is strongly warranted.

Social networks and cognitive function in older adults: findings from the HAPIEE study

BackgroundSocial networks are associated with better cognitive health in older people, but the role of specific aspects of the social network remains unclear. This is especially the case in Central and Eastern Europe. This study examined associations between three aspects of the social network (network size of friends and relatives, contact frequency with friends and relatives, and social activity participation) with cognitive functions (verbal memory, learning ability, verbal fluency, processing speed, and global cognitive function) in older Czech, Polish, and Russian adults.MethodsLinear regression estimated associations between baseline social networks and cognitive domains measured at both baseline and follow-up (mean duration of follow-up, 3.5 ± 0.7 years) in 6691 participants (mean age, 62.2 ± 6.0 years; 53.7% women) from the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study.ResultsCross-sectional analyses, adjusted for country, age, and sex, showed positive associations of global cognitive function with social activity participation and network size of friends and relatives, but not with contact frequency in either network. Further adjustment for sociodemographic, behavioural, and health characteristics attenuated the associations with network size of relatives (P-trend = 0.074) but not with network size of friends (P-trend = 0.036) or social activities (P-trend< 0.001). In prospective analyses, network size and social activity participation were also linked with better cognition in simple models, but the associations were much stronger for social activities (P-trend< 0.001) than for network size of friends (P-trend = 0.095) and relatives (P-trend = 0.425). Adjustment for baseline cognition largely explained the prospective associations with network size of friends (P-trend = 0.787) and relatives (P-trend = 0.815), but it only slightly attenuated the association with social activities (P-trend< 0.001). The prospective effect of social activities was largely explained by sociodemographic, health behavioural, and health covariates (P-trend = 0.233). Analyses of specific cognitive domains generally replicated the cross-sectional and prospective findings for global cognitive function.ConclusionsOlder Central and Eastern European adults with larger social networks and greater social activities participation had better cognitive function, but these associations were stronger at baseline than over the short-term follow-up.

Traditional Eastern European diet and its relationship with mortality: results from the HAPIEE study

Abstract Background Cardiovascular disease (CVD) and cancer mortality rates in Eastern European countries are among the highest in the world. Although unhealthy diet is an important risk factor for both of these chronic diseases, traditional eating habits and their health effects in this region have not yet been explored. This analysis assessed the relationship between traditional dietary pattern and mortality from all-causes, CVD and cancer in Eastern European population-based cohorts. Methods We used data from the Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) multi-centre prospective cohort study based in Russia, Poland and the Czech Republic (age range at baseline: 45-70 years). Diet was assessed by food frequency questionnaire, and we constructed an Eastern European diet score (EEDS) from nine food groups considered as “traditional” in this region. The relationship between EEDS and all-cause, CVD and cancer mortality was calculated with Cox-regression models. Results From the 18,852 participants, 2,234 died during the average follow-up of 11.7 years. In multivariable adjusted models, participants with high adherence to the traditional Eastern European diet had significantly higher risk of all-cause (HR 1.20; 95% CI 1.05-1.38) and CVD deaths (1.32; 1.05-1.64) compared to those with low adherence. The association with cancer mortality was not significant (1.12; 0.90-1.40). From the specific EEDS components, high consumption of lard was significantly positively related to all three mortality outcomes, while processed fruit or vegetable consumption showed consistent inverse associations. Conclusions Our results suggest that traditional eating habits may contribute to the poor health status, particularly the high CVD mortality rates, of populations in Eastern Europe. Adequate public health nutritional interventions in this region are essential. Key messages This work indicates that traditional dietary habits in Eastern European countries may be one of the reasons for the poor health status of populations in this region. Public health nutritional interventions which target traditional but unhealthy foods, such as lard, have the potential to considerably improve population health in Eastern Europe.

Mediterranean diet and physical functioning trajectories in Eastern Europe: Findings from the HAPIEE study.

