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

Aims: To study 50-year mortality trends in men and women of northern and southern Western Europe. Methods: 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. Results: 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). Conclusions: 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.