COMPARATIVE TOTAL MORTALITY IN 25 YEARS IN ITALIAN AND GREEK MIDDLE-AGED RURAL MEN

Study objective-Mortality over 25 years has been low in the Italian an d very low in the Greek cohorts of the Seven Countries Study; factors responsible for this particularity were studied in detail. Participant s and settings-1712 Italian and 1215 Greek men, aged 40-59 years, coho rts of the Seven Countries Study, representing over 95% of the populat ions in designated rural areas. Design-Entry (1960-61) data included a ge, systolic blood pressure (SBP), smoking habits, total serum cholest erol, body mass index (BMI), arm circumference, vital capacity (VC), a nd forced expiratory volume in 3/4 seconds (FEV); the same data were o btained 10 years later. Multivariate Cox analysis was performed with a ll causes death in 25 gears as end point. Main results-Italian men had higher entry levels of SEP, arm circumference, BMI, and VC; Greek men had higher cholesterol levels, smoking habits, and FEV. Mortality of Italian men was higher throughout; at 25 years cumulative mortality wa s 48.3% and 35.3% respectively. Coronary heart disease and stroke mort ality increased fivefold in Italy and 10-fold in Greece between years 10 and 25. The only risk factor with a significantly higher contributi on to mortality in Italian men was cholesterol. However, differences i n entry SEP (higher in Italy) and FEV (higher in Greece) accounted for , according to the Lee method, 75% of the differential mortality betwe en the two populations. At 10 years increases in SEP, cholesterol, BMI , and decreases in smoking habits, VC, FEV, and arm circumference had occurred (deltas). SEP increased more and FEV and VC decreased more in Italy than in Greece. Deltas, fed stepwise in the original model for the prediction of 10 to 25 years mortality, were significant for SEP, smoking, arm circumference, and VC in Greece, and for SEP and VC in It aly. Conclusion-Higher mortality in Italian men is related to stronger positive effects of entry SEP and weaker negative (protective) effect s of FEV; in addition 10 year increases in SEP are higher and 10 year decreases in FEV are larger in Italy. Unaccounted factors, however, re lated to, for example, differences in the diet, may also have contribu ted to the differential mortality of these two Mediterranean populatio ns.