Swiss Urban Population Research Articles

Spatial analysis of 10-year predicted risk and incident cardiovascular atherosclerotic diseases in a swiss urban population

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Swiss National Science Foundation GlaxoSmithKline. Introduction Whether cardiovascular risk score geographically aggregates and informs on spatial development of atherosclerotic cardiovascular disease (ASCVD) remains unknown. Aims We first determined the spatial distribution of cardiovascular risk predicted in an urban population. Second, we compared risk maps with clustering of incident ASCVD over a 10-year follow-up. Sensitivity analyses were conducted to identify explanatory risk factors for both clusters of predicted risk and observed ASCVD. Methods Using data from a population-based cohort study, we computed the Systematic Coronary Risk Evaluation Score 2 (SCORE2 and SCORE2-OP) in participants free from ASCVD at baseline (2003-2006). Geographical distributions of predicted risk and incident ASCVD were determined using global and local spatial autocorrelation statistics. Different models were tested to identify explanatory variables (alcohol consumption, body mass index, socio-economic status, anxiety disorder, major depressive disorder, Mediterranean diet, sport activity, polygenic risk score, mean noise, concentration of PM2.5, normalized difference vegetation index, land surface temperature). Results 6203 individuals (56% women, mean age 52.5 ± SD 10.7) with a median follow-up of 10 years (IQR, 6-10) were included in the analyses. Over the period, there was persistent geographical clustering of predicted risk and ASCVD (Figures 1 and 2). Predicted risk and incident ASCVD marginally overlapped spatially. Body-mass index (BMI) and alcohol consumption explained most of the spatial distribution of predicted risk, reducing high-risk clusters from 286 to 5 and low-risk clusters from 391 to 44. For ASCVD, high clusters either persisted or were reinforced depending upon locations, after adjustment for potential risk factors, with an increase from 100 to 118. Low clusters reduced from 293 to 76 after the adjustment. Incidence rate of ASCVD was 2.5% (IC95%, 3.7-2.4%]) in high-risk clusters compared to the rest of the population. Conclusions Using a population-based cohort, we showed that in an urban area there exists clusters of high and low incidence of ASCVD. Geographical distribution of clusters of high clinical risk score was not congruent with that of incident ASCVD, limiting the use of clinical risk scores in identifying areas where ASCVD may develop.

Vegetarian, pescatarian and flexitarian diets: sociodemographic determinants and association with cardiovascular risk factors in a Swiss urban population.

Prevalence and trends of different vegetarian diets remain unknown, with estimates varying depending on the source. Evidence suggests that vegetarian diets are associated with a more favourable cardiovascular risk profile. The present study aimed to assess the prevalence and trends of different types of vegetarian diets in a population-based representative sample, sociodemographic characteristics of participants following such diets and the association of these diets with cardiovascular risk factors. Using repeated cross-sectional population-based surveys conducted in Geneva, Switzerland, 10 797 individuals participated in the study between 2005 and 2017. Participants were classified as vegetarians, pescatarians, flexitarians or omnivores using an FFQ. Sociodemographic and cardiovascular risk factors were evaluated through questionnaires, anthropometric measurements and blood tests. Findings show prevalence of vegetarians increased from 0·5 to 1·2 %, pescatarians from 0·3 to 1·1 % and flexitarians remained stable at 15·6 % of the population over the study period. Compared with omnivores, vegetarians were more likely to be young (OR 2·38; 95 % CI 1·01, 5·6), have higher education (OR 1·59; 95 % CI 1·01, 2·49) and lower income (OR 1·83; 95 % CI 1·04, 3·21); pescatarians and flexitarians were more likely to be women (pescatarian: OR 1·81; 95 % CI 1·10, 3·00; vegetarian: OR 1·57; 95 % CI 1·41, 1·75) and flexitarians were also more likely to have a lower income (OR 1·31; 95 % CI 1·13, 1·53). Participants who adhered to any diet excluding/reducing meat intake had lower BMI, total cholesterol and hypertension compared with omnivores. The present study shows an increase in the prevalence of vegetarians over a 13-year period and suggests that the different vegetarian diets assessed are associated with a better cardiovascular risk profile.