BackgroundUnhealthy diet may increase the risk of impaired physical functioning in older age. Although poor diet and limited physical functioning both seem to be particularly common in Eastern Europe, no previous study has assessed the relationship between these two factors in this region. The current analysis examined the association between overall diet quality and physical functioning in Eastern European populations.MethodsWe used data on 25,504 persons (aged 45–69 years at baseline) who participated in the Health Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study. Dietary assessment at baseline used food frequency questionnaire, and the overall diet quality was evaluated by the Mediterranean diet score (MDS). Physical functioning (PF) was measured by the physical functioning subscale (PF-10) of the 36-item Short-Form Health Survey at baseline and three subsequent occasions over a 10-year period. The cross-sectional and longitudinal relationships between the MDS and PF were examined simultaneously using growth curve models.ResultsMen and women with higher adherence to the Mediterranean diet had significantly better PF at baseline; after multivariable adjustment, the regression coefficient per 1-unit increase in the MDS was 0.39 (95% CI: 0.25, 0.52) in men and 0.50 (0.36, 0.64) in women. However, we found no statistically significant link between baseline MDS and the subsequent slope of PF decline in neither gender; the coefficients were -0.02 (-0.04, 0.00) in men and -0.01 (-0.03, 0.02) in women.DiscussionOur results do not support the hypothesis that the Mediterranean diet has a substantial impact on the trajectories of physical functioning, although the differences existing at baseline may be related to dietary habits in earlier life.

Serum folate, vitamin B-12 and cognitive function in middle and older age: The HAPIEE study

BackgroundNutrient status of B vitamins, particularly folate and vitamin B-12, may be related to cognitive ageing but epidemiological evidence remains inconclusive. ObjectiveThe aim of this study was to estimate the association of serum folate and vitamin B-12 concentrations with cognitive function in middle-aged and older adults from three Central and Eastern European populations. MethodsMen and women aged 45–69 at baseline participating in the Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study were recruited in Krakow (Poland), Kaunas (Lithuania) and six urban centres in the Czech Republic. Tests of immediate and delayed recall, verbal fluency and letter search were administered at baseline and repeated in 2006–2008. Serum concentrations of biomarkers at baseline were measured in a sub-sample of participants. Associations of vitamin quartiles with baseline (n=4166) and follow-up (n=2739) cognitive domain-specific z-scores were estimated using multiple linear regression. ResultsAfter adjusting for confounders, folate was positively associated with letter search and vitamin B-12 with word recall in cross-sectional analyses. In prospective analyses, participants in the highest quartile of folate had higher verbal fluency (p<0.01) and immediate recall (p<0.05) scores compared to those in the bottom quartile. In addition, participants in the highest quartile of vitamin B-12 had significantly higher verbal fluency scores (β=0.12; 95% CI=0.02, 0.21). ConclusionsFolate and vitamin B-12 were positively associated with performance in some but not all cognitive domains in older Central and Eastern Europeans. These findings do not lend unequivocal support to potential importance of folate and vitamin B-12 status for cognitive function in older age. Long-term longitudinal studies and randomised trials are required before drawing conclusions on the role of these vitamins in cognitive decline.

Mediterranean diet score and total and cardiovascular mortality in Eastern Europe: the HAPIEE study

PurposeMediterranean-type dietary pattern has been associated with lower risk of cardiovascular (CVD) and other chronic diseases, primarily in Southern European populations. We examined whether Mediterranean diet score (MDS) is associated with total, CVD, coronary heart disease (CHD) and stroke mortality in a prospective cohort study in three Eastern European populations.MethodsA total of 19,333 male and female participants of the Health Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study in the Czech Republic, Poland and the Russian Federation were included in the analysis. Diet was assessed by food frequency questionnaire, and MDS was derived from consumption of nine groups of food using absolute cut-offs. Mortality was ascertained by linkage with death registers.ResultsOver the median follow-up time of 7 years, 1314 participants died. The proportion of participants with high adherence to Mediterranean diet was low (25 %). One standard deviation (SD) increase in the MDS (equivalent to 2.2 point increase in the score) was found to be inversely associated with death from all causes (HR, 95 % CI 0.93, 0.88–0.98) and CVD (0.90, 0.81–0.99) even after multivariable adjustment. Inverse but statistically not significant link was found for CHD (0.90, 0.78–1.03) and stroke (0.87, 0.71–1.07). The MDS effects were similar in each country cohort.ConclusionHigher adherence to the Mediterranean diet was associated with reduced risk of total and CVD deaths in these large Eastern European urban populations. The application of MDS with absolute cut-offs appears suitable for non-Mediterranean populations.

A Mediterranean-type diet is associated with better metabolic profile in urban Polish adults: Results from the HAPIEE study

ObjectiveThe aim of this study was to evaluate the relationship between adherence to a Mediterranean-type diet and metabolic syndrome (MetS) in the Polish arm of the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) cohort study. Materials/methodsA cross-sectional survey including 8821 adults was conducted in Krakow, Poland. Food intake was evaluated through a validated food frequency questionnaire and adherence to the dietary pattern was assessed using a score specifically developed for non-Mediterranean countries (MedTypeDiet score). Linear and logistic regression models were performed to estimate beta and odds ratios (ORs) and 95% confidence intervals (CIs), respectively. ResultsSignificant associations between the MedTypeDiet score and waist circumference (β=−0.307±0.239cm), systolic blood pressure (β=−0.440±0.428mmHg), and triglycerides (β=−0.021±0.016mmol/L) were observed. After multivariable adjustment, individuals in the highest quartile of the score were less likely to have MetS, central obesity, high triglycerides, and hypertension. Increase of one standard deviation of the score was associated with 7% less odds of having MetS (OR 0.93, 95% CI: 0.88, 0.97). When analyzing the relation of single components of the MedTypeDiet score, wine, dairy products, and the total unsaturated:saturated fatty acids ratio were associated with MetS. ConclusionsAdherence to a Mediterranean-like diet may decrease the risk of MetS also among non-Mediterranean populations.

PP06 Healthy diet indicator score and metabolic syndrome in the Czech Republic, Russia, and Poland: cross-sectional findings from the HAPIEE study

<h3>Background</h3> In Eastern Europe, cardiovascular disease (CVD) mortality is high, but the causes of this remain poorly understood. Metabolic syndrome (MetS) is a risk factor for CVD and is thought to be partly determined by diet. However, few studies have examined the associations between dietary quality and MetS in Eastern European populations <h3>Methods</h3> This cross-sectional study used data from the baseline wave of the prospective Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study—21,142 randomly selected adults aged 45–69 years. MetS was defined using the ATP III definition (at least three of the following: central obesity (waist circumference ≥102 cm in men; ≥88 cm in women), high blood pressure (≥130/85 mmHg), high triglycerides (≥1.7 mmol/L), low HDL-C (&lt;1.03 mmol/L in men; &lt;1.29 mmol/L in women), high plasma blood glucose (≥6.1 mmol/L)). Dietary intake was obtained using a self-reported food frequency questionnaire in the preceding 3 months, and the Healthy Diet Indicator (HDI) was derived using WHO 2003 recommendations (intake of polyunsaturated/saturated fatty acids, fruit and vegetables, fibre, cholesterol, sugar, and protein; each component has a score ranging from 0 (worst) to 10 (best adherence) and the total score ranges from 0 (worst) to 70 (best dietary quality)). Anthropometric data and blood samples were collected during clinic visits, and other data by structured questionnaire. Logistic regression was used to examine the association between HDI and MetS (using Stata 12). All models were adjusted for potential confounders (age, sex, education, employment status, physical activity, smoking status, family history of diabetes and stroke, use of medication, alcohol intake, and total daily energy intake). <h3>Results</h3> Prevalence of MetS was high in the Czech Republic (45.8%), Russia (29.1%), and Poland (27.8%). The risk of having MetS increased with age in all three countries (p &lt; 0.001). Higher HDI score was associated with lower risk of MetS in the Czech Republic (OR of Mets per 10 unit increase in HDI=0.91, 95% CI: 0.83–1.00) and Russia (0.92, 0.85–0.99) but not Poland (1.01, 0.94–1.11). <h3>Conclusion</h3> In the Czech Republic and Russia (but not Poland), higher adherence to HDI was associated with lower risk of MetS. Findings provide some support for the beneficial role of diet quality in lowering MetS prevalence. Future longitudinal studies should examine whether higher adherence to HDI reduces the risk of MetS and CVD.

Psychometric properties and confirmatory factor analysis of the CASP-19, a measure of quality of life in early old age: the HAPIEE study

Objectives: The aim was to assess the reliability and validity of the quality of life (QoL) instrument CASP-19, and three shorter versions of CASP-12 in large population sample of older adults from the HAPIEE (Health, Alcohol, and Psychosocial factors In Eastern Europe) study.Methods: From the Czech Republic, Russia, and Poland, 13,210 HAPIEE participants aged 50 or older completed the retirement questionnaire including CASP-19 at baseline. Three shorter 12-item versions were also derived from original 19-item instrument. Psychometric validation used confirmatory factor analysis, Cronbach's alpha, Pearson's correlation, and construct validity.Results: The second-order four-factor model of CASP-19 did not provide a good fit to the data. Two-factor CASP-12v.3 including residual covariances for negative items to account for the method effect of negative items had the best fit to the data in all countries (CFI = 0.98, TLI = 0.97, RMSEA = 0.05, and WRMR = 1.65 in the Czech Republic; 0.96, 0.94, 0.07, and 2.70 in Poland; and 0.93, 0.90, 0.08, and 3.04 in Russia). Goodness-of-fit indices for the two-factor structure were substantially better than second-order models.Conclusions: This large population-based study is the first validation study of CASP scale in Central and Eastern Europe (CEE), which includes a general population sample in Russia, Poland, and the Czech Republic. The results of this study have demonstrated that the CASP-12v.3 is a valid and reliable tool for assessing QoL among adults aged 50 years or older. This version of CASP is recommended for use in future studies investigating QoL in the CEE populations.