Individual-level high definition spatial distribution of mammography uptake in Geneva (Switzerland)

Abstract Background The local social and physical environment influences health outcomes and individual behaviour. It remains unknown if the environmental influence is independent of individual socioeconomic status (SES). We studied the spatial distribution of mammography screening uptake in the Swiss urban population of Geneva and determined its independence from SES. Methods We used individual-level geo-referenced data (n = 5 002) from the participants in the Bus Santé study, a population-based cross-sectional study ongoing in Geneva since 1992. Data from 1992 to 2014 have been included in this study. Local indicators of spatial association (LISA) were calculated and used to assess the spatial dependence of mammography uptake (defined as having had a mammography in the past). We report unadjusted spatial clusters; adjusted for neighbourhood income and individual educational attainment; and for demographic variables (age and Swiss nationality). Furthermore, we evaluated the association between the distance to the nearest screening centre and the identified spatial clusters. Results Mammography uptake was not randomly distributed, with spatial clusters overlapping with those of SES. Spatial clusters were reduced to 56.2% of their initial size (n = 1,033) after adjustment for SES variables. Adjustment for age and nationality further reduced the proportion of individuals exhibiting spatially-dependent behaviour (to 36.5% of the initial size). Distance to the nearest screening centre was not associated with the spatial distribution of mammography uptake. Conclusions High definition spatial distribution studies using analysis of individual data allow identifying spatial clusters which are not based on pre-determined administrative units (e.g. postal code) but rather on individual behaviour. Persistent spatial clusters after adjustment for SES and demographic confounders suggest additional area-level determinants influencing the spatial distribution of mammography uptake. Key messages High definition spatial studies can help uncover new patterns of health outcomes distribution independent of SES and based on individual behaviour, rather than administrative units. While SES explains a great proportion of the spatial distribution of mammography uptake, other still elusive factors may be contributing to the observed spatial inequalities in mammography uptake.

Alcohol control policies and socioeconomic inequalities in hazardous alcohol consumption: a 22-year cross-sectional study in a Swiss urban population

ObjectiveHarmful use of alcohol represents a large socioeconomic and disease burden and displays a socioeconomic status (SES) gradient. Several alcohol control laws were devised and implemented, but their equity impact...

The impact of a public smoking ban on smoking socioeconomic inequalities in a Swiss urban population

The impact of a public smoking ban on smoking socioeconomic inequalities in a Swiss urban population

The impact of a public smoking ban on smoking socioeconomic inequalities in a Swiss urban population

The impact of a public smoking ban on smoking socioeconomic inequalities in a Swiss urban population

Spatial distribution of mammography adherence in a Swiss urban population and its association with socioeconomic status.

PurposeLocal physical and social environment has a defining influence on individual behavior and health‐related outcomes. However, it remains undetermined if its impact is independent of individual socioeconomic status. In this study, we evaluated the spatial distribution of mammography adherence in the state of Geneva (Switzerland) using individual‐level data and assessed its independence from socioeconomic status (SES).MethodsGeoreferenced individual‐level data from the population‐based cross‐sectional Bus Santé study (n = 5002) were used to calculate local indicators of spatial association (LISA) and investigate the spatial dependence of mammography adherence. Spatial clusters are reported without adjustment; adjusted for neighborhood income and individual educational attainment; and demographic factors (age and Swiss nationality). The association between adjusted clusters and the proximity to the nearest screening center was also evaluated.ResultsMammography adherence was not randomly distributed throughout Geneva with clusters geographically coinciding with known SES distributions. After adjustment for SES indicators, clusters were reduced to 56.2% of their original size (n = 1033). Adjustment for age and nationality further reduced the number of individuals exhibiting spatially dependent behavior (36.5% of the initial size). The identified SES‐independent hot spots and cold spots of mammography adherence were not explained by proximity to the nearest screening center.ConclusionsSES and demographic factors play an important role in shaping the spatial distribution of mammography adherence. However, the spatial clusters persisted after confounder adjustment indicating that additional neighborhood‐level determinants could influence mammography adherence and be the object of targeted public health interventions.

Persistent spatial clusters of high body mass index in a Swiss urban population as revealed by the 5-year GeoCoLaus longitudinal study

ObjectiveBody mass index (BMI) may cluster in space among adults and be spatially dependent. Whether and how BMI clusters evolve over time in a population is currently unknown. We aimed...