Socioeconomic inequalities in all-cause mortality in the Czech Republic, Russia, Poland and Lithuania in the 2000s: findings from the HAPIEE Study

BackgroundRelatively large socioeconomic inequalities in health and mortality have been observed in Central and Eastern Europe (CEE) and the former Soviet Union (FSU). Yet comparative data are sparse and virtually...

Age at natural menopause in three Central and Eastern European urban populations: The HAPIEE study

ObjectivesTo investigate the age at menopause in three urban populations in Central and Eastern Europe and to assess whether the (suspected) differences can be explained by a range of socioeconomic, reproductive and behavioural factors. MethodsThe Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) Study examined random samples of populations aged 45–69 years in Novosibirsk (Russia), Krakow (Poland) and six Czech towns. Participants completed a questionnaire and attended an examination in clinic. A total of 12,676 of women were included in these analyses. ResultsThe median age at menopause was 50 years in Novosibirsk, 51 years in Czech towns and 52 years in Krakow; the Cox regression hazard ratios of menopause, compared with Krakow, were 1.47 (95% CI 1.40–1.55) for Novosibirsk and 1.10 (1.04–1.16) for Czech women. In multivariate analyses, higher education, using vitamin and mineral supplements and ever use of oral contraceptives were associated with later menopause, while smoking, abstaining from alcohol and low physical activity were associated with earlier menopause. These factors, however, did not explain the differences between populations; the multivariate hazard ratios of menopause, compared with Krakow, were 1.48 (1.40–1.57) for Novosibirsk and 1.11 (1.05–1.17) for Czech women. ConclusionsIn this large population based study, differences in age at menopause between Central and Eastern Europe populations were substantial and unexplained by a range of risk factors. Associations of age at menopause with risk factors were largely consistent with studies in other populations.

Socio-economic circumstances and food habits in Eastern, Central and Western European populations

To assess the relationship between several socio-economic indicators and frequency of consumption of seven predefined healthy foods (consumption of fruit, vegetables, wholegrain bread, vegetable-fat spread, vegetable cooking fat, low-fat milk and low-fat cheese) in populations from Eastern, Central and Western Europe. Analysis of baseline data collected in two cross-sectional cohort studies between 2000 and 2005: the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study and the Finnish Helsinki Health Study (HHS). Urban populations in the Czech Republic, Russia, Poland and Finland. In the HAPIEE study, random samples of men and women aged 45-69 years were drawn from population registers and electoral lists of selected cities. In the HHS, men and women aged 40-60 years employed by the City of Helsinki were recruited. Data on 21,326 working subjects from both cohorts were analysed. Healthy food habits were, in general, positively associated with higher education, occupational position and fewer economic difficulties, but there were differences in the strength of the gradient by food and country. Fruit consumption showed the most consistent gradients, especially in relation to socio-economic status among men (country-specific relative index of inequality (RII)=2.02-5.17) and women (RII=2.09-3.57). The associations between socio-economic indicators and healthy food habits showed heterogeneity between countries. Future studies of dietary behaviours should consider multiple measures of socio-economic position.

Non-fatal injuries in three Central and Eastern European urban population samples: the HAPIEE study

Background: Despite high mortality from injuries and accidents, data on rates and distribution of non-fatal injuries in Central and Eastern European populations are scarce. Methods: Cross-sectional study of random population samples of 45–69-year-old men and women (n = 28 600) from Novosibirsk (Russia), Krakow (Poland) and six Czech towns, participating in the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study. Participants provided information on non-fatal injuries in the past 12 months, socio-economic characteristics, alcohol consumption and other covariates. Results: The period prevalence of non-fatal injuries in the last year among Czech, Russian and Polish men was 12.5, 9.4 and 5.3%, respectively; among women, the respective proportions were 9.9, 9.8 and 6.4%. Injury prevalence declined with age in men and increased with age in women. Higher injury prevalence was associated with being unmarried, material deprivation, higher drinking frequency and problem drinking. In the pooled data, the adjusted odds ratio (OR) for the highest versus lowest material deprivation category was 1.57 [95% confidence interval (CI) 1.38–1.79]; for problem drinking, the OR was 1.44 (95% CI 1.23–1.69). Alcohol did not mediate the link between socio-economic status and injury. Conclusion: Non-fatal injuries were associated with material deprivation, other socio-economic characteristics and with alcohol. These results not only underscore the universality of the inequality phenomenon, but also suggest that the mediating role of alcohol in social differentials in non-fatal injury remains an unresolved issue.

Dietary habits in three Central and Eastern European countries: the HAPIEE study.

BackgroundThe high cardiovascular mortality in Eastern Europe has often been attributed to poor diet, but individual-level data on nutrition in the region are generally not available. This paper describes the methods of dietary assessment and presents preliminary findings on food and nutrient intakes in large general population samples in Russia, Poland and the Czech Republic.MethodsThe HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) study examined random samples of men and women aged 45-69 years at baseline in Novosibirsk (Russia), Krakow (Poland) and six Czech urban centres in 2002-2005. Diet was assessed using a food frequency questionnaire (at least 136 items); complete dietary information was available for 26,870 persons.ResultsTotal energy intakes among men ranged between 8.7 MJ in the Czech sample and 11.7 MJ in the Russian sample, while among women, energy intakes ranged between 8.2 MJ in the Czech sample and 9.8 MJ in the Russian sample. A Healthy Diet Indicator (HDI), ranging from a score of 0 (lowest) to 7 (highest), was developed using the World Health Organisation's (WHO) guidelines for the prevention of chronic diseases. The mean HDI scores were low, ranging from 1.0 (SD = 0.7) among the Polish subjects to 1.7 (SD = 0.8) among the Czech females. Very few subjects met the WHO recommended intakes for complex carbohydrates, pulses or nuts; intakes of saturated fatty acids, sugar and protein were too high. Only 16% of Polish subjects met the WHO recommendation for polyunsaturated fat intake. Consumption of fruits and vegetables was lower than recommended, especially among those Russian subjects who were assessed during the low intake season. Fewer than 65% of subjects consumed adequate amounts of calcium, magnesium and potassium, when compared with the United Kingdom's Reference Nutrient Intake.ConclusionThis first large scale study of individual-based dietary intakes in the general population in Eastern Europe implies that intakes of saturated fat, sugar and complex carbohydrates are a cause for concern. The development of country-specific nutritional tools must be encouraged and nutritional campaigns must undergo continuing development.

Neighbourhood socioeconomic status and cardiovascular risk factors: a multilevel analysis of nine cities in the Czech Republic and Germany

BackgroundPrevious studies have shown that deprived neighbourhoods have higher cardiovascular mortality and morbidity rates. Inequalities in the distribution of behaviour related risk factors are one possible explanation for this trend. In our study, we examined the association between cardiovascular risk factors and neighbourhood characteristics. To assess the consistency of associations the design is cross-national with data from nine industrial towns from the Czech Republic and Germany.MethodsWe combined datasets from two population based studies, one in Germany ('Heinz Nixdorf Recall (HNR) Study'), and one in the Czech Republic ('Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) Study'). Participation rates were 56% in the HNR and 55% in the HAPIEE study. The subsample for this particular analysis consists of 11,554 men and women from nine German and Czech towns. Census based information on social characteristics of 326 neighbourhoods were collected from local administrative authorities. We used unemployment rate and overcrowding as area-level markers of socioeconomic status (SES). The cardiovascular risk factors obesity, hypertension, smoking and physical inactivity were used as response variables. Regression models were complemented by individual-level social status (education) and relevant covariates.ResultsSmoking, obesity and low physical activity were more common in deprived neighbourhoods in Germany, even when personal characteristics including individual education were controlled for. For hypertension associations were weak. In the Czech Republic associations were observed for smoking and physical inactivity, but not for obesity and hypertension when individual-level covariates were adjusted for. The strongest association was found for smoking in both countries: in the fully adjusted model the odds ratio for 'high unemployment rate' was 1.30 [95% CI 1.02–1.66] in the Czech Republic and 1.60 [95% CI 1.29–1.98] in Germany.ConclusionIn this comparative study, the effects of neighbourhood deprivation varied by country and risk factor; the strongest and most consistent effects were found for smoking. Results indicate that area level SES is associated with health related lifestyles, which might be a possible pathway linking social status and cardiovascular disease. Individual-level education had a considerable influence on the association between neighbourhood characteristics and risk factors.