Thermal discomfort with cold extremities in relation to age, gender, and body mass index in a random sample of a Swiss urban population

BackgroundThe aim of this epidemiological study was to investigate the relationship of thermal discomfort with cold extremities (TDCE) to age, gender, and body mass index (BMI) in a Swiss urban population.MethodsIn a random population sample of Basel city, 2,800 subjects aged 20-40 years were asked to complete a questionnaire evaluating the extent of cold extremities. Values of cold extremities were based on questionnaire-derived scores. The correlation of age, gender, and BMI to TDCE was analyzed using multiple regression analysis.ResultsA total of 1,001 women (72.3% response rate) and 809 men (60% response rate) returned a completed questionnaire. Statistical analyses revealed the following findings: Younger subjects suffered more intensely from cold extremities than the elderly, and women suffered more than men (particularly younger women). Slimmer subjects suffered significantly more often from cold extremities than subjects with higher BMIs.ConclusionsThermal discomfort with cold extremities (a relevant symptom of primary vascular dysregulation) occurs at highest intensity in younger, slimmer women and at lowest intensity in elderly, stouter men.

Cold extremities and difficulties initiating sleep: evidence of co‐morbidity from a random sample of a Swiss urban population

Difficulties initiating sleep (DIS) can frequently occur in psychiatric disorders but also in the general population. The primary vasospastic syndrome is a functional disorder of vascular regulation in otherwise healthy subjects complaining of thermal discomfort from cold extremities (TDCE). Laboratory studies have shown a close relationship between long sleep onset latency and increased distal vasoconstriction in healthy young subjects. Considering these findings, the aims of the Basel Survey were to assess the prevalence rates for DIS and TDCE and to determine whether both symptoms can be associated in the general population. In a random population sample of Basel-Stadt, 2800 subjects (age: 20-40 years) were requested to complete a questionnaire on sleep behavior and TDCE (response rate: 72.3% in women, n = 1001; 60.0% in men, n = 809). Values of DIS and TDCE were based on questionnaire-derived scores. In addition, TDCE was externally validated in a separate group of subjects (n = 256) by finger skin temperature measurements--high TDCE values were significantly associated with low finger skin temperature. A total of 31.1% of women and 6.9% of men complain of TDCE. In contrast, prevalence rates of DIS were only slightly higher in women in comparison to men (9.3% versus 6.7%, P < 0.1). Irrespective of gender, each seventh subject complaining of TDCE had concomitant DIS and the relative risk in these subjects was approximately doubled. Therefore, a thermophysiological approach to DIS may be relevant for its differential diagnosis and its treatment.

Urban Consumers’ Attitudes Towards Non-wood Forest Products and Services in Switzerland and an Assessment of Their Market Potential

To obtain empirical data on future market potential, a consumer survey about supply, demand and consumption of non-wood forest products and services (NWFP&S) was conducted in six cities in different cantons of Switzerland. A total of 897 persons–about 150 per city–were interviewed through arbitrary selection in which women and youths were overrepresented in comparision to the Swiss population. A high consumer acceptance of forest products and particularly forest services among the Swiss urban population was observed. Preferences in purchasing honey, berries, mushrooms and roots among other NWFP were reported. The quality of the products and their environmental friendliness ranked highest in the attitudes of potential consumers who prefer to buy NWFP at market stands, in retail traders’ shops and in drugstores. The most popular forest activities among the respondents are recreation and various kinds of sports activities followed by the gathering of NWFP. As far as the consumers’ wishes and aspirations are concerned, sports, camping and adventure rank high apart from the desire to acquire environmental knowledge about the forest flora and fauna. NWFP&S are highly estimated in Switzerland and have a considerable market potential and, if well marketed, could add substantially to the income of forest enterprises.

Gender differences in physical activity and fitness?association with self-reported health and health-relevant attitudes in a middle-aged Swiss urban population

In Switzerland lack of exercise is common. To improve physical exercise in both women and men, campaigns should consider the motivation for physical activity with respect to gender. This study explores the patterns of self-reported sport activity, habitual physical activity and physical fitness, and associated indicators of self-reported health, health-relevant attitudes, and resources in an urban Swiss population. Using the Bern Lifestyle Panel questionnaire, 511 women and 413 men, aged 55–65 years, in the German-speaking capital of Switzerland were assessed. From the three surveys carried out from 1996 to 1998, this study used the data from the 1997 survey for a cross-sectional analysis. Women demonstrated a lower prevalence of sport activity than men but a higher prevalence of habitual physical activity. Forty-six percent of the women but 80% of the men reported a high level of fitness. In the logistic regression analysis, sport activity in the women was significantly associated with indicators of health, health-relevant attitudes such as internal and external health locus of control, and social class. Among the men, no association with health-relevant orientation could be found. The probability of habitual physical activity among the women was associated with perceived good health, health-relevant orientation and social class, while related factors among the men were indicators of health. In both women and men, perceived good health was strongly associated with self-reported physical fitness. Additionally, women’s fitness was related to perceived disease-related limitation and indicators of health status. The findings indicate a gender-specific distribution of sport activity, habitual physical activity and fitness. Compared to men, physical activity in women is associated more with health-relevant orientation. Along with indicators of health, attention should be paid to both female and male perception of health and self-reported attitudes when there is an attempt to improve physical activity. Since self-reported health status, disease-related limitations, and habitual physical activity, among others, are strongly affected by sociocultural and structural influences, caution should be kept in drawing general conclusions from the findings.

Effects of smoking and smoking cessation on dietary habits of a Swiss urban population

To assess whether current smokers eat differently than never smokers and the relation of smoking cessation to dietary change. Population-based survey from 1993-1997. The Bus Sante 2000, epidemiologic observatory of Geneva, Switzerland. A representative sample of 2301 men and 2306 women resident of Geneva, Switzerland. In both genders, compared to never smokers, current heavy smokers (> or = 20 cigarettes/d) consumed daily less total vegetables proteins (P <0.03), carbohydrates (P<0.0001), saccharose (P<0.01), fibers (P < 0.0001), beta-carotene (P < 0.001), fruit (P < 0.0001) and vegetables (P < 0.04), but they drank more alcohol (P < 0.0001) and more coffee (P < 0.005). In addition, female current smokers ate less energy (P < 0.4), complex carbohydrates (P < 0.002), cereals (P < 0.003), vegetables (P < 0.0001) and less iron (P < 0.02). The diet of ex-smokers tended to become more similar to that of never smokers. When longer duration of smoking cessation increased, the consumption of total carbohydrates and complex carbohydrates increased (P < 0.01 and P < 0.06), and alcohol decreased (P < 0.07) in both genders. As in other Western countries, the diet of Swiss smokers appears less healthy than that of never smokers in both men and women, while smoking cessation has beneficial aspect on the quality of the diet. Current smoking appears to have an even stronger effect on the diet of women than on the diet of men.

Smoking Behavior in a Swiss Urban Population: The Role of Gender and Education

Background.Smoking has become more prevalent among U.S. men and women and European men in lower socioeducational groups. The relation between socioeducational status and smoking among European women has been studied less.Methods.A survey assessing the smoking behavior and educational level of 943 women and 961 men ages 35 to 74 years from Geneva, Switzerland, was conducted.Results.The prevalence of never smokers has declined among younger women but has remained stable among men. More men than women have ever smoked, but the difference has decreased among younger generations. Ever smoking was more prevalent among women with secondary (47.6%, age-adjusted OR 2.03, 95% CI 1.29 to 3.18) or tertiary (46.6%, age-adjusted OR 1.83, 95% CI 1.13 to 2.97) education relative to women with primary education (30.7%). Among males, ever smoking was slightly more prevalent among lower levels of education. There were moderate differences in quit ratio (ex-smokers/ever smokers) across educational levels among women (trendP= 0.08). In contrast, men with tertiary education stopped smoking more often (63.6%) than those with secondary (54.2%) or primary (47.6%) education (trendP= 0.008). For most women, primary education was associated with a later age at start of smoking while the inverse was true for men.Conclusion.Smoking behavior is evolving across generations of women in Geneva. It is more prevalent among educated women of the older generations, but this is less so among the younger generations. Women from Geneva may be currently experiencing the transition of smoking from upper to lower social classes